Decreased Patient Satisfaction Research Articles

Depression and Anxiety in Traumatic Brachial Plexus Injury Patients Are Associated With Reduced Motor Outcome After Surgical Intervention for Restoration of Elbow Flexion.

Depression has been associated with poor outcomes in neurosurgical patients, including increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding an association of psychiatric diagnoses with outcomes after brachial plexus reconstruction. As outcomes and patient satisfaction become increasingly important to payers and physician reimbursement, assessing modifiable preoperative risk factors for their association with poor outcome and patient satisfaction is imperative. To analyze patients undergoing brachial plexus reconstruction to assess the relationship of depression/anxiety with functional outcome. Data were collected retrospectively on all patients who underwent brachial plexus reconstruction to restore elbow flexion between 2005 and 2013. Elbow flexion, graded via the Medical Research Council scale, was assessed at latest follow-up. Multiple variables, including the presence of Axis I psychiatric diagnoses, were assessed for their association with the dichotomous outcome of Medical Research Council scale score ≥3 (antigravity) vs <3 elbow flexion. Standard statistical methods were used. Thirty-seven patients met inclusion criteria. The median postsurgical follow-up time was 21 months. Operations included neurolysis (n = 3), nerve graft repair (n = 6), and nerve transfer (n = 28). Depression was present in 10 of 37 patients (27%). Of variables tested, only depression was associated with poor elbow flexion outcome (odds ratio: 6.038; P = .04). Preoperative depression is common after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery after reconstruction. Our data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction. MRC, Medical Research CouncilTBI, traumatic brain injury.

Sa1751 A Novel Device for Improving Visualization in an Inadequately Prepared Colon

Poor bowel preparation affects the completeness of the colonoscopy and can result in longer procedural times, missed adenomas, earlier repeat procedures and increase costs and decrease patient satisfaction. The Motus GI Pure Vu (Tirat Carmel, Israel) is a new medical device that has been designed to improve visualization in an inadequately prepared colon by facilitating intra-procedural cleaning. The system consists of a disposable single-use over-sleeve and a workstation controller. The disposable over-sleeve easily fits over standard colonoscopes without interfering with the working channel or the colonoscopy procedure. The workstation controls the delivery of a novel irrigation mode via 4 jets and a regulated evacuation cycle that effectively removes considerable colon content.

Remote Prenatal Care Monitoring With Digital Health Tools Can Reduce Visit Frequency While Improving Satisfaction [3

INTRODUCTION: A high frequency of in-clinic visits is standard for prenatal surveillance. Yet in studies, reduction in prenatal care visits is not correlated with adverse perinatal outcomes for low-risk pregnancies. However, it is associated with decreased patient satisfaction. This study sought to measure the effect of reducing the frequency of prenatal visits while applying mobile/digital health technology for improved patient satisfaction and equivalent outcomes in low-risk pregnancies. METHODS: 100 first-trimester low-risk obstetric patients were enrolled in a controlled study. 50 patients were placed on an alternative prenatal care schedule (8 visits), supplemented with an integrated technology platform of a mobile application and connected devices (wireless weight scale and blood pressure cuff). The remaining 50 patients in the control group received routine frequency of care, without technology. Patients were evaluated for satisfaction, outcomes and engagement throughout pregnancy. RESULTS: The study group attended 8.0±0.0 prenatal care visits, compared to 14.0±0.0, P<.005 in the control group. There was also increased patient satisfaction, and high engagement rates with the technology platform (determined by mean app task completion rates of 86.7±18.1%). On average, we generated fivefold more data points for weight and blood pressure measurements per patient with the digital devices. No adverse clinical outcomes occurred in either group. CONCLUSION/IMPLICATIONS: Despite a 43% reduction of in-clinic visits, prenatal care supplemented with remote monitoring demonstrates enhanced satisfaction and increased engagement with no change in perinatal outcomes. Thus, mobile/digital technology may facilitate a new paradigm of prenatal care delivery that is safe, cost-effective and risk-appropriate.

