BACKGROUND : Diabetic retinopathy (DR) is a leading cause of preventable blindness. However, Indonesia lacks a comprehensive screening program. Artificial intelligence (AI)-assisted screening in primary health care (PHC) is a promising solution. Patient satisfaction is crucial for ensuring the participation and sustainability of such programs. This study aimed to adapt Indonesian version of evaluate client satisfaction questionnaire-18 (CSQ-18) and evaluate its acceptability. METHODS : This study was conducted from August 5–29, 2024 at 2 public PHCs in Jakarta. Patients with diabetes underwent DR screening, which included fundus photography and an AI-based grading system (RADR). Referable cases were graded secondarily by ophthalmologists. Satisfaction was assessed from November 10–20, 2024 using the Indonesian-translated CSQ-18, adapted through forward-backward translation, expert review, and pilot testing. Reliability was assessed using Cronbach’s alpha, validity was evaluated using Pearson’s correlation, and satisfaction scores were summarized as descriptive statistics. RESULTS : Of 300 selected participants, 216 completed telephone or in-person interviews. The Indonesian CSQ-18 demonstrated a strong internal consistency (Cronbach’s alpha = 0.886). All items showed acceptable item-total correlations. The mean (SD) satisfaction score was 60.19 (5.50) of 72, with a median of 59, indicating high patient satisfaction. Most participants expressed positive perceptions of screening duration, accessibility, and provider competence, although awareness-related items scored slightly lower. Potential interviewer bias and nonresponse may have affected the findings. CONCLUSIONS The Indonesian CSQ-18 is a reliable tool for assessing patient satisfaction with DR screening. These findings confirm the feasibility and acceptability of AI-assisted DR screening at the PHC level, supporting its potential for broader implementation in Indonesia.
artificial intelligence ; diabetic retinopathy ; patient satisfaction ; primary health care ; surveys and questionnaires

BACKGROUND AND OBJECTIVE

Long-term treatment of people living with HIV (PLHIV) encounters various challenges, such as medication adherence, stigma, discrimination, and healthcare access. Patient satisfaction with healthcare services is vital for maintaining treatment adherence. Therefore, understanding the factors influencing patient satisfaction is crucial. We conducted a qualitative study to explore these factors in primary HIV care facilities in Metro Manila, Philippines.

In this qualitative study, we interviewed PLHIV aged 18-59 receiving antiretroviral therapy (ART) in primary HIV care facilities in Metro Manila. Data saturation was reached after 19 in-depth interviews. We transcribed all audio files verbatim in Filipino and analyzed the data using deductive and inductive thematic analysis, guided by the SERVQUAL model as a theoretical framework. We employed MAXQDA, a qualitative data analysis software for coding and data management. We illustrated themes and sub-themes with quotes derived from the data.

Six key themes emerged regarding factors influencing patient satisfaction: tangibles, reliability, responsiveness, assurance, empathy, and location. The first five themes aligned with the SERVQUAL model, while location emerged as a new theme. PLHIV preferred accessible clinics, a clean and pleasant ambiance, and positive interactions with healthcare providers. Moreover, they suggested facility improvements, including expansion, better ventilation, enhanced service delivery, and increased healthcare staff.

Enhanced service delivery and positive healthcare interactions, along with favorable physical attributes of primary HIV care facilities, drive patient satisfaction and long-term retention. These modifiable factors contribute to the continuous care of PLHIV, ultimately improving their quality of life.

OBJECTIVE

This study aimed to translate and validate the Telehealth Usability Questionnaire in Filipino (TUQ-F) among users of the Department of Family and Community Medicine Facebook Page.

This study focused on translating and validating the Telehealth Usability Questionnaire (TUQ) into Filipino (TUQ-F) for patients consulting using the Facebook Page of the Department of Family and Community Medicine at the Batangas Medical Center. The said study was conducted from April to September 2024. This involved a methodological study in two phases: translation and validation, followed by reliability testing. The first phase was done via forward and backward translation conducted by experts and subsequently by content validation using a 5 point-Likert scale. The second phase was testing the reliability of the questionnaire using Cronbach’s alpha. 

In the first phase, the final translated Telehealth Usability Questionnaire–Filipino (TUQ-F) was reviewed for content validity by three experts, all of whom rated every item as important or relevant, yielding an I-CVI of 1.00 for all items and for the overall tool.

