Comprehensive Patient Education Research Articles

The clinical prognosis of elderly patients with decompensated congestive heart failure greatly improved for 7 years after introduction of our unique clinical pathway

Abstract Background In Japan, especially in rural areas where our facility is located, the number of elderly decompensated congestive heart failure(DCHF) cases is increasing remarkably. Their hospitalization period tends to prolonged due to various complications peculiar to the elderly, and after discharge, they often admit in a short period with DCHF. In August 2015, we introduced the clinical pathway (PATH), which stipulates the efficient medical care for DCHF and comprehensive patient education by multidisciplinary staff. We have previously reported its effect about wide shortening of mean hospitalization period and significant reduction of rehospitalization in CHF patients admitted to our hospital. Purpose In this study, we re-examined the short-term and long-term clinical effects of PATH in elderly DCHF patients for 7 years, and also considered the residual problems about them. Methods We enrolled 929 DCHF cases (1128 admissions) aged 75 years or older who ware admitted to our hospital from April 2014 to July 2022. We divided them into two groups: 152 cases(199 admissions) admitted before the introduction of PATH (N-group) and 667 cases(929 admissions) applied PATH (P-group). About two groups we compared the acute care situation for DCHF, mean hospitalization period(HP), and DCHF readmission rate within 1 year after discharge(RA). Results The mean age of the P-group was slightly older. There were no significant differences between the two groups in the living conditions before admission, the proportion of each underlying disease or clinical data at admission. The performance rate of each treatment procedure in the acute phase was lower, and these performance period ware all shorter in P-group. The introduction rate of cardiac rehabilitation was higher and start timing was earlier in P-group. (Figure1) As a result, HP was significantly shorter), and the RA rate was lower in P-group. However, even in P-group, the cases who could not be discharged from the hospital to home(OTHER-group) took more time to adjust for hospital transfer or nursing home admission, so their HP was longer than that of the cases who could be directly discharged to home(HOME-group). And the RA rate of cases with past history of hospitalization for DCHF(PH-group) was higher than that of cases without history(NPH- group). (Figure2) Conclusion In the 7 years after the introduction of unique clinical pathway for acute phase treatment of decompensated congestive heart failure, even in elderly patients, it confirmed that each acute phase treatment had become more efficient, and the mean hospitalization period had been widely shortened. In addition, comprehensive lifestyle guidance to prevent worsening of their condition has seemed to reduce the rehospitalization rate for heart failure after discharge. However, we also confirmed f a few residual problems to be solved about the cases who could not discharged at home for any reason or repeated re-admission for heart failure.Figure 2

Integrating Artificial Intelligence for Improved Management of Frozen Shoulder and Complications in Breast Cancer Surgery: A Perspective from Thailand

Breast cancer is a leading cause of mortality among women worldwide, necessitating surgical interventions like lumpectomy, mastectomy, or modified radical mastectomy. However, these procedures often lead to postoperative complications, such as frozen shoulder, significantly impacting patients’s quality of life. This review focuses on the challenges associated with frozen shoulder and other complications following breast cancer surgery. It proposes the integration of Artificial Intelligence (AI) in assessment and intervention as a cost- effective solution. Frozen shoulder, also known as adhesive capsulitis, affects around 22.2% of breast cancer patients, particularly those undergoing axillary approaches. It is frequently accompanied by Axillary Web Syndrome (AWS) and Post-Mastectomy Pain Syndrome (PMPS), resulting in pain, limited range of motion, and compromised functional abilities. Conservative treatments, including exercises and rehabilitation programs, have shown positive outcomes in managing these symptoms. Previous studies have demonstrated the effectiveness of exercises, joint mobilization techniques, and home-based exercise programs in improving muscle strength, range of motion, and functional ability in breast cancer survivors. Abnormal neuromuscular control and kinematic distortions in shoulder and spinal movements have also been identified, highlighting the significance of neuromuscular training for shoulder joint complex recovery. The integration of AI in the assessment and intervention of frozen shoulder can offer cost-effective solutions and reduce waiting times at healthcare centers in Thailand. AI technologies can enable precise evaluations and personalized treatment plans, optimizing patient outcomes and resource utilization. In conclusion, physical therapy plays a crucial role in managing frozen shoulder and other complications following breast cancer surgery. Evidence-based practices, including comprehensive patient education, tailored exercise programs, manual therapy techniques, and pain management strategies, are essential for effective treatment. Integrating AI in assessment and intervention can further enhance outcomes and alleviate the burden on healthcare resources.