A Resource and Cost Analysis on the Impact of Reduced Visits for Prenatal Care [29F

INTRODUCTION: Prenatal care is resource intensive, marked by frequent provider visits. Several studies have demonstrated reduced prenatal visits show no difference of outcomes in low risk pregnancies, yet are subject to decreased patient satisfaction. Our objective was to perform a resource analysis of reduced visits supplemented by the use of digital tools during prenatal care for improved satisfaction. METHODS: As accurate data on resource consumption during prenatal care is lacking, we first gathered these data from interviews of over 100 clinicians representing a variety of practice settings (private practices, academic centers & large systems). We then studied an alternative prenatal schedule with reduced visits supplemented with mobile technology and home monitoring. Finally, we extrapolated the impact of visit reduction from an individual pregnancy to a large system. RESULTS: On average, outpatient prenatal care was $1,164.66. With a modified visit schedule, the cost for a low risk pregnancy is reduced to $665.52, leading to a cost savings of $499.14 per pregnancy. Similarly, an analysis of clinic time per pregnancy showed that effective care was delivered with an average of 6 fewer visits (or 90 minutes clinical time) with the modified schedule. When extrapolated to a typical practice with 1000 deliveries/year, this translated to $499,140 in cost savings and 6000 fewer visits (or 1,500 hours). CONCLUSION: While further studies are required to validate the benefits for using mobile/digital tools, the initial analysis indicates that it could lead to significant cost savings or additional revenue while still delivering high quality care.

P014: An investigation to determine if being roomed next to a psychiatric patient affects patient satisfaction and perception of care in those not being evaluated for a psychiatric complaint

Introduction: Nearly 12 million emergency department (ED) visits in the USA annually are related to a mental health and/or substance abuse condition. This is equivalent to 1 out of every 8 ED visits or 12.5 percent of all ED visits annually. States cut $5 billion in mental health services from 2009 to 2012. In the same period, the country eliminated at least 4,500 public psychiatric hospital beds. This has led to an increase in psychiatric boarding. Boarding consumes scarce ED resources and prolongs the amount of time that all patients must spend waiting for services. The aim of this study is to determine if being roomed next to a psychiatric patient affects patient satisfaction and perception of care. Methods: A survey consisting of 15 patient satisfaction questions was distributed to patients over a period of three months in the ED at a tertiary care center with &gt;125,000 visits a year. Patients included were English-speaking adults (18 years or older) with an Emergency Severity Index of 3-5. Responses were analyzed with a chi-square across 2 groups with p-value of 0.05 considered as significant. Results: A convenience sample of 78 surveys was obtained. 40 surveys were completed by those roomed next to a patient with a psychiatric complaint and 38 surveys were completed by patients not roomed next to a patient being seen for a psychiatric complaint. For every satisfaction question asked, the patients placed away from mental health encounters gave significantly higher ratings than the patients roomed near psychiatric patients. Patients roomed next to psychiatric patients had a statistically significant decrease in satisfaction in nursing attentiveness, nursing promptness in responding to the call bell, attentiveness of the physician team, and of the overall encounter itself. All values were significant with all but one p-value being &lt;0.01.There was no difference between the 2 groups with respect to gender, age range, reason for visit or wait time. Conclusion: This study suggests that patients being roomed next to a patient with a psychiatric complaint had significantly decreased patient satisfaction.

Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus: A Meta-Analysis of Randomized Trials.

