High Rates Of Dissatisfaction Research Articles

Satisfacción de pacientes y cuidadores con el programa de rehabilitación seguido tras el ictus

Objectives To assess patient and caregiver satisfaction with the regular rehabilitation care after stroke. To identify patient features or aspects of the rehabilitation programme related to lower rates of satisfaction in our area. Material and methods Cross-sectional study of 74 stroke in-patients admitted from June 2005 to June 2006 (70.3% men, age 65.4±12.2 years, Barthel discharge 70.5±27). A telephone Satisfaction questionnaire (Pound 1999) was administered at 13.6±3.1 months to assess satisfaction regarding in-patient care, therapy and recovery, and services after hospital discharge. Three items addressed to caregiver satisfaction were also included. A total of 84 caregivers were identified: 71% relatives (partner or children), of which 80.9% were women. Results The satisfaction questionnaire was completed by 52.9% of patients. Over 80% of interviewed patients were completely satisfied with in-patient care, and 52.7% were satisfied with therapy and recovery during admission, but more patients were dissatisfied with the amount of therapy received. The lowest rate of satisfaction was related to the services after discharge, with less than 25% of patients satisfied. A total of 83.1% of caregivers completed the questionnaire, of which 74.1% were satisfied with the information provided. Stroke educational training was given to 63.5% of caregivers, and 42.4% were given support after discharge. Only the presence of depression during admission and time passed after stroke were significantly related to patient satisfaction. ( p<0.05). Conclusions Dissatisfaction with some aspects of stroke rehabilitation is considerable in our care area. Despite general patient and caregiver satisfaction regarding information provided, high dissatisfaction rates are also detected related to the amount of therapy and the social support provided after hospital discharge. According to these results, systematic information and training programs for patients and caregivers should be included in stroke rehabilitation, as well as providing social support at discharge.

Immunogenic yeast-based fermentation product reduces allergic rhinitis-induced nasal congestion: a randomized, double-blind, placebo-controlled trial

Allergic rhinitis (AR) impacts around 25% of the worldwide population. However, cost, safety, and a high dissatisfaction rate with numerous conventional medications continues to be an issue in the largest patient surveys, due primarily to a lack of efficacy on nasal congestion. Our previously published randomized trial demonstrated a significant reduction in cold and flu-like symptoms, and a secondary potential observation of a decrease in nasal congestion with an oral yeast-derived compound; therefore, the objective of this study was to test the effects of this same product on nasal congestion and other notable AR symptoms. A 12-week, randomized, double-blind, placebo-controlled clinical trial of 96 healthy subjects with a recent clinically documented history of seasonal allergies and AR was conducted. Participants received once-daily supplementation with 500 mg of a dried, modified Saccharomyces cerevisiae oral fermentation product (EpiCor, Embria Health Sciences, Ankeny, Iowa, USA) or placebo during the 12-week period of the highest recorded concentrations of total pollen counts for this Midwest geographic area. Clinical outcome measurements included in-clinic examinations, validated questionnaire and standard diary, and serologic analysis at baseline, 6 and 12 weeks. During the highest pollen count period (weeks 1-6), EpiCor significantly reduced the mean severity of specific AR symptoms, including a significant reduction in nasal congestion (P=0.04), rhinorrhea (P=0.005), and a nonsignificant reduction in ocular discharge symptoms. A significantly (P=0.04) reduced total number of days with nasal congestion (12.5 fewer days) favored EpiCor compared with placebo, as did the nasal congestion section of the quality of life questionnaire (P=0.04). Subjects receiving the intervention also experienced significantly (P=0.03) higher salivary IgA levels. Adverse events were similar to placebo. This yeast-derived product appeared to be safe and efficacious, and should receive more clinical research with and without standard medications to reduce the impact of seasonal allergies, especially AR-induced nasal congestion.