In the second phase, reliability testing was conducted among 128 respondents, most of whom were aged 25–54 years (92.97%) and female (78.13%). Cronbach’s alpha values for all domains exceeded 0.80, indicating good to excellent internal consistency: usefulness (0.793–0.794), ease of usability and learnability (0.856–0.884), interface quality (0.854–0.888), interaction quality (0.819–0.900), reliability (0.797–0.881), and satisfaction (0.880–0.910). The overall Cronbach’s alpha for the TUQ-F was 0.858, demonstrating good reliability of the translated tool.

The translated telehealth Questionnaire in Filipino (TUQ-F) was found to be a valid and reliable tool which can be used within the Philippine setting. This study supported its objective in adapting and validating the questionnaire in local use. The outcome of the validation study proved that the TUQ-F has a potential as a standard tool which may help improve the country’s health service delivery in different settings. However, further studies may have to be conducted such as its applicability in other local dialects. This may further broaden the tool’s accuracy in determining the validity and reliability further when applied among different users across the country who are not native Filipino speakers.

INTRODUCTION: Medical errors commonly occur in medical imaging departments. These errors are frequently influenced by patient safety culture. This study aimed to develop a suitable patient safety culture assessment tool for medical imaging departments. METHODS: Staff members of a teaching hospital medical imaging department were invited to complete the generic short version of the Safety Attitude Questionnaire (SAQ). Internal consistency and reliability were evaluated using Cronbach's α. Confirmatory factor analysis (CFA) was conducted to examine model fit. A cut-off of 60% was used to define the percentage positive responses (PPR). PPR values were compared between occupational groups. RESULTS: A total of 300 complete responses were received and the response rate was 75.4%. In reliability analysis, the Cronbach's α for the original 32-item SAQ was 0.941. Six subscales did not demonstrate good fit with CFA. A modified five-subscale, 22-item model (SAQ-MI) showed better fit (goodness-to-fit index ≥0.9, comparative fit index ≥ 0.9, Tucker-Lewis index ≥0.9 and root mean square error of approximation ≤0.08). The Cronbach's α for the 22 items was 0.921. The final five subscales were safety and teamwork climate, job satisfaction, stress recognition, perception of management and working condition, with PPR of 62%, 68%, 57%, 61% and 60%, respectively. Statistically significant differences in PPR were observed between radiographers, doctors and others occupational groups. CONCLUSION The modified five-factor, 22-item SAQ-MI is a suitable tool for the evaluation of patient safety culture in a medical imaging department. Differences in patient safety culture exist between occupation groups, which will inform future intervention studies.
Humans ; Surveys and Questionnaires ; Patient Safety ; Attitude of Health Personnel ; Diagnostic Imaging ; Reproducibility of Results ; Male ; Female ; Adult ; Job Satisfaction ; Factor Analysis, Statistical ; Middle Aged ; Hospitals, Teaching ; Safety Management ; Organizational Culture ; Medical Errors/prevention & control*

OBJECTIVE: To investigate effectiveness of the modified edge resection technique for composite labia minora and clitoral hood reduction with preserved microstructures. METHODS: A retrospective analysis was conducted on 36 female patients, who were diagnosed with composite hypertrophy of the labia minora and clitoral hood and admitted between September 2022 and December 2024. The patients' ages ranged from 18 to 45 years (mean, 27.4 years). The primary surgical motivations included poor appearance alone (8 cases), functional impairment alone (14 cases), both poor appearance and functional impairment (12 cases), and psychological factors (2 cases). All patients were treated with the modified edge resection technique for composite labiaminora and clitoral hood reduction with preserved microstructures. The surgical technique emphasized precise adjustments to the clitoral-labial junction and optimization of the anterior labial structure to ensure a natural postoperative appearance and functional integrity. Postoperative follow-up assessed improvements in appearance and function of clitoral hood and labia minora, complications, and overall patient satisfaction. RESULTS: One patient exhibited suboptimal wound healing, while the remaining patients experienced no complications such as postoperative bleeding, hematoma, wound dehiscence, suture cutting, or labial edema and enlargement. Thirty patients were followed up with a duration of 1-6 months (mean, 2.4 months). In the early postoperative period, 2 patients perceived asymmetry of the bilateral labia minora; 1 underwent labial revision surgery, while the other achieved near-symmetry without intervention. At last follow-up, 25 patients experienced varying degrees of relief from preoperative functional impairments, while the remaining patients showed no improvement; 27 patients reported varying degrees of improvement in appearance, 2 reported no change, and 1 reported a worse appearance compared to preoperatively. Sixteen patients were very satisfied with the surgical results, 8 were satisfied, 5 were moderate satisfied, and 1 was dissatisfied, with a satisfaction rate of 80% (24/30). CONCLUSION The modified edge resection technique for composite labia minora and clitoral hood reduction with preserved microstructures which preserves and optimizes fine anatomical structures through precise adjustments at the clitoral-labial junction, achieves high patient satisfaction with both aesthetic and functional outcomes while minimizing postoperative complications.
Humans ; Female ; Adult ; Retrospective Studies ; Vulva/pathology* ; Clitoris/pathology* ; Middle Aged ; Plastic Surgery Procedures/methods* ; Adolescent ; Patient Satisfaction ; Young Adult ; Treatment Outcome ; Hypertrophy/surgery*