Pruritus is a common side effect of intrathecal fentanyl or sufentanil that decreases patient satisfaction and may delay hospital discharge. There are conflicting reports about the efficacy of prophylactic ondansetron in reducing the incidence of pruritus. This meta-analysis aimed to assess the effect of prophylactic ondansetron on the incidence of intrathecal fentanyl- or sufentanil-mediated pruritus and the need for rescue treatment. A systematic search on PubMed, Medline, and the Cochrane Central Register of Controlled Trials from January 1, 1994, to January 1, 2014, was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Randomized controlled trials evaluating the efficacy of prophylactic ondansetron on pruritus associated with intrathecal fentanyl or sufentanil were included. The primary outcome was the incidence of pruritus, and the secondary outcome was patients' need for rescue therapy. Sensitivity analyses were conducted to assess the outcomes in obstetric and nonobstetric patients and in patients who received ondansetron before or after intrathecal opioid injection. Analyses used random-effect models. Six randomized controlled trials involving 555 patients were included. In the overall analysis, prophylactic ondansetron did not significantly decrease the incidence of pruritus, but there was a trend toward reduced rescue medication use (risk ratio [RR], 0.57; 95% confidence interval [CI], 0.35-0.91; I = 0%; P = 0.02). Exploratory subgroups, including nonobstetric surgery patients and patients who received ondansetron before spinal opioid administration, also suggest a trend toward less rescue medication use (RR, 0.47; 95% CI, 0.26-0.85; P = 0.01; and RR, 0.62; 95% CI, 0.38-1.00; P = 0.05). IV 8 mg prophylactic ondansetron does not decrease the incidence of fentanyl- or sufentanil-mediated pruritus but may decrease the need for pruritus rescue medication, particularly in specific subgroups. Randomized trials are needed to confirm these results.

Modern Total Knee Arthroplasty Designs: Are we Improving Outcomes?

Although the volume of total knee Arthroplasties (TKAs) performed around the world continues to increase, recent studies on patient satisfaction as the primary outcome measure have shown that up to 30% of the patients remain unsatisfied. Especially in younger individuals, TKAs are associated with higher rates of revision and with decreased patient satisfaction. Because of these reports, several manufacturers have implemented specific design modifications and have increased the modularity of their systems. However, little is known of the safety and functionality of these newer designs. This editorial note highlights recent advances in TKA implant designs, focusing on the reported outcomes of high-flex and extremely modular new primary TKA designs.

Interventions to Improve Adherence in Patients with Immune-Mediated Inflammatory Disorders: A Systematic Review.

BackgroundIn patients with immune-mediated inflammatory disorders, poor adherence to medication is associated with increased healthcare costs, decreased patient satisfaction, reduced quality of life and unfavorable treatment outcomes.ObjectiveTo determine the impact of different interventions on medication adherence in patients with immune-mediated inflammatory disorders.DesignSystematic review.Data sourcesMEDLINE, EMBASE and Cochrane Library.Study eligibility criteria for selecting studiesIncluded studies were clinical trials and observational studies in adult outpatients treated for psoriasis, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, spondyloarthritis, psoriatic arthritis or multiple sclerosis.Study appraisal and synthesis methodsIntervention approaches were classified into four categories: educational, behavioral, cognitive behavioral, and multicomponent interventions. The risk of bias/study limitations of each study was assessed using the GRADE system.ResultsFifteen studies (14 clinical trials and one observational study) met eligibility criteria and enrolled a total of 1958 patients. Forty percent of the studies (6/15) was conducted in patients with inflammatory bowel disease, half (7/15) in rheumatoid arthritis patients, one in psoriasis patients and one in multiple sclerosis patients. Seven out of 15 interventions were classified as multicomponent, four as educational, two as behavioral and two as cognitive behavioral. Nine studies, of which five were multicomponent interventions, had no serious limitations according to GRADE criteria. Nine out of 15 interventions showed an improvement of adherence: three multicomponent interventions in inflammatory bowel disease; one intervention of each category in rheumatoid arthritis; one multicomponent in psoriasis and one multicomponent in multiple sclerosis.ConclusionThe assessment of interventions designed for increasing medication adherence in IMID is rare in the literature and their methodological quality may be improved in upcoming studies. Nonetheless, multicomponent interventions showed the strongest evidence for promoting adherence in patients with IMID.

The Incidence and Severity of Postoperative Pain following Inpatient Surgery.