Actitudes y percepciones del personal médico del hospital acerca de los Cuidados Intensivos y de la especialidad de Medicina Intensiva

To evaluate the attitudes and perceptions of the doctors of a hospital regarding critical care and the speciality of Intensive Medicine. Prospective, descriptive study during 3 months. Insular University Hospital in Gran CanaRia, Canary Islands, Spain. Medical specialists and residents. Anonymous survey. Demographic data of the interviewed doctors were collected and they were asked about their labour or personal previous relation with the Intensive Care Unit (ICU), the attitudes of the critical care doctors' of their hospital and their perceptions regarding the critical care speciality. We interviewed 116 doctors, 75 staff and 41 residents. Less of the third part believed that the ICU was a ward for potentially critical patients. A high percentage of the doctors whom had been refused some admission were not to agree with the arguments that they received. More than 40% of the interviewed ones affirmed had not requested bed in the ICU for any patient who had benefited from it, especially because they were thinking that the admission would be refused. Some doctors think that the professio - nals employed at the ICU are doctors of different specialities. The speciality of Intensive Medicine is perceived by a high level of stress among the professionals. We detect the ignorance of other professionals about the function of a Service of Intensive Medicine and the model of ICU of our country. Also we find high rates of dissatisfaction among the professionals who was refused some admission in the unit, because of we believe that clinical guides about the criteria of admission must be elaborated and to announce them among the doctors of the hospital. The professionals perceive that we suffer a high level of stress.

Obstacles to an integrated, joint forces approach to organized crime enforcement

PurposeThis paper aims to explore some of the problems that arise in the execution of a joint force operation (JFO) involving various law enforcement agencies. Particular emphasis is placed on examining factors that impede inter‐agency cooperation and coordination in the context of a JFO targeting serious and major crimes.Design/methodology/approachThis paper is informed by primary research that assessed the level of satisfaction of enforcement agencies involved in a Canadian‐based multi‐agency task force mandated to combat organized crime. Research for this study entailed a questionnaire survey of, and semi‐structured interviews with, operational and supervisory personnel assigned to the JFO, as well senior management within agencies participating in the JFO.FindingsThe research uncovered significant differences in the level of satisfaction with the execution of the JFO concept between members from the lead (federal) enforcement agency and those of other participating (municipal and provincial) agencies. The majority of survey participants overwhelmingly believe that the integrated, multi‐agency approach is an essential ingredient in the effectiveness of this JFO. However, among respondents from participating agencies there was a high rate of dissatisfaction with intelligence dissemination and sharing by the JFO, communication between the JFO and member agencies, and the contribution the JFO makes to the priorities and outputs of participating agencies in their own jurisdictions.Practical implicationsThese problems strike at the very heart of a multi‐agency approach to major crimes enforcement and can be generalized to other jurisdictions and countries. Indeed, impediments to the timely sharing of criminal intelligence continue to constitute one of the most significant obstacles to inter‐agency cooperation and coordination, and, by extension, the optimal enforcement of organized crime and terrorism. The problems addressed in this study should be of concern to any manager of a multi‐agency task force, and similar research is recommended to unearth problems that may undermine inter‐agency cooperation and plague the effectiveness of a JFO.Originality/valueDespite the increased prevalence and importance of multi‐agency operations in combating major and serious crimes, little research has been conducted into the issues and problems that obstruct inter‐agency cooperation within this context. This paper represents one attempt to fill this void.

Improving Practice Environments Based on Best Management Practices

The challenge of getting clinicians to base their on research evidence, when available, is a long-standing one. In fact, when the term practice is used, it often is associated only with clinical practice. However, there is an equally compelling need for health care organizations to implement evidence-based management strategies where sufficient evidence exists. After all, it is in these organizations where environments are created and shaped and where patient care is provided. Evidence that these organizational environments can have a major effect on both the performance and attitudes of clinicians and the health care services they deliver is growing. The notion of change in the organizational or environment based on evidence is not new. However, due to the pressing problems faced in many environments today, interest is renewed. Issues of interest include patient safety, chronic shortages of health workers of all types, high levels of dissatisfaction among health care workers, and the rapid pace of change that is present globally. As an example, evidence of high rates of dissatisfaction among nurses in a global context was reported recently in an international survey of 43,000 nurses conducted in 5 countries. Approximately 40% of the nurses reported that work-related conditions are contributing increasingly to job dissatisfaction, burnout, and intent to leave nursing. Many of the issues that contribute to these levels of dissatisfaction are not new and most are amenable to changes in the organizational environment that could be made by management (Aiken et al., 2001). An extensive body of research, within health care and the broader organizational and management sciences, has identified management practices that are consistently associated with designing and implementing effective initiatives for improvement and change. One example can be found in a recent Institute of Medicine (IOM) report that addressed nursing work environment issues from the perspective of patient safety (Page, 2004). Five management practices that are evidence-based are described. These practices have been applied unevenly in health care organizations and hold promise for improving environments. The evidence-based best practices identified by the IOM that are directly related to work and environments are: * Creating systems to balance the tension between production efficiency and reliability, such as consciously incorporating redundancy into some aspects of the work and thereby increasing reliability and safety in the organization; * Creating and sustaining trust throughout the organization so that employees feel both heard and valued; * Actively managing the change process through ongoing communication, training, and the use of measurement and feedback techniques to make adjustments during the change process if necessary; * Involving employees in decision-making around the design and flow of their work, using strategies such as those depicted by shared governance; * Creating a learning organizational environment that is always trying to acquire and manage new knowledge as well as to modify the behavior of the organization to reflect this new knowledge. Implementation of these evidence-based strategies has been consistently demonstrated to result in improved organizational outcomes, whether defined in terms of performance goals or by employees' rating their employing organizations as desirable places to work (Page, 2004). Another recent report, produced by the International Council of Nurses (ICN), focuses on evidence related to human resource management in health care organizations. …

