Determine Patient Satisfaction Research Articles

The Feasibility and Acceptability of Virtual Therapy Environments for Early ICU Mobilization.

Early mobilization in critically ill patients has been documented to reduce neuromuscular complications, but access to rehabilitation services is often limited in the intensive care unit (ICU). Virtual platforms that deliver therapy may increase access to rehabilitation services and improve patient motivation to participate. Xbox Kinect Jintronix software delivers interventions using games and activities designed for therapy. To determine the feasibility of the Jintronix virtual therapy system in an ICU setting by observing outcomes related to patient satisfaction, adverse events, and technical applicability. Prospective observational feasibility study. Medical ICU at a Level 1 Trauma Center within an academic medical center. Twenty adults admitted to ICU. Participants engaged in one therapy session with a maximum of 14 Jintronix modules targeting arm, leg, and/or trunk strength, range of motion, and endurance. A trained physician-observer recorded events related to adverse events and technical applicability. Participants completed a survey to determine patient satisfaction. A total of 188 modules were completed. Participants completed a median of nine modules each. Five participants completed the maximum of 14 modules. Fatigue was the most common reason for cessation. Mean intervention time was 29 minutes. There were no falls, lines dislodged, or medical events. Participants required physical assistance or verbal cues in 36% of modules. Technical errors affected 25% of modules and led to activity cessation in one case. Nearly all participants reported the activity was enjoyable, comfortable, safe, easy to understand, would improve range of motion and strength, and would motivate them to continue. Use of a virtual therapy environment in an intensive care setting is feasible.

Patient satisfaction with the CMC controller: A cohort study

Study DesignCohort study. IntroductionThe evidence specific to understanding patient satisfaction, preference and the effects on occupational performance using a CMC orthosis is sparse. Purpose of the StudyThe main purpose of this study was to determine patient satisfaction, aspects of the orthotic preference, and the effect on pain and function of the CMC Controller Plus neoprene orthotic device. MethodsThis research was conducted at two outpatient clinics located in Pennsylvania and Florida during 2019. The subjects of this study included any individuals referred to one of two participating hand therapy facilities with either a primary or secondary diagnosis of thumb CMC joint arthritis or present with this diagnosis as a comorbidity. The CMC Controller Plus orthosis (Hely & Weber) was provided to each patient by the treating therapist at no cost to the patient after the patient agreed to take part in the study. None of the patients received hand therapy treatment for the CMC pain; the only intervention provided was the CMC Controller Plus. ResultsThe CMC Controller Plus orthosis improved the patients' functional status and reduced their pain. The effect size for the change in function was large (1.29) compared to the effect size for the reduction in pain which approached moderate at 0.49. DiscussionThe CMC Controller Plus orthosis improved the patient's functional status by 52% and reduced their pain by 29%. ConclusionThe results were both statistically and clinically significant.

The Clinical Efficacy of Two Endoscopic Surgical Approaches for Intractable Plantar Fasciitis

In this randomized retrospective study, 2 different endoscopic approaches were used to treat intractable plantar fasciitis with the aim to reduce complications and improve therapeutic effects. The lateral double incisions group included 23 feet in 22 patients, and the medial and lateral incisions group included 21 feet in 19 patients. Both groups were treated with endoscopy through the suprafascial approach. Patients were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS-AHS) and visual analog scale (VAS) preoperatively and 3, 6, 12, and 24 months postoperatively. At the final follow-up, the Roles-Maudsley (R-M) score was used to determine patient satisfaction. The AOFAS-AHS scores of the lateral double incisions group were 54.54 ± 7.02 preoperatively and 97.71 ± 3.67 postoperatively. Similarly, AOFAS-AHS scores in the medial and lateral incisions group were 55.52 ± 6.41 preoperatively and 96.64 ± 3.18 postoperatively. There was no significant difference in AOFAS-AHS scores between groups before and after surgery. The time to full weightbearing after surgery and the time to return to full athletic activities in the 2 groups showed no significant difference. The postoperative VAS scores were significantly lower than the preoperative values for both groups. However, no differences were noted in VAS scores or R-M scores postoperatively between the 2 groups. In the medial and lateral incisions group, 3 cases of injury of the first branch of the lateral plantar nerve occurred postoperatively. In conclusion, both endoscopic approaches are effective in the treatment of intractable plantar fasciitis. The lateral double incisions approach showed a lower incidence of nerve injury.

Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis

Long-term results support antibiotics for uncomplicated acute appendicitis as an alternative to appendectomy. To our knowledge, treatment-related long-term patient satisfaction and quality of life (QOL) are not known. To determine patient satisfaction and QOL after antibiotic therapy and appendectomy for treating uncomplicated acute appendicitis. Open appendectomy vs antibiotics with intravenous ertapenem, 1 g once daily, for 3 days followed by 7 days of oral levofloxacin, 500 mg once daily, and metronidazole, 500 mg 3 times per day. This observational follow-up of the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotics included 530 patients age 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis who were randomized to undergo appendectomy (273 [52%]) or receive antibiotics (257 [49%]). The trial was conducted from November 2009 to June 2012; the last follow-up was May 9, 2018. The data were analyzed in February 2019. In this analysis, post hoc secondary end points of postintervention QOL (EQ-5D-5L) and patient satisfaction and treatment preference were evaluated. Of the 530 patients enrolled in the trial (appendectomy group: 273 [174 men (64%)] with a median age of 35 years; (antibiotic group: 257 [155 men (60%)] with a median age of 33 years), 423 patients (80%) were available for phone interview at a median follow-up of 7 years; 206 patients (80%) took antibiotics and 217 (79%) underwent appendectomy. Of the 206 patients taking antibiotics, 81 (39%) had undergone appendectomy. The QOL between appendectomy and antibiotic group patients was similar (median health index value, 1.0 in both groups; 95% CI, 0.86-1.0; P = .96). Patients who underwent appendectomy were more satisfied in the treatment than patients taking antibiotics (68% very satisfied, 21% satisfied, 6% indifferent, 4% unsatisfied, and 1% very unsatisfied in the appendectomy group and 53% very satisfied, 21% satisfied, 13% indifferent, 7% unsatisfied, and 6% very unsatisfied in the antibiotic group; P < .001) and in a subgroup analysis this difference was based on the antibiotic group patients undergoing appendectomy. There was no difference in patient satisfaction after successful antibiotic treatment compared with appendectomy (cumulative odds ratio [COR], 7.8; 95% CI, 0.5-1.3; P < .36). Patients with appendectomy or with successful antibiotic therapy were more satisfied than antibiotic group patients who later underwent appendectomy (COR, 7.7; 95% CI, 4.6-12.9; P < .001; COR, 9.7; 95% CI, 5.4-15.3; P < .001, respectively). Of the 81 patients taking antibiotics who underwent appendectomy, 27 (33%) would again choose antibiotics as their primary treatment. In this analysis, long-term QOL was similar after appendectomy and antibiotic therapy for the treatment of uncomplicated acute appendicitis. Patients taking antibiotics who later underwent appendectomy were less satisfied than patients with successful antibiotics or appendectomy. Clinicaltrials.gov Identifier: NCT01022567.

Outpatient endometrial ablation: audit of outcomes and patient satisfaction

Endometrial ablation in outpatient setting is associated with shorter hospital stay and quicker recovery. The primary outcome of this observational study was initiation and completion of procedure and secondary outcome measures were pain during the procedure and complications. The study was conducted in outpatient women’s health clinic of Bolton Foundation NHS Trust UK, between March 2015 and July 2017. Out of 151 patients, all had oral analgesia at home. The procedure was initiated and completed in 83% cases. The median time for procedure was 78.5 s with range (34–120 s). The median intraoperative and immediate post-op pain score was 8 and 2, respectively. Post-procedure hysteroscopy confirmed intact cavity in all. Post-op analgesia was required in 2% cases. Eight-nine percent were discharged immediately, 10% had to be rested and observed for 30–60 min. None had serious complications. Ninety percent were satisfied with outpatient service and would recommend to friends and family.Impact StatementWhat is already known on this subject? Second-generation endometrial ablation is an effective first-line management option for heavy menstrual bleeding. Outpatient procedure is associated with shorter hospital stay, quicker recovery and avoids general anaesthesia and its complications.What do the results of this study add? This observational study confirmed that it was suitable to start the procedure in 83% cases. Once started, it was possible to complete in 100%. The most common cause for not being able to start the procedure was intolerability to the patients. The median immediate post-procedure pain score was 2 which was highly acceptable to patients. 90% of patients who underwent the outpatient endometrial ablation would choose to have further hysteroscopic procedures as outpatient.What are the implications of these findings for clinical practice and/or further research? Patients should be given choice for endometrial ablation either with or without general anaesthesia. Patients should be carefully selected for outpatient procedure taking into account informed consent, tolerability of speculum examination and endometrial pipelle biopsy as well as understanding anticipation of some discomfort. Further randomised controlled trials should be carried out to determine patient satisfaction with endometrial ablation with or without general anaesthesia.