In recent years, there has been increased attention to pain management after surgery in the hospital setting along with financial enticement from the US government. The aim of this study is to evaluate the current efficacy of postoperative pain management. In a prospective study, patients in an academic private nonprofit medical center were asked the same questions about their postoperative pain as in a previously published 2003 survey. Questionnaires on 1) pain intensity on a verbal categorical scale and 2) patient satisfaction with pain medication were completed in the patient's room before hospital discharge, and followed-up by telephone interviews at 1 and 2 weeks later. Numerical Pain Scale (NRS) pain scores were obtained at the same time points. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results for pain management were obtained at bedside interview along with standard mailed HCAHPS survey obtained by Press Ganey. Based on 441 surgical inpatients (Orthopedic, General, Neurosurgery, Gynecological) 12% of patients had "Severe-to-Extreme" pain and 54% had "Moderate-to-Extreme" pain at discharge. During the first 2 weeks after discharge, 13% of patients had "Severe-to-Extreme" pain and 46% had "Moderate-to-Extreme" pain. Pain scores at discharge and after discharge were negatively correlated with patient satisfaction with pain medication (P < 0.0001), indicating that increased pain intensity was associated with decreased patient satisfaction. For the HCAHPS question "how often was your pain well controlled?," 66% answered "Always" in the Press Ganey report versus 51% at bedside (P < 0.0001). The incidence of severe-to-extreme pain in patients before and after discharge following inpatient surgery is 12-13%, and this is a reduction from 10 years ago.

Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care.

Shared decision making is an important component of patient-centred care. It is a set of communication and evidence-based practice skills that elicits patients' expectations, clarifies any misperceptions and discusses the best available evidence for benefits and harms of treatment. Acute respiratory infections (ARIs) are one of the most common reasons for consulting in primary care and obtaining prescriptions for antibiotics. However, antibiotics offer few benefits for ARIs, and their excessive use contributes to antibiotic resistance - an evolving public health crisis. Greater explicit consideration of the benefit-harm trade-off within shared decision making may reduce antibiotic prescribing for ARIs in primary care. To assess whether interventions that aim to facilitate shared decision making increase or reduce antibiotic prescribing for ARIs in primary care. We searched CENTRAL (2014, Issue 11), MEDLINE (1946 to November week 3, 2014), EMBASE (2010 to December 2014) and Web of Science (1985 to December 2014). We searched for other published, unpublished or ongoing trials by searching bibliographies of published articles, personal communication with key trial authors and content experts, and by searching trial registries at the National Institutes of Health and the World Health Organization. Randomised controlled trials (RCTs) (individual level or cluster-randomised), which evaluated the effectiveness of interventions that promote shared decision making (as the focus or a component of the intervention) about antibiotic prescribing for ARIs in primary care. Two review authors independently extracted and collected data. Antibiotic prescribing was the primary outcome, and secondary outcomes included clinically important adverse endpoints (e.g. re-consultations, hospital admissions, mortality) and process measures (e.g. patient satisfaction). We assessed the risk of bias of all included trials and the quality of evidence. We contacted trial authors to obtain missing information where available. We identified 10 published reports of nine original RCTs (one report was a long-term follow-up of the original trial) in over 1100 primary care doctors and around 492,000 patients.The main risk of bias came from participants in most studies knowing whether they had received the intervention or not, and we downgraded the rating of the quality of evidence because of this.We meta-analysed data using a random-effects model on the primary and key secondary outcomes and formally assessed heterogeneity. Remaining outcomes are presented narratively.There is moderate quality evidence that interventions that aim to facilitate shared decision making reduce antibiotic use for ARIs in primary care (immediately after or within six weeks of the consultation), compared with usual care, from 47% to 29%: risk ratio (RR) 0.61, 95% confidence interval (CI) 0.55 to 0.68. Reduction in antibiotic prescribing occurred without an increase in patient-initiated re-consultations (RR 0.87, 95% CI 0.74 to 1.03, moderate quality evidence) or a decrease in patient satisfaction with the consultation (OR 0.86, 95% CI 0.57 to 1.30, low quality evidence). There were insufficient data to assess the effects of the intervention on sustained reduction in antibiotic prescribing, adverse clinical outcomes (such as hospital admission, incidence of pneumonia and mortality), or measures of patient and caregiver involvement in shared decision making (such as satisfaction with the consultation; regret or conflict with the decision made; or treatment compliance following the decision). No studies assessed antibiotic resistance in colonising or infective organisms. Interventions that aim to facilitate shared decision making reduce antibiotic prescribing in primary care in the short term. Effects on longer-term rates of prescribing are uncertain and more evidence is needed to determine how any sustained reduction in antibiotic prescribing affects hospital admission, pneumonia and death.