Awareness About the Benefits of Post-bariatric Surgery in Diabetic Patients in Makkah Almukarramah, Saudi Arabia.

To measure awareness about the benefits of post-bariatric surgery, which is a shortening of the gut in order to lose weight in diabetic patients in the Makkah region, Saudi Arabia. A cross-sectional survey was conducted among diabetic patients aged 18-65 from February to July 2023. An online questionnaire via Google Forms was distributed and used to assess the participants' awareness of the benefits of post-bariatric surgery for diabetic patients. Overall, 388 participants (56.40% female, 43.60% male) were surveyed. Most participants (91.5%) showed awareness of gastric sleeve surgery, while a significant proportion (85.8%) recognized obesity as a disease. A majority of participants (80.90%) showed awareness of the association between obesity, diabetes, and high blood pressure. However, only 46.10% of participants showed awareness of eligibility criteria associated with bariatric surgery. The majority recognized the effectiveness of bariatric surgery for weight loss but did not consider it the first choice, emphasizing a preference for non-surgical weight loss strategies. Participants demonstrated good knowledge about obesity and its implications for health. They also demonstrated good knowledge about bariatric surgery as an effective weight reduction method but expressed a preference for non-surgical methods, which reflects their awareness of the complications of bariatric surgery. However, the results showed a lack of awareness of postoperative indications and lifestyle changes, thus highlighting the need for comprehensive patient education and counseling.

Evidence-Supported Interventions for Reducing Secondary Stroke Risk in Sub-Saharan Africa: A Systematic Review.

The study set out to perform a systematic literature review of evidence-based interventions that target the reduction of secondary stroke risk in Africa. The review analyzed longitudinal intervention studies conducted in Sub-Saharan Africa, focusing on adult participants who had suffered a prior stroke. It encompassed publications and peer-reviewed papers sourced from reputable databases, including PubMed, Ovid, Cochrane, and Web of Science. Three randomized clinical trial (RCT) studies were included with sample sizes ranging from 16 to 400 participants, mean age ranged between 50 and 66 years, with 64.5% male participants. All studies applied multidisciplinary team interventions of enhanced patient follow-up involving care givers, nurse educators, physicians, and social workers. Interventions ranged from comprehensive patient education, tracking of medication adherence and enforcing healthy lifestyle behaviors (regular exercise, regular BP checks, and dietary changes). We found a decrease in Systolic Blood Pressure over time in 2 of 3 treatment groups, an improvement in medical adherence in all treatment groups, and a decrease in cholesterol levels in 1 treatment group. Evidence-based interventions involving multidisciplinary teams and comprehensive patient education were found to demonstrate promising results in reducing secondary stroke risk in Africa, leading to significant improvements in medical adherence and reductions in systolic blood pressure in the majority of treatment groups. However, more research is required to confirm the influence of these interventions on cholesterol levels and to establish their lasting advantages in preventing strokes among African communities.

A physiotherapy-led review of guideline-based care for community-dwelling older people presenting to a metropolitan hospital with accidental falls.

Several guidelines exist to inform best-practice management of community-dwelling fallers. This study aimed to outline a pragmatic approach to developing an audit tool for guideline-based care of falls and provide an overview of current practice. An audit tool to determine compliance with guideline-based care was developed with an allied health and physiotherapy focus, utilising the Australian Commission on Safety and Quality in Health-Care Guidelines for Preventing Falls and Harm from Falls in Older People (2009) and Queensland State Government 'Stay on your Feet' guidelines. A retrospective audit of medical records was completed in July 2020 of community-dwelling people aged 65 years and over with a fall-related emergency department (ED) presentation in a medium-sized metropolitan hospital in Australia. Data were compared between patients admitted to hospital and those discharged home from the ED. Ninety-three patients were included: 68 were discharged home from ED and 25 were admitted to hospital. There was a significant difference in receiving an allied health review (p < .001) between admitted patients (96%) and those who discharged home from ED (68%). The Clinical Frailty Scale was only completed for 23% of patients. Physiotherapy quality-of-care (n = 46 patients) was variable, with poor completion of physical outcome measures (7%) and fall education (4%). However, assessment of mobility was routinely completed (94%), and most patients were referred to an appropriate community service (66%). Adherence to guideline-based care of community-dwelling fallers is inconsistent. Improvements are required in the consistency of risk stratification, comprehensive physical assessment and patient education.