OBJECTIVE: To describe a novel arthroscopic technique of modified tri-anchor double-pulley suture-bridge in repairing medium-sized supraspinatus tendon tears and evaluate the early effectiveness. METHODS: Between June 2021 and January 2024, 26 patients with medium-sized supraspinatus tendon tears who underwent arthroscopic modified tri-anchor double-pulley suture-bridge repair and met the selective criteria were included. There were 11 males and 15 females with an average age of 61.4 years (range, 43-74 years). Five patients had a significant history of trauma, while the remaining 21 patients had no apparent cause. The time from symptom onset to hospitalization was 3-25 months (mean, 7.9 months). The effectiveness was evaluated during follow-up, including the scores of University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), visual analogue scale (VAS), the range of forward flexion, abduction, external rotation, and internal rotation, and patient's satisfaction. Either MRI or ultrasound examination were used to evaluate structural integrity of the tendon. RESULTS: The operation time was 65-110 minutes (mean, 81.8 minutes). All patients were followed up 12-43 months (mean, 23.0 months). At 3 and 12 months after operation, the shoulder range of flexion, abduction, external rotation, and internal rotation, and the scores of VAS, UCLA, and ASES significantly improved when compared with those before operation ( P<0.05). The improvement was further observed at 12 months compared to 3 months ( P<0.05). At last follow-up, 13 patients were very satisfied with the effectiveness, 11 patients were satisfied, 1 was relatively satisfied, and 1 was dissatisfied. During follow-up, 15 patients underwent imaging examination and imaging reexamination showed that the re-tear rate of tendon was 6.6%(1/15). The remaining 11 patients refused imaging examination. Complications included partial anchor withdrawal in 1 case, shoulder stiffness in 5 cases, and mild pain in shoulder joint in 2 cases in physical activity or heavy physical activity. CONCLUSION Arthroscopic modified tri-anchor double-pulley suture-bridge technique is a novel surgical technique that uses double-loaded suture anchors as medial- and lateral-row anchors. In repairing medium-sized supraspinatus tendon tears, 6 sets of double-pulley suture-bridges can be created from one medial-row anchor; knotless medial-row can reduce re-tear rate of the tendon; good early effectiveness is obtained.
Humans ; Female ; Male ; Middle Aged ; Arthroscopy/methods* ; Adult ; Rotator Cuff Injuries/surgery* ; Aged ; Suture Techniques ; Treatment Outcome ; Suture Anchors ; Rotator Cuff/surgery* ; Range of Motion, Articular ; Tendon Injuries/surgery* ; Patient Satisfaction