Pregabalin and pain after total knee arthroplasty: a double-blind, randomized, placebo-controlled, multidose trial

Pregabalin may reduce postoperative pain and opioid use. Higher doses may be more effective, but may cause sedation and confusion. This prospective, randomized, blinded, placebo-controlled study tested the hypothesis that pregabalin reduces pain at 2 weeks after total knee arthroplasty, but increases drowsiness and confusion. Patients (30 per group) received capsules containing pregabalin (0, 50, 100, or 150 mg); two capsules before surgery, one capsule twice a day until postoperative day (POD) 14, one on POD15, and one on POD16. Multimodal analgesia included femoral nerve block, epidural analgesia, oxycodone-paracetamol, and meloxicam. The primary outcome was pain with flexion (POD14). Pregabalin did not reduce pain at rest, with ambulation, or with flexion at 2 weeks (P=0.69, 0.23, and 0.90, respectively). Pregabalin increased POD1 drowsiness (34.5, 37.9, 55.2, and 58.6% in the 0, 50, 100, and 150 mg arms, respectively; P=0.030), but did not increase confusion (0, 3.5, 0, and 3.5%, respectively; P=0.75). Pregabalin had no effect on acute or chronic pain, opioid consumption, or analgesic side-effects. Pregabalin reduced POD14 patient satisfaction [1-10 scale, median (first quartile, third quartile): 9 (8, 10), 8 (7, 10), 8 (5, 9), and 8 (6, 9.3), respectively; P=0.023). Protocol compliance was 63% by POD14 (50.0, 70.0, 76.7, and 56.7% compliance, respectively), with no effect of dose on compliance. Per-protocol analysis of compliant patients showed no effect of pregabalin on pain scores. Pregabalin had no beneficial effects, but increased sedation and decreased patient satisfaction. This study does not support routine perioperative pregabalin for total knee arthroplasty patients. ClinicalTrials.gov: http://www.clinicaltrials.gov/ct2/show/study/NCT01333956.

Application of the Goutallier/Fuchs Rotator Cuff Classification to the Evaluation of Hip Abductor Tendon Tears and the Clinical Correlation With Outcome After Repair