Anxiety and Abnormal Eating Behaviors Associated with Cyclical Readiness Testing in a Naval Hospital Active Duty Population

Studies of abnormal eating behaviors in active duty military personal have found rates similar to or higher than the general population. We have reviewed these studies and extended the research to examine abnormal eating behaviors in a heterogeneous population at a major military medical center. We found high rates of body dissatisfaction, abnormal eating behaviors, and worry about passing the semiannual personal fitness assessment in both men and women. Abnormal eating behaviors were associated with worrying about the personal fitness assessment, and these measures were associated with body mass index and gender. Our data extend previous research indicating that cyclic or external pressure to maintain body weight within specified standards can produce unsafe eating and dieting behaviors. We recommend changes to the current system to incorporate treatment programs aimed at recognizing and treating eating disorders with a goal of producing more fit and healthy service members.

Job satisfaction and psychological health of doctors at the University of Benin Teaching Hospital.

Studies on job satisfaction and health have mainly been carried out among Caucasian populations. Similar studies are lacking in Nigeria. To investigate the level of job satisfaction and its relationship to psychological disorder amongst Nigerian doctors. All 190 doctors at the University of Benin Teaching Hospital were invited to participate in a cross-sectional study. The respondents completed two self-administered questionnaires, a specifically designed (25-item) questionnaire and a standard instrument--the General Health Questionnaire (GHQ 28). One hundred and fifty-two doctors responded, giving a response rate of 80%. Twenty-one (14%) doctors had a GHQ score of 4 and above, and were at increased likelihood of having a psychological disorder. Fifty-four per cent were either very dissatisfied or dissatisfied with their jobs, while 30% were very satisfied or satisfied with their jobs. The proportion of doctors with GHQ scores of 4 or above increased with the level of dissatisfaction although this was not statistically significant. The crude odds ratio of psychological disorder (GHQ score 4 and above) in dissatisfied respondents compared to satisfied respondents was 2.2 (95% confidence interval = 0.6-8.4). The odds ratio remained non-significant after controlling for the presence of adolescent children, stress outside work and length of service. This study showed a high rate of job dissatisfaction among Nigerian doctors compared to their European and North American counterparts. The reason for this is not altogether obvious. Further research is needed to determine the causes of job dissatisfaction amongst Nigerian doctors.

Thin, Sexy Women and Strong, Muscular Men: Grade-School Children's Responses to Objectified Images of Women and Men

There are data that show that women are objectified in the media, that girls and women experience a high rate of body dissatisfaction and eating problems, and that exposure to objectified media images of women is related to the experience of self-objectification and body shame among women. Media images of women promote a thin, sexy ideal. The objectification of men in the media has increased, perhaps promoting a “drive for muscularity” among boys. In the present study grade-school girls and boys ages 6 through 12 were shown four pictures of objectified images of women and men, respectively, and asked about their responses to the pictures. Although girls and boys responded equally positively to the objectified images of the people of their gender, girls showed a more consistent response to the pictures. Further, there were stronger relationships between girls' responses to the pictures, awareness and internalization of media images, and body esteem. Girls who consistently showed a rejection response to the pictures had higher body esteem than those girls who were uncertain about how to respond to the pictures. It was concluded that, perhaps due to cultural images and cultural pressures, girls more readily develop a consistent response to objectified images of women (than boys do to objectified images of men) that relates to their feelings about their own bodies.