OBJECTIVE: To evaluate the functional and aesthetic evaluation of external fixator lengthening through plantar approach for fourth brachymetatarsia. METHODS: A retrospective analysis was conducted on 20 patients (23 feet) with fourth brachymetatarsia who met the selection criteria between January 2016 and January 2024, including 3 males and 17 females, with 8 left, 9 right, and 3 bilateral cases. The mean age was 24.7 years (range, 14-51 years). The preoperative metatarsal shortening length was (13.8±3.2) mm. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was 79.5±3.9, the visual analogue scale (VAS) score of appearance satisfaction was 1.7±0.8, and the appearance index (AI) score was 13.6±0.9. All patients underwent external fixator lengthening through plantar approach. The lengthening length of metatarsal bone, lengthening ratio, healing time, and healing index were recorded. Functional outcomes were assessed using the AOFAS forefoot score, VAS score of appearance satisfaction, and quality-of-life impact with AI questionnaire. RESULTS: All 20 patients were followed up 14-55 months with an average of 36.3 months. During the follow-up, complications occurred in 4 cases (17.4%), including 2 cases of metatarsophalangeal joint stiffness, which had no significant effect on the function and appearance. Delayed union of osteotomy occurred in 1 case (healed at 12 weeks after operation). Pin loosening occurred in 1 case and recovered after outpatient reinforcement. No complications related to plantar scar occurred. At last follow-up, the lengthening length of metatarsal bone was (13.9±3.1) mm, and the lengthening ratio was 25.8%±5.6%. All cases achieved bony union, with a mean healing time of (64.3±12.5) days and a healing index of (46.9±4.8) d/cm. At last follow-up, AOFAS score was 98.9±2.1, the VAS score of appearance satisfaction was 9.3±0.7, and the AI score was 0.6±0.8, which significantly improved when compared with those before operation ( t=27.398, P<0.001; t=32.994, P<0.001; t=56.135, P<0.001). CONCLUSION External fixator lengthening through plantar approach is a safe and effective technique for fourth brachymetatarsia, achieving satisfactory functional and aesthetic outcomes.
Humans ; Male ; Female ; Adult ; External Fixators ; Retrospective Studies ; Bone Lengthening/instrumentation* ; Middle Aged ; Metatarsal Bones/abnormalities* ; Adolescent ; Young Adult ; Treatment Outcome ; Patient Satisfaction ; Esthetics ; Osteotomy/methods* ; Foot Deformities, Congenital/surgery*

Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m -2 . In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.
Humans ; Male ; Patient Satisfaction ; Adult ; Lipectomy/methods* ; Penis/surgery* ; Retrospective Studies ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Young Adult ; Penile Diseases/surgery* ; Urologic Surgical Procedures, Male/methods*

Comfortable supragingival scaling uses ultrasonic cleaning with sedation and minimally invasive techniques to minimize the negative emotions of patients and improve patient compliance. At present, there is still much room for optimization of the environment, equipment, and operation steps for the development of comfortable supragingival scaling. On this basis, the Department of Periodontology, College of Stomatology, Xi'an Jiaotong University proposed a 16-step new model of comfortable supragingival scaling. The new model incorporates adjustments to the previous model concerning the environment, equipment, operational procedures, process links and services, comprising 16 steps for optimization and innovation. Clinical practice has confirmed that the 16-step new model of comfortable supra-gingival scaling can significantly improve patient satisfaction and adherence to medical treatment, and it has good promotional value.
Humans ; Dental Scaling/instrumentation* ; Patient Satisfaction ; Patient Compliance ; Gingiva

Objective:To investigate the effect of intraoperative ultrasound-guided nasal bone fracture repair on the clinical outcome of pediatric patients with nasal bone fracture. Methods:A total of 83 patients with nasal bone fracture who underwent prosthesis in our hospital from June 2022 to March 2024 were selected and assigned to control group （endoscopic nasal bone fracture repair） and experimental group （ultrasound-guided nasal bone fracture repair） using random number table method. Both groups were treated with the same nursing measures after surgery. There were 41 cases in the control group and 42 cases in the experimental group. The evaluation parameters of nasal bone fracture, nasal ventilation function, nasal appearance and olfactory function score, postoperative complications and satisfaction were compared between the two groups. Results:The operation time and hospital stay were significantly lower in the experimental group than in the control group （P<0.05）, and secondary repair case （n=0） in the experimental group was significantly less than in the control group （P<0.05）. Compared to preoperative status, the minimum nasal cross-sectional area, nasal volume and total nasal expiratory volume of the two groups increased three months post-operatively, and those in the experimental group were higher （P<0.05）, nasal expiratory and inspiratory resistance, nasal appearance and olfactory disorder scores decreased and those in the experimental group were lower （P<0.05）. The postoperative complications incidence in the experimental group was lower than in the control group （7.14% and 14.63%, respectively, P>0.05）. The overall satisfaction in the experimental group was higher than in the control group（90.48% and 82.93%, respectively, P>0.05）. Conclusion:Ultrasound-guided nasal fracture repair can effectively shorten the operation time, improve the success rate, and promote the postoperative recovery of nasal appearance and nasal function, reduce complications, and enhance the overall satisfaction of children and their families.
Humans ; Nasal Bone/surgery* ; Patient Satisfaction ; Child ; Female ; Male ; Postoperative Complications ; Treatment Outcome ; Postoperative Period ; Fractures, Bone/surgery* ; Ultrasonography