To assess the reliability and reproducibility of the Goutallier/Fuchs classification for the evaluation of abductor tendon tears of the hip, as well as to identify the relation between preoperative tear size, abductor muscle quality, and the success of endoscopic tendon repair. This is a retrospective review of 30 consecutive endoscopic abductor tendon repairs performed by a single surgeon over a 2-year period. Preoperative magnetic resonance imaging scans were reviewed, and the muscle was assigned a grade according to the Goutallier/Fuchs classification. Patient-rated outcome scores--visual analog scale score, Hip Outcome Score (HOS), and modified Harris Hip Score (mHHS)--were collected preoperatively and at a minimum of 2 years postoperatively. Intraobserver and interobserver reliability for muscle grading was calculated. Postoperative outcome measures were compared with preoperative tear size, muscle grade, and repair type to assess for correlations. Of the 30 hips included in the study, over 75% were classified as grade 1 (n = 15) or grade 2 (n = 8). The intraobserver reliability and interobserver reliability of the classification system averaged 0.872 and 0.916, respectively. Two patients (grades 3 and 4) had repair failure and underwent muscle transfer. In the remaining 28 hips, improvement was seen in the visual analog scale score (6.0 v 1.7, P < .0001), HOS-Activities of Daily Living subscale score (58.8 v 83.4, P < .0001), HOS-Sport-Specific subscale score (40.0 v 75.0, P < .0001), and mHHS (55.6 points v 81.1 points, P < .0001) postoperatively. Increasing preoperative fatty infiltration and atrophy correlated with increased postoperative pain levels (regression coefficient, 0.93; P < .001) and decreased postoperative HOS-Activities of Daily Living subscale scores (regression coefficient, -3.36; P = .011), HOS-Sport-Specific subscale scores (regression coefficient, -5.63; P = .016), mHHS values (regression coefficient, -3.50; P = .0008), and patient satisfaction (regression coefficient, -1.04; P < .0001). Patient age, tear size, or repair type (double v single row) did not affect postoperative outcomes. The Goutallier/Fuchs classification system can be reliably and reproducibly applied to the evaluation of abductor tendon tears of the hip and appears to correlate with patient-rated outcomes after repair. Increasing preoperative muscle fatty atrophy correlates with increased patient pain and decreased patient satisfaction and functional outcomes after repair. Level IV, prognostic case series.

Aesthetic and Functional Results of Lateral Crural Repositioning.

Thin or cephalically malpositioned lateral crura cause nasal obstruction by depressing nasal valves and decrease patient satisfaction with rhinoplasty as a result of nostril asymmetry and alar collapse. To demonstrate the aesthetic and functional efficacy of lateral crural repositioning with lateral strut grafting in patients with cephalic malposition of the lateral crura undergoing primary septorhinoplasty. We prospectively selected 80 patients with lateral crural malposition who underwent primary septorhinoplasty performed by the same surgeon from December 1, 2013, through May 30, 2014. The surgeon measured the angle between the lateral crura and midline intraoperatively with a goniometer to confirm malposition (angle, ≤30°). Data analysis was performed from March 13 to 23, 2015. All the patients underwent primary rhinoplasty with the open approach. Lateral crural repositioning with lateral crural strut graft was used in all selected patients. Preoperative and 6- and approximately 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation (NOSE) scale (range, 0-20; decreased scores indicate improved functional results) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaire (range, 0-24; increased scores indicate improved aesthetic results). Seventy-five of 80 patients were confirmed to have cephalic malposition intraoperatively. Four patients were excluded owing to selection of different surgical techniques, leaving 71 patients for analysis. The mean (SD) and median postoperative NOSE scores at 6 months (3.18 [3.12] and 2.0) and 12 months (0.39 [1.07] and 0) showed significant improvement compared with the preoperative scores (6.96 [5.10] and 7.0) (P < .01 for each comparison). The mean (SD) and median postoperative ROE scores also showed significant improvement at 6 months (21.06 [3.82] and 23.0) and 12 months (23.12 [2.09] and 24.0) compared with preoperative scores (7.03 [3.70] and 6.0) (P = .001). However, the changes from preoperative to 12-month postoperative scores (mean [SD] and median) were not significantly different between patients with normal (NOSE scores, 8.41 [4.59] and 90 to 0.28 [0.79] and 0, respectively; ROE scores, 6.97 [3.24] and 6.0 to 23.31 [1.91] and 24.0, respectively) and thin (NOSE score, 6.59 [5.09] and 8.0 to 0.11 [0.33] and 0, respectively; ROE scores, 7.76 [3.82] and 7.0 to 23.29 [1.72] and 24.0, respectively) skin types and those with thick skin types (NOSE scores, 5.52 [5.42] and 4.0 to 0.72 [1.54] and 0, respectively; ROE scores, 6.60 [4.16] and 6.0 to 22.80 [2.53] and 24.0, respectively) (P > .05). Lateral crural repositioning is a useful and versatile technique to achieve successful functional and aesthetic results in a 1-year follow-up. We detected no significant difference by skin type in improvement of nasal function and aesthetic satisfaction. 3.