Use of assistive devices to address hearing impairment by older persons with disabilities

Hearing impairment impacts on the lives of almost half of people over the age of 65. For many people, a hearing aid or other assistive device can enhance communication. However, there is a high rate of dissatisfaction with hearing aids among those who currently use, or have used them in the past. This study of 227 elders with hearing impairment sought to gain a description of their multiple needs relative to demographics, health status physical status, and psychosocial status. Furthermore, we compared along the same dimensions the 227 elders with hearing impairment with 495 frail elders who reported no hearing impairment. We found that hearing-impaired elders are older, have poorer eyesight and have a high level of co-morbidity, especially with arthritis and heart and circulatory conditions. We also found a higher rate of depression among those with hearing impairment. Although hearing aid use increased as the impact of impairment on activity increased, three-quarters of those who reported that hearing impairment had a large impact on daily life did not use a hearing aid. A factor relating to hearing aid use was race; being Caucasian, and living alone. Study participants listed their reasons for dissatisfaction or non-use of their hearing aids and provided suggestions for hearing aid design.

Reducing parental dissatisfaction with a child and adolescent psychology service: A process of quality improvement

Objectives : To describe a process of quality improvement within a community child and adolescent psychology service by focusing upon areas of dissatisfaction as identified by parents. Design : Follow-up study of parents who finished contact with the service during a specified period during 1993, 1995 and 1997. Methods : The views of parents about the service were assessed by the Parent Satisfaction Questionnaire. This was posted to all families approximately 4 weeks after their last contact with the service. Non-respondents were followed-up by a researcher and the questionnaire completed. High rates of dissatisfaction were identified and quality improvement targets implemented. Results : Levels of dissatisfaction as assessed by qualitative and quantitative data decreased over time. Conclusion : The research design does not allow us to conclude that decreases in dissatisfaction were directly attributed to the changes implemented. Nonetheless, consumer satisfaction surveys can have an important role in ensuring and monitoring quality within mental health services although their traditional emphasis upon satisfaction is not helpful. Focusing upon dissatisfaction can inform service change with qualitative and quantitative data providing a way of assessing the impact of this change.

CORTICAL EVOKED POTENTIALS OF THE DORSAL NERVE OF THE CLITORIS AND FEMALE SEXUAL DYSFUNCTION IN MULTIPLE SCLEROSIS

We evaluated whether disrupting genital central nervous system pathways is associated with subjective reports of sexual dysfunction in women with multiple sclerosis. We performed pudendal somatosensory evoked potential testing in and had sexual questionnaires completed by 14 women with a mean age of 47 years who had multiple sclerosis. The mean expanded disability status score was 5. All but 1 woman reported the desire for sexual intercourse. There was a high rate of dissatisfaction with their sex life and all study participants had concomitant bladder and bowel function problems. The most common sexual complaint was difficult or no orgasm, which was statistically associated with abnormalities or absence of 1 or both pudendal cortical evoked potentials. Fatigue and arousal disorders were also common. Women with multiple sclerosis have a high self-reported rate of sexual dysfunction, which decreases quality of life. Electrodiagnostic data imply that pudendal somatosensory innervation is necessary for normal female orgasmic function. More study is needed to confirm these findings.

Secondary correction of unsatisfactory blepharoplasty: removing multilaminated septal structures and grafting of preaponeurotic fat.

Oriental blepharoplasty, commonly known as a "double eyelid operation," is the most frequently practiced cosmetic procedure in Orientals, who have probably become more fold conscious because of social westernization and an influx of Caucasians into their society. Anatomically, the upper eyelids of an Oriental are considerably different from those of a white person, and nearly half of Orientals have single eyelids. When performing blepharoplasty, an appropriate design and operative technique must be carefully selected, taking into consideration the anatomical characteristics of Koreans to obtain an aesthetically pleasing result. However, the incidence of complications is high. Patients who are faced with unsatisfactory results are often perplexed by the fact that such a commonly performed procedure could have a very high rate of dissatisfaction and that an improvement is not easy. An unfavorable result need not imply a postoperative complication, but only that the result is not acceptable to the patient, whose goal may not be based on good aesthetic principles. The most common sources of dissatisfaction are postoperative asymmetry and high placement of the lid fold. From 1991 to 1998, secondary blepharoplasty was performed on 72 patients by slitting transversely, removing the multilaminated septal structures exposed to the previous operative scar, spreading the preaponeurotic fat that extruded, and removing the septal structures into a space where the scar was eliminated to prevent secondary adhesion. The average age of the patients was 26.5 years, and the average follow-up period was 2 years. No remarkable complication was encountered after operation with this method, and the desired aesthetic improvements were achieved in the majority of the patients.

