Clinician's attitude to enteral nutrition with percutaneous endoscopic gastrostomy: a survey in China

Background Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians’ opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding. Methods A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses. Results Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p = 0.000). Overall, 241 (46%) participants did not know PEG and 284 (54%) have different understanding degree of PEG. Age (p = 0.002), working life (p = 0.044) and professionalism (p = 0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The highest scoring factor (score of 3.91) that influenced clinicians’ choice of PEG was resistance from patients and families and the second one was the poor cooperation among departments (score of 3.80). Conclusions Doctors’ insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among departments, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.

Clinician's Attitude to Enteral Nutrition with Percutaneous Endoscopic Gastrostomy: A Survey in China

Background: Percutaneous endoscopic gastrostomy (PEG) are recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians’ opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding.Methods: A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses.Results: Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p=0.000). Overall, 241 (46%) participants do not know PEG and 284 (54%) have different understanding degree of PEG. Age (p=0.002), working life (p=0.044) and professionalism (p=0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The listed factors influencing physicians' choice of PEG for long-term feeding scored high for all items, ranging from 3.57 to 3.89. Conclusions: Doctors’ insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among healthcare professionals (HCPs) and between departments, and a crisis of doctor-patient trust all influence the medical decision-making process, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.

Influence of polycrystalline diamond compact bit geometric parameters on drilling performance during gas drainage borehole in soft coal seam

Polycrystalline diamond compact bit is the main rock-breaking tool of gas drainage borehole. In order to investigate the influence of geometric parameters of polycrystalline diamond bit on its drilling performance, the integrated force model of polycrystalline diamond bit pressed into rock was established. The stress analysis results show that the tooth rake angle, pressing depth, and horizontal tangential displacement are the main factors to influence the normal load and the axial load of polycrystalline diamond bit. There is an optimal tooth rake angle value of polycrystalline diamond bit cutter when it is used in the soft coal seam. The drilling experiment system was built to verify the drilling performance of drill bits with different geometric structure and different tooth rake angle through drilling the soft coal wall. The experiment results show that the drilling torque and feeding resistance of polycrystalline diamond bit are higher than that of the wing bit at the beginning of drilling the soft coal wall. With the increase in the drilling depth, the feeding resistance of wing bit will increase to exceed that of the polycrystalline diamond bit. So the polycrystalline diamond bits should be selected to drill the gas drainage borehole in soft coal seam. The polycrystalline diamond bit with bigger tooth rake angle cannot cut and break the coal rock effectively, which will reduce the drilling efficiency and the feeding speed. When the tooth rake angle is smaller, polycrystalline diamond bit cannot cut in coal wall effectively, which will increase the feeding resistance. So the polycrystalline diamond bit with tooth rake angle of 15°–20° is suitable for the gas drainage borehole in soft coal seam. With the increase in the rotary speed of polycrystalline diamond bit, the cutting thickness of coal rock decreases and the horizontal tangential displacement increases. When the rotary speed of polycrystalline diamond bit is 290 r/min, the mean drilling torque and mean feeding resistance of polycrystalline diamond bit reach the minimum. Therefore, in order to reach the optimum drilling performance, the working parameters of low drilling pressure and high rotary speed are usually selected during the actual gas drainage borehole in soft coal seam.