Patient-Adapted Treatment for Prosthetic Hip Joint Infection

Hip joint replacement is 1 of the most successful surgical procedures of the last century and the number of replacements implanted is steadily growing. An infected hip arthroplasty is a disaster, it leads to patient suffering, surgeon's frustration and significant costs to the health system. The treatment of an infected hip replacement is challenging, healing rates can be low, functional results poor with decreased patient satisfaction. However, if a patient-adapted treatment of infected hip joints is used a success rate of above 90% can be obtained.Patient-adapted treatment is based on 5 important concepts: teamwork; understanding the biofilm; diagnostic accuracy; correct definition and classification of PJI; and patient-tailored treatment.This review presents a patient-adapted treatment strategy to prosthetic hip infection. It incorporates the best aspects of the single and staged surgical strategies and promotes the short interval philosophy for the 2-stage approach.

Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review.

Purpose:Total hip arthroplasty (THA) is a common and effective treatment of hip osteoarthritis. Activity restrictions known as hip precautions are widely practiced in rehabilitation post THA, aiming to foster healing and prevent hip dislocation. The focused clinical question was: Does the application of hip precautions in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation?Methods:A comprehensive literature search was conducted for randomized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up, with dislocation as an end point. Retrieved titles were assessed independently by 2 reviewers for inclusion and underwent standardized data extraction.Results:Title search produced 80 potentially relevant articles. Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria. No eligible studies were found that concerned posterior approaches to hip arthroplasty, so the results of this review concern only anterolateral approaches. Neither included study showed any benefit of hip precautions in preventing dislocation.Conclusion:The rate of dislocation after anterolateral THA is low and is not improved by hip precautions. Hip precautions are associated with a slower return to activities, significant expense, and decreased patient satisfaction. Existing studies risk being compromised by a type II error, but a definitive study may be prohibitively large and expensive.

Compassion fatigue among pediatric healthcare providers.

Compassion fatigue is a term used to describe the unique stressors affecting people in caregiving professions. For nurses and other direct care providers, the impact of compassion fatigue may result in stress-related symptoms, job dissatisfaction, decreased productivity, decreased patient satisfaction scores, safety issues, and job turnover. Those who care for seriously ill children and their families are at increased risk for compassion fatigue. Constant exposure to children who are suffering, in combination with work place stressors and personal issues, may contribute to the development of compassion fatigue. The Professional Quality of Life Scale Version 5 was used to determine the risk for compassion fatigue among 296 direct care providers at St. Louis Children's Hospital. Compassion satisfaction, burnout, and secondary traumatic stress scores did not differ by age, work category, level of education, or work experience. There were, however, significant differences in scores as a function of nursing unit. Nurses who work in the pediatric intensive care unit reported lower compassion satisfaction scores, and higher burnout and secondary traumatic stress scores. Results demonstrated the risk for compassion fatigue and provided data necessary to support development of a compassion fatigue program for direct care providers.

The Use of Chewing Gum Postoperatively in Pediatric Scoliosis Patients Facilitates an Earlier Return to Normal Bowel Function