Very superficial ultrasound-assisted lipoplasty for the treatment of axillary osmidrosis.

Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was that liposuction could not effectively remove the apocrine gland located in the dermis and dermosubcutaneous junction. A high rate of residual malodor and dissatisfaction were reported. The author used ultrasound-assisted lipoplasty (UAL) in the very superficial plane to remove the apocrine gland located in the dermis and dermosubcutaneous junction. The purpose of this study was to prove the efficacy of the very superficial UAL (VSUAL) for the treatment of axillary osmidrosis. From December 1998 to December 1999, 21 consecutive patients underwent UAL in their axilla for axillary osmidrosis. The follow-up period ranged from 2 to 12 months (mean: 8 months). UAL was performed in the very superficial plane with an amplitude of 40%. The very superficial UAL (VSUAL) was done mainly in a withdrawing manner with the tip of the cannula against the skin. The UAL (VSUAL) was done aggressively until the skin changed slightly erythematous. The results were assessed subjectively and objectively, and classified as excellent, good, fair, and poor. Nineteen patients were graded as excellent and one patient as good. The total satisfaction rate was 95.2%. One patient complained of residual malodor in her left axilla. There were no cases of skin necrosis, hematoma, or seroma. Histology showed partial removal of the subcutaneous layer and deep dermis, and degenerative epithelial changes in the apocrine glands in the residual deep dermis. These microscopic findings meant near-total functional ablation of the apocrine gland in the axilla comparable to "flap-to-graft conversion" or surgical excision of axillary skin. The UAL (VSUAL) for axillary osmidrosis has the advantages of a high success rate with minimal complications. Rapid recovery, less restriction of movement, and tiny scars were other major benefits of this technique. Therefore, UAL (VSUAL) is a viable option for treatment of axillary osmidrosis.

Patients' perspective on their relatives' involvement in treatment during a short-term psychiatric hospitalization.

With the growing interest in the patient's perspective regarding mental health services, several instruments have been developed for this area of research. However, despite the availability of multidimensional questionnaires, the dimensions evaluated have rarely addressed the issue of the involvement of relatives in treatment. The present study aimed at documenting the preferences and level of satisfaction of 92 patients hospitalized in short-term psychiatric units regarding the involvement of their relatives in treatment. Data was collected using an open-ended question and two standardized scales developed for the purposes of this study. The results demonstrated that the majority of patients preferred that their relatives be involved in many aspects of their treatment. In fact, a relatively high rate of dissatisfaction of 35.6% was observed among patients concerning the lack of notification of their relatives about changes in their treatment. In the context of deinstitutionalization, where relatives are invited to play an increasing role in the community reintegration of the patient, these findings highlight the pertinence of addressing the patient's perspective with regard to treatment planning with relatives.

Acute pain services: transition from the Middle Ages to the 21st century

In this issue of the European Journal of Anaesthesiology, Rawal and co-workers are presenting data from a survey performed in 1993 about the acute pain services (APS) in Europe [1]. The investigators have revealed a negative picture in European contemporary acute pain management during 1993. Despite the evidence that APS result in an improved quality of patient care, [2] only one third of the selected hospitals provided an organized APS and even in those hospitals less than 65% kept strict protocols or guidelines for pain management. In addition, the limited quality assurance measurements made in acute pain management demonstrate another major drawback in acute pain therapy during the early 1990s. The first official guidelines for the management of severe pain, including acute post-operative pain, were published in Australia in 1988 [3] followed by the United Kingdom in 1990 [4] and the United States in 1992 [5]. These recommendations, in addition to other guidelines, included the need for acute pain teams together with audit and quality assurance. However, there is a clear discrepancy between the strong agreement among experts of the need for APS and its implementation into clinical practice as shown by this current survey. Insufficient funding was reported by the survey as one of the foremost reasons for the lack of APS at their separate institutions. The cost of such equipment including patient controlled analgesia (PCA) devices and the cost of trained APS members needs to be considered in terms of the clear-cut benefits of reduced mortality, morbidity or hospital stay. We have recently demonstrated, in our institution, that these result from the introduction of APS [6]. The high rate of dissatisfaction regarding individual APS indicated in Rawal's study clearly reflects the physician's position. If there is no improvement in acute pain therapy within the peri-operative setting, this negative perception could also be shared more and more by individual patients. In the competition for patients between hospitals, those providing an optimal APS [7] will be at an advantage. A number of guidelines have been published with regard to the techniques used for post-operative pain control [8]. Several different models for the optimal organization of APS have been described [9,10]. Future studies comparing the different approaches will be needed to achieve an evidence base for APS. The role of anaesthesiologists, with their particular professional skills, are essential to provide leadership for the integration of acute pain management in their institutions. The results of this study are both, discouraging on one side, but also stimulating on the other side, if the anaesthesiologists in Europe will take adequate action implied by this report. We are encouraging the authors to perform a follow-up study and hopefully a positive trend towards modern acute pain management will be demonstrated. H. Van Aken H. Buerkle Anästhesiologie und operative; Intensivemedizin, der Westfälischen; Wilhelms-Universität Münster, Germany