Improving Pharmacist-Led Pediatric Patient Education on Oral Chemotherapy at Home.

Oral chemotherapy (OC) has been increasingly used in pediatric patients diagnosed with cancer, which is primarily managed in the outpatient setting. Different from adults, pediatric patients face unique challenges in administering these hazardous medications at home. Because of the complexity of pediatric pharmaceutical care and the hazardous nature of chemotherapy agents, comprehensive patient education is imperative to mitigate the potential safety risks associated with OC administration at home. Pharmacists play a vital role in patient education and medication consultations. However, the lack of practice guidelines and limited resources supporting OC counseling are noted. Additional barriers include insufficient knowledge and training on OC, which can be improved by continuing education. In a regional children's hospital, a comprehensive OC education checklist was developed for pediatric patients and their caregivers to standardize consultations led by pharmacists. An infographic OC handout was also formulated to improve patient knowledge and awareness. Moreover, innovative approaches such as using telepharmacy, smartphone applications, and artificial intelligence have been increasingly integrated into patient care, which can help optimize OC consultations for children and adolescents. Further studies are warranted to enhance oral chemotherapy education specifically tailored for pediatric patients in outpatient settings.

Current status of outpatient heart failure management in Egypt and recommendations for the future.

Heart failure (HF) represents one of the greatest healthcare burdens worldwide, and Egypt is no exception. HF healthcare programmes in Egypt still require further optimization to enhance diagnosis and management of the disease. Development of specialized HF clinics (HFCs) and their incorporation in the healthcare system is expected to reduce HF hospitalization and mortality rates and improve quality of care in Egypt. We conducted a literature search on PubMed on the requirements and essential infrastructure of HFCs. Retrieved articles deemed relevant were discussed by a panel of 10 expert cardiologists from Egypt and a basic HFC model for the Egyptian settings was proposed. A multidisciplinary team managing the HFC should essentially be composed of specialized HF cardiologists and nurses, clinical pharmacists, registered nutritionists, physiotherapists, and psychologists. Other clinical specialists should be included according to patients' needs and size and structure of individual clinics. HFCs should receive patients referred from primary care settings, emergency care units, and physicians from different specialties. A basic HFC should have the following fundamental investigations available: resting electrocardiogram, basic transthoracic echocardiogram, and testing for N-terminal pro-B-type natriuretic peptide. Fundamental patients' functional assessments are assessing the New York Heart Association functional classification and quality of life and conducting the 6min walking test. guideline-directed medical therapy should be implemented, and device therapy should be utilized when available. In the first visit, once HF is diagnosed and co-morbidities assessed, guideline-directed medical therapy should be started immediately. Comprehensive patient education sessions should be delivered by HF nurses or clinical pharmacists. The follow-up visit should be scheduled during the initial visit rather than over the phone, and time from the initial visit to the first follow-up visit should be determined based on the patient's health status and needs. Home and virtual visits are only recommended in limited and emergency situations. In this paper, we provide a practical and detailed review on the essential components of HFCs and propose a preliminary model of HFCs as part of a comprehensive HF programme model in Egypt. We believe that other low-to-middle income countries could also benefit from our proposed model.

374 Shared decision making for eczema patients and caregivers is not dependent on length of relationship with a provider or provider specialty