PurposeIn surgical correction of scoliosis in pediatric patients, gastrointestinal complications including postoperative ileus can result in extended hospital stays, poorer pain management, slower progression with physical therapy, and overall decreased patient satisfaction. In patients undergoing gastrointestinal, gynecological, and urological surgery, gum chewing has been shown to reduce time to flatus and passage of feces. The authors hypothesized that chewing gum could also speed return to normal bowel function in pediatric patients undergoing surgical correction of scoliosis. MethodsThe researchers obtained institutional review board approval for a prospective, randomized, controlled trial. Eligible patients included all adolescent idiopathic scoliosis patients undergoing posterior spinal fusion. Exclusion criteria included previous gastrointestinal surgery or preexisting gastrointestinal disease. Patients were randomized by coin flip. The treatment group chewed sugar-free bubble gum 5 times a day for 20 to 30 minutes beginning on postoperative day 1; the control group did not chew gum. Patients were asked a series of questions regarding subjective gastrointestinal symptoms each day. Time to flatus and first passage of feces were recorded as indicators of return to normal bowel function. Normality of data was assessed using normal probability plots. ResultsA total of 83 patients completed the study (69 females and 14 males; mean age, 14.4 years). Of the 42 patients in the chewing gum group, 8 elected to stop chewing gum regularly before discharge for to a variety of reasons. Patients who chewed gum experienced first bowel movement on average 145.9 hours after surgery, 30.9 hours before those who did not chew gum (p = .04). Gum-chewing patients first experienced flatus an average of 55.2 hours after surgery, compared with 62.3 hours for controls. This trend did not reach statistical significance (p = .12). No difference was noted in duration of hospital stay, medications administered as required, or subjective symptoms. ConclusionChewing gum after posterior spinal fusion for scoliosis is safe and may speed return of normal bowel function. Chewing gum after surgical correction of scoliosis facilitates an earlier return to normal bowel function, which may improve patient satisfaction in the early postoperative period.

Topical intra-articular and intravenous tranexamic acid to reduce blood loss in total knee arthroplasty.

Different blood loss prevention protocols have been adopted after total knee replacement (TKR) because bleeding is a major complication of TKR and transfusions is frequently required. Increased bleeding has been associated with delayed recovery, increased complications, increased costs and decreased patient satisfaction.

Clinical outcomes in patients undergoing revision rotator cuff repair with extracellular matrix augmentation.

Outcomes following revision surgery for failed rotator cuff repairs are far less predictable than and are associated with decreased patient satisfaction compared with primary repairs. Extracellular matrix augmentation (ECM) may improve the biologic potential for healing during revision repair. The authors examined clinical outcomes and healing rates based on postoperative imaging of patients who underwent revision open rotator cuff repair with an ECM patch for symptomatic recurrent rotator cuff tear. Twenty-four (77%) of 31 patients with a mean follow-up of 50 months (range, 30-112 months) completed post-revision surgery outcome questionnaires at a mean of 5.3 years after revision surgery, and 16 patients (67%) underwent a physical examination and repeat imaging (ultrasound or magnetic resonance imaging) at a mean of 4.2 years after revision surgery. Ten (63%) of those 16 patients were found to have failed revision rotator cuff repair on imaging, with American Shoulder and Elbow Surgeons (ASES) outcome measures that were significantly (P=.04) better in patients with confirmed intact repairs than those with confirmed failed revision repair. Outcome measures for all patients (n=24) included a mean ASES score of 67.2 (SD, 27.9) and a mean Single Assessment Numeric Evaluation (SANE) score of 66.9 (SD, 26.0). Based on these scores, excellent results were achieved in 24% of patients, good in 13%, fair in 21%, and poor in 42%. Results of this investigation demonstrated that augmentation of revision rotator cuff repair with an ECM patch through an open approach showed no significant improvement in outcomes when compared to historical reports without augmentation.

The Effect of Compassionate Nursing on Non-English-Speaking Patients

The purpose of this article is to examine, through a literature review, the relationship between compassionate nursing and patient satisfaction in non-English-speaking patients. Research suggests that compassionate nursing may increase patient satisfaction in non-English-speaking patients and suggests that uncompassionate nursing decreases patient satisfaction. Most studies remained inconclusive in their demonstration of negative effects of uncompassionate nursing on English and non-English-speaking patients. Some studies conclusively demonstrated positive effects of compassionate nursing on English-speaking patients. Current research recommends nurses practice and advocate compassion for all. However, more outcome-based research is needed to demonstrate how compassionate nursing affects patient satisfaction in non-English-speaking patients.