Is bulimia nervosa increasing in frequency?

Objective To assess whether or not claims of an increase in the incidence of bulimic disorders are empirically justified. Method: Review of the epidemiological data informative to gauge time trends: Studies based on hospital records or registers, community surveys of bulimic disorders, questionnaire-based investigations. Results: Epidemiological studies conducted since 1980 do not show an upward trend in rates. Reports of increased rates among recent birth cohorts were unreliable and did not control for confounding comorbid disorders. Changes in diagnostic and referral practices are likely to account for higher numbers of patients seen in specialized treatment centers. Discussion: Although based on a limited number of studies, the empirical evidence does not support secular changes in the incidence of bulimic disorders. In keeping with this conservative conclusion, it is noted that high rates of dieting and body dissatisfaction were already reported 30 years ago among adolescent girls. © 1996 John Wiley & Sons, Inc.

Is bulimia nervosa increasing in frequency?

To assess whether or not claims of an increase in the incidence of bulimic disorders are empirically justified. Review of the epidemiological data informative to gauge time trends: Studies based on hospital records or registers, community surveys of bulimic disorders, questionnaire-based investigations. Epidemiological studies conducted since 1980 do not show an upward trend in rates. Reports of increased rates among recent birth cohorts were unreliable and did not control for confounding comorbid disorders. Changes in diagnostic and referral practices are likely to account for higher numbers of patients seen in specialized treatment centers. Although based on a limited number of studies, the empirical evidence does not support secular changes in the incidence of bulimic disorders. In keeping with this conservative conclusion, it is noted that high rates of dieting and body dissatisfaction were already reported 30 years ago among adolescent girls.

Silastic Single-Stem Implants in the Treatment of Hallux Rigidus

Forty cases of hallux rigidus treated by Silastic hemiarthroplasty over an average period of 110 months have been reviewed here. As many as 36% (14 feet) of the patients were unhappy with the results of their operation. Six implants had to be removed because of increasing pain and fragmentation of the prosthesis. These patients improved after the prosthesis was removed. It is concluded that Silastic hemiarthroplasty does not give an acceptable level of good results when compared with published reports of other forms of treatment. The probable causes of the high dissatisfaction rate are discussed.

SURGICAL TREATMENT FOR PRIMARY INTERDIGITAL NEUROMA

We studied 366 feet in 313 patients who underwent surgical treatment for a primary interdigital neuroma through a dorsal web-splitting incision. Three hundred five feet in 259 patients were available for follow up, which averaged 5.9 years (range: 2.8 to 13); 45.2% of these patients were completely satisfied, 33.8% were satisfied with minor reservations, 9.2% were satisfied with major reservations, and 11.8% were dissatisfied after the surgical procedure. Patient satisfaction was directly related to the size of the neuroma found at the time of operation. Bilateral procedures were associated with a higher rate of dissatisfaction. The third web space accounted for 91% of the neuromas.

A PATIENT SATISFACTION QUESTIONNAIRE AS A TEACHING AND COMPARATIVE AUDIT TOOL

This paper explores the development and use of a Patient Satisfaction Questionnaire which was chosen by members of the South Australian Quality Assurance Research Officers' Association (SAQAROA) as a method of learning how to undertake quality assurance. Overall this process was rated as being successful by the members. Use of the Questionnaire revealed high overall satisfaction with services being provided. However, for most questions one or more hospitals returned comparatively high dissatisfaction rates, the significance of which was not appreciated until comparative data became available.