Abstract Shared decision making (SDM) is used in clinical settings to help patients make decisions regarding their treatment in collaboration with their healthcare provider (HCP). Shared decision making is well-suited for eczema as many treatment and management options exist, and there is significant disease, lived experience and patient preference heterogeneity. While a strong patient–provider relationship is likely important to facilitate SDM, the assumption that a long-term relationship between a patient and an eczema specialist leads to better SDM has not been evaluated. This study aims to understand the impact of the duration of the patient–provider relationship and type of provider on SDM experience, confidence to engage and trust in the HCP. The National Eczema Association conducted an online 64-question survey January 12 to March 14, 2021 of adult patients and caregivers of children with atopic dermatitis (AD). The SDM experience, assessed with the SDMQ9 instrument (score ranges transformed to 0–100), self-reported confidence to engage in SDM (categories: not confident at all/slightly confident/moderately confident vs. very confident/extremely confident) and trust in provider were compared by time with primary eczema HCP (categories: ≤12 months, 13–36 months and &amp;gt;36 months) and whether or not the HCP was a specialist (Dermatologist or Allergist vs. other provider types). Additionally, four groups were created for comparison of SDM experience: (i) patients who considered themselves to be well informed about the causes of eczema currently working with eczema specialists, (ii) patients not adequately informed and working with specialists and patients (iii) informed or (iv)uninformed working with nonspecialists. ANOVA was used for group comparison of continuous variables and Kruskal–Wallis tests were used for proportions. Responses from 767 adults and 177 caregivers (944 total) met inclusion criteria. Patients were primarily female (80.2%) and had a mean eczema RECAP score of 11.4. There was no difference in SDMQ9 score by time with HCP [≤12 months (62.6; n = 281), 13–36 months (66.9; n = 261) and &amp;gt;36 months (65.1; n = 402)], although respondents who saw their HCP longer than 12 months indicated they were more confident to engage in SDM (P &amp;lt; 0.001) and were more likely to ‘always’ trust their HCP (P &amp;lt; 0.001). There was no difference in SDMQ9 score, confidence to engage or trust in HCP for those seeing specialists (n = 734) vs. nonspecialists (n = 210). However, patients who were well informed had higher SDMQ9 scores than those who were not adequately informed, regardless of whether or not they were seeing a specialist (20.1 points higher for those who were well informed/seeing a specialist and 17.6 points higher for well informed/nonspecialist). The same was true for confidence to engage in SDM. Trust and confidence can build over time between patients with AD and providers, which may have an impact on treatment decisions and adherence. However, not all patients with AD and caregivers have access, resources or the ability to have long-term relationships with providers who are eczema specialists. This study shows that neither of those are prerequisite for patients with AD to engage in productive SDM, but that patient knowledge may be highly important. This highlights the need for comprehensive patient education across eczema care settings.

Venous thromboembolism prophylaxis: Nurses' perceived knowledge and barriers

Nurses, as primary healthcare providers who maintain regular patient contact, play a crucial role in preventing venous thromboembolism (VTE). This study aims to explore nurses' perceptions, knowledge, and barriers related to VTE prevention. A descriptive cross-sectional study was conducted among 263 staff nurses in governmental hospitals in the Hail region, Kingdom of Saudi Arabia. Data collection took place between January and May 2022. The majority of nurses considered VTE prevention to be an important issue (mean = 4.03±0.614) and perceived the current use of anticoagulant strategies as effective (mean = 2.91±1.16). However, nurses expressed some uncertainty regarding the safety of the current anticoagulant use (mean = 3.79±0.822) and felt that they underutilized available anticoagulant strategies (mean = 2.69±1.01). Generally, nurses demonstrated a good level of knowledge about VTE (83.2%). Gender was found to significantly influence knowledge (t = -2.841; p &lt; 0.005), perception (t = -7.919; p &lt; 0.000; mean = 3.85±0.707), and barriers (t = -4.661; p &lt; 0.000). Regarding age, significant differences were observed in knowledge (F = 5.665; p &lt; 0.004; mean = 15.87±4.39) and perception (F = 13.401; p &lt; 0.000; mean = 4.16±0.782). No significant differences were found in educational attainment, work experience, and position concerning knowledge, perception, and barriers. The working area was found to have a significant impact on knowledge (F = 4.657; p &lt; 0.000), perception (F = 4.347; p &lt; 0.001), and barriers (F = 4.257; p &lt; 0.001). By providing comprehensive and consistent patient education, nurses can play a critical role in minimizing morbidity and mortality rates associated with VTE, making VTE prevention a vital aspect of their responsibilities.

The switching process from buprenorphine sublingual tablets to the monthly buprenorphine subcutaneous depot injection in opioid dependent patients.

The 2018 European Union (EU) approved weekly and monthly subcutaneous buprenorphine depot injection (BUP-XR), for opioid substitution medication proved to offer some specific treatment benefits. The present study examines the process of switching from buprenorphine sublingual tablets (BUP-SL) to BUP-XR from a patient's point of view. In total, nine patients were surveyed by means of an open-answer questionnaire regarding course and side effects of the medication switch. Six of these patients were surveyed in more detail under BUP-SL, as well as 4 and 16 weeks after the switch to BUP-XR by means of a test battery of questions on socio-demography, withdrawal symptoms, craving, physical well-being, treatment satisfaction and concomitant use of illegal substances. Patients reported significant worse physical well-being and lower treatment satisfaction in 4weeks compared with 16 weeks after the medication switch to the BUP-XR. Furthermore, they reported significant more frequent co-use of illicit drugs, worse physical well-being, lower treatment satisfaction and more craving experience 4weeks after the switch compared with the treatment under BUP-SL. Patients 16 weeks under BUP-XR reported significant more illicit co-use and lower treatment satisfaction compared with patients under BUP-SL. Connections between therapy dissatisfaction, physical discomfort, experienced craving and drug co-consumption were discovered. In the first weeks after the medication switch, patients experience potentially distressing symptoms, which, however, seem to diminish over time. Close supervision and comprehensive patient education on possible burdens of the medication switch to the BUP-XR might prevent unfavourable treatment courses and premature therapy dropouts.

The attitude of parents of children with hearing impairment toward the prevention of major dental diseases

Relevance. The significant increase in the number of children with hearing impairment worldwide and the peculiarity of their dental status demonstrates a need for a specialized approach during preventive care. However, the choice of preventive measures has to consider both the parental perception of the process and its effectiveness.Aim. The study aimed to assess the level of parental knowledge of primary schoolchildren with hearing impairment associated with neurological pathology on the oral hygiene of children and their readiness for dental preventive care measures to improve their child’s dental status.Materials and methods. The study involved the parents of 94 primary schoolchildren aged 6-8 y.o. with hearing impairment associated with neurological pathology. The survey received information on different attitudes to preventive measures to improve children’s dental health.Results. The results demonstrated poor oral hygiene knowledge among parents of primary schoolchildren with hearing impairment associated with neurological pathology and unreadiness for full-scale cooperation with dentists.Conclusion. The obtained data indicate the need for more comprehensive and thoughtful patient education among parents of primary schoolchildren with hearing impairment associated with neurological pathology to create prerequisites for improving the children’s dental status.

An evaluation of current practice patterns for patients with renal cell carcinoma.

655 Background: First-line immunotherapy and tyrosine kinase inhibitor (TKI) treatment combinations have significantly improved clinical outcomes for patients with renal cell carcinoma (RCC). To maximize clinical benefit of these regimens, risk stratification should guide treatment selection and treatment-related adverse events (AEs) should be appropriately managed. The goal of this project was to identify current practice patterns regarding treatment selection, guideline-based management of AEs, care coordination, and patient education for individuals with RCC treated in community oncology programs and practices. Methods: In July-September 2022, ACCC administered an online survey to evaluate current practice patterns for patients with RCC treated in community cancer programs. To maximize participant engagement, the survey was also shared with advanced practitioner, pharmacist, and oncology nurse members of the Advanced Practitioner Society for Hematology and Oncology (APSHO) and the Kidney Cancer Association who provide care to patients with RCC. Results: Respondents (n=104) were mainly surveyed from community cancer care programs or private/physician practices (69%) in urban/suburban settings (90%) who average 25-75 patients with RCC annually (77%). Most respondents (89%) reported using a combination of an immunotherapeutic and a TKI as initial treatment for advanced clear cell RCC while only 61% of respondents reported frequently using risk scores for newly diagnosed patients. 45% of regimen-specific patient education happens as a separate visit, usually conducted by the oncologist (23%) or the infusion nurse (22%), and 37% of respondents conduct this education on the first day of treatment. The responsibility of providing comprehensive patient education seems to vary by program with the oncologist being the most reported (23%), followed by infusion nurse (22%), clinic nurse (20%), advanced practice provider (18%), and pharmacist (16%). The frequency of monitoring AEs differed based on the given regimen. Respondents mainly (54%) monitored on day 1 of the cycle and again mid-cycle in patients receiving immunotherapy, while 40% monitor only on day 1 of the cycle in patients receiving single-agent TKIs. Clinic nurses are primarily responsible (40%) for monitoring treatment adherence in patients receiving TKIs and also triage for associated AEs. Conclusions: This survey has identified real-world practice patterns related to the management and monitoring of patients with RCC prescribed immunotherapy and tyrosine kinase inhibitor combinations. Opportunities exist to increase utilization of risk assessments, create patient education materials for the multidisciplinary cancer care team, and address the optimal frequency of adverse event monitoring.

Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape.

Treatment of non-communicable diseases (NCD) requires patient education and counselling (PEC). Initiatives have focused on Group Empowerment and Training (GREAT) for diabetes and Brief behaviour change counselling (BBCC). However, the implementation of comprehensive PEC in primary care remains a challenge. The aim of this study was to explore how such PEC could be implemented. This was a descriptive, exploratory, qualitative study at the end of the first year of a participatory action research project to implement comprehensive PEC for NCDs at two primary care facilities in the Western Cape. Focus group interviews were held with healthcare workers and reports from co-operative inquiry group meetings were used as qualitative data. Staff were trained in GREAT for diabetes and BBCC. There were problems with training appropriate staff and sufficient numbers and a need for ongoing support. Implementation was limited by poor internal sharing of information, staff turnover and leave, rotation of staff, lack of space and fears of disrupting the efficiency of service delivery. Facilities had to embed the initiatives into appointment systems and fast track patients who attended GREAT. For those patients that were exposed to PEC, there were reported benefits. Group empowerment was feasible to introduce, while BBCC was more challenging as it required extra time in the consultation.Contribution:Implementation of PEC requires alternative approaches that do not extend consultations (such as GREAT and maybe digital solutions) as well as commitment to facility organisation for PEC from managers.

A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes

A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes

A Comprehensive Assessment of Cleft Lip and Palate Websites and Patient Education Information.

The objective of this study is to evaluate online educational resources on cleft lip and palate teams. A Cross-Sectional Study. An International, Multi-Institutional Study. All American Cleft Palate and Craniofacial Association-approved teams with websites. None. Websites were assessed for patient education and support content. Affiliation between presence of materials and U.S. Newsweek Top 100 Hospitals was also assessed. 187 teams were included. Presence of educational videos were available in 29.4% of websites, educational infographics in 18.2%, written materials in 66.8%, perioperative instructions in 19.3%, diagnosis information in 34.8% and treatment information in 63.1%. Information on team members were available on 77.0% of websites, resources in languages other than English in 38.5%, and support group resources in 25.7%. Cleft lip and palate diagnosis information was significantly associated with geographic region, with the largest impact from the West region (P = .03). There was a significant difference between teams affiliated with U.S. Newsweek Top 100 hospitals: Top 100 hospitals had a higher presence of educational infographics, perioperative instructions, definitions, diagnosis, and treatment (P < .01). There was no significant difference between presence of educational videos (P = .37). While many websites had basic educational materials, very few included detailed information on peri-operative planning, as well as additional forms of information including videos, infographics, and non-English languages. Providing comprehensive patient education materials online is an important supplement for patients with cleft lip and palate and should be prioritized by cleft teams.

Gel Cohesivity and Breast Augmentation: Applications to Clinical Practice.

Abstract Matching breast implant gel cohesivity to the patient’s needs based on anatomical and soft tissue considerations and patient preferences is essential to optimizing aesthetic outcomes and patient satisfaction. Generally, gel cohesivity contributes to the feel and shape of the breast, which reflects volume distribution within the breast. Studies on the physical properties of silicone gel breast implants have established the relative cohesivity of implants from several manufacturers. Comprehensive patient education, tissue-based preoperative planning, and a thorough understanding of how implant properties may affect outcomes are recommended before breast augmentation. This review summarizes the literature on breast implant physical properties with a focus on gel cohesivity and translates gel cohesivity to practical considerations in choosing the right implant for the right patient in primary augmentation. Based on clinical experience, the authors generally recommend lower-cohesivity implants for patients who desire a tapered upper pole or a natural appearance/“anatomic shape” as well as for those with a high body mass index or a large amount of native breast tissue. Medium-cohesivity implants are most widely used and are appropriate for those with ptosis/augmentation mastopexy, patients with tight skin envelope, and for those seeking upper pole fullness. A high-cohesivity implant is recommended for patients desiring a round shape, those with constricted lower poles, and patients with a postpartum loose envelope, a thin, soft tissue envelope, or fibrous breast tissue.

Same-Day Home Recovery for Benign Foregut Surgery

Same-day home recovery (SHR) is now the standard of care for many major surgical procedures and has the potential to become standard practice for benign foregut procedures (eg, hiatal hernia repair, fundoplication, and Heller myotomy). To determine whether SHR for patients undergoing benign foregut surgery is feasible, safe, and effective. This prospective cohort study took place across 19 medical centers within an integrated health care system in northern California from January 2019 through September 2021. Participants included consecutive patients undergoing elective benign foregut surgery. Standardized SHR program. The primary end point was the rate of SHR. The secondary end points were 7-day and 30-day rates of postoperative emergency department visits, hospital readmissions, and reoperations. Of 1248 patients who underwent benign foregut surgery from January 2017 through September 2021, 558 were patients before implementation of the SHR program and 690 were patients postimplementation. The mean age of patients was 60 years, and 759 (59%) were female. The preimplementation SHR rate was 64 of 558 patients (11.5%) in 2018 and increased to 82 of 113 patients (72.6%) by 2021 (94/350 [26.9%] in 2019 and 112/227 [49.3%] in 2020; P < .001). There were no statistical differences in the 7-day and 30-day rates of postoperative emergency visits, hospital readmissions, and reoperations or 30-day mortality in the SHR vs non-SHR groups in the postimplementation era. In this study, implementation of a regional SHR program among patients undergoing elective benign foregut surgery was feasible, safe, and effective. The changes in perioperative care require comprehensive patient education and full multidisciplinary support. An SHR program for benign foregut procedures has the potential to improve patient care and cost-effectiveness in care delivery.

The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation.

The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug "tail" that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.

A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes

ObjectivesThe impact of a comprehensive therapeutic patient education (TPE) on the prognosis of diabetic foot ulcer (DFU) has not yet been evaluated in the literature. The purpose of this study was to determine whether TPE is a predictor of outcome in type 2 diabetes patients with DFU. MethodsWe evaluated 583 consecutive individuals with a recent and single DFU. They were treated and followed for 42.8±23.3 months. Patients were divided into 2 groups. The TPE group included subjects who had been receiving regular sessions of a comprehensive TPE, including a specific foot care education (FCE), for at least 12 months before DFU occurred (n=129). The non-TPE group comprised the remaining subjects (n=454). All 583 patients received intensive FCE during the treatment period. ResultsWe identified a significantly higher percentage of healed DFUs (96.0% vs 74.9%; p<0.0001) and a lower percentage of major amputations (0.8% vs 4.4%; p=0.0511), minor amputations (1.6% vs 12.3%; p=0.0003), DFU persistence (1.6% vs 8.4%; p=0.0069) and deaths (1.6% vs 21.4%; p<0.0001) in the TPE group than in the non-TPE group. Among 464 patients with healed ulcers, the proportion of subjects with re-ulceration was greater in the non-TPE group than in the TPE group (48.8% vs 6.5%; p<0.0001). Multivariate analysis showed that TPE can predict healing (odds ratio [OR], 4.202; 95% confidence interval [CI], 1.604 to 11.004; p=0.0035) and may significantly reduce DFU recurrence (OR, 0.093; 95% CI, 0.043 to 0.201; p<0.0001) and mortality (OR, 0.096; 95% CI, 0.022 to 0.410; p=0.0016). ConclusionA comprehensive TPE may have a positive impact on wound healing, ulcer recurrence and mortality in people with DFU.

Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery.

To identify key recommendations for maximizing the efficiency and efficacy of perioperative care in transsphenoidal pituitary surgery. The authors performed a comprehensive literature search of Enhanced Recovery After Surgery protocols implemented for patients undergoing transsphenoidal adenomectomy (TSA); individual recommendations were abstracted, and the evidence base thoroughly reviewed. The authors identified 19 individual recommendations pertinent to the care of patients undergoing TSA, which were subdivided into preoperative (n=6), intraoperative (n=6), and postoperative (n=7) interventions. Key factors recommended for minimizing length of stay, preventing readmission, and improving patient outcomes included comprehensive patient education, multidisciplinary evaluation, avoidance of routine lumbar drain placement and nasal packing, and rigorous postoperative monitoring of pituitary function and salt-water imbalances. The overall level of evidence for 7/19 (37%) implemented recommendations was found to be low, suggesting a need for continued research in this patient population. Several key interventions should be considered in the development of Enhanced Recovery After Surgery protocols for TSA, which may aid in further decreasing length of stay and promoting positive patient outcomes.