Satisfaction and adherence with glatiramer acetate 40mg/mL TIW in RRMS after 12 months, and the effect of switching from 20mg/mL QD

BackgroundPatient satisfaction with treatment in relapsing-remitting multiple sclerosis (RRMS) has a direct impact on adherence to treatment and, consequently, upon treatment outcomes and costs. Patient-reported outcomes (PROs) are a common method for determining patient satisfaction in MS and other diseases. MethodsThe 12-month, open-label, Phase IV CONFIDENCE study assessed patient satisfaction and treatment adherence, using PROs, as well as safety outcomes in patients with RRMS treated with glatiramer acetate (GA). In the previously reported (Cutter et al., 2019) initial 6-month core phase of the study, patients were randomized to receive three-times-weekly (TIW) GA 40 mg/mL (GA40; n = 431) or once-daily GA 20 mg/mL (GA20; n = 430). In the 6-month, single-arm extension phase, 789 patients completing the core phase were treated with GA40 to determine whether benefits observed in the core phase were sustained during the extension phase, to ascertain if switching from GA20 to GA40 resulted in PRO changes, and to assess safety outcomes. ResultsSuperior PRO scores for patient satisfaction with treatment, patient perception of treatment convenience, and symptomatic changes (fatigue impact and mental health) observed in the GA40 group versus the GA20 group in the core phase were all maintained in the extension phase. Treatment adherence, significantly greater in the GA40 versus the GA20 group in the core phase, was sustained in patients continuing to receive GA40 in the extension phase, while those who switched from GA20 to GA40 increased their adherence during the extension phase. Safety variables remained consistent throughout the study, with no notable changes observed in patients switching from GA20 to GA40. ConclusionsData from the extension phase of the CONFIDENCE study show that the benefits associated with GA40 treatment in terms of medication satisfaction, treatment convenience perception, symptomatic changes in fatigue impact and mental health status, and treatment adherence were maintained over a 12-month observation period. These results confirm the preferential utility of GA40 versus GA20 in clinical practice, with no additional safety concerns associated with switching from GA20 to GA40.

Recall of consent information by day care prostate biopsy patients: An assessment of the role of a third-party check.

To evaluate the extent of recall of consent information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient's recall of consent information. As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third-party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher-administered questionnaire. Consecutive patients participated in this cross-sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). The use of a third-party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low-literacy settings. Using a third-party, in this manner, may assist in checking paternalism inherent in the patient-doctor relationship.

A new adhesive bone conduction hearing system as a treatment option for transient hearing loss after middle ear surgery.

The objective of this prospective, single-subject, repeated measures study was to evaluate the audiological benefit and patient satisfaction with an adhesive, pressure-free bone conduction hearing system (ADHEAR; MED-EL, Innsbruck, Austria) in patients who underwent middle ear surgery with transient hearing loss due to auditory canal tamponade. Eleven adult subjects suffering from transient conductive hearing loss were enrolled in the study and followed up to 3weeks after middle ear surgery. Bone and air conduction thresholds were measured pre and postoperatively to evaluate eligibility for enrollment. Postoperative unaided and aided sound-field thresholds, as well as speech tests in quiet and noise were compared to confirm hearing improvement with the hearing system. To determine patient satisfaction, the SSQ12 and a system-specific quality of life questionnaire was administered to all subjects. Speech perception for monosyllables in quiet improved by 46%, with statistical significance for the ADHEAR system compared to the unaided condition after one week. The functional hearing gain improved by 19dB. Speech perception in noise with the device was - 6.7dB SNR on average, with a statistically significant improvement of 2.7dB SNR. The results of the questionnaire showed a high level of patient satisfaction and subjective hearing improvement. No serious skin reactions or other severe complications occurred. As long as the auditory canal is blocked due to tamponade, patients benefit from hearing rehabilitation. This adhesive hearing system is a safe and effective device to treat transient conductive hearing loss and may considerably improve treatment for patients even with short-term hearing loss.

Factors associated with patient satisfaction with health care among Polish older people: results from the polish part of the COURAGE in Europe

ObjectivesThe growing number of chronic conditions and functional limitations resulting from demographic changes and the aging of the population poses several challenges for health care and public health. Consequently, it plays a role in the assessment of the impact of diagnostic and treatment effects on patient satisfaction. The study aims to assess older patients’ overall satisfaction with the medical care and healthcare system in Poland and to verify such factors as patient-doctor interactions, access to health care and other sociodemographic characteristics as possible determinants of patient satisfaction at the later stage of life. MethodsThe survey data represent the polish part of the cross-sectional COURAGE in Europe study. Satisfaction with hospital care, outpatient care, and the healthcare system in Poland was assessed. The indices for the psychosocial dimension of the patient-doctor relationships and access to hospital/outpatient care were developed based on patients’ experiences as the possibility of talking about private matters, the clarity of explanations, the involvement in decision-making process, being treated respectfully, the duration of waiting and the ease of access to a preferred doctor or other healthcare professional. The ordered probit regression models were used. ResultsThe psychosocial dimension of patient-doctor relationships was associated with the satisfaction with both hospital and outpatient care. Being treated with respect (very good experience vs. bad odds ratio [OR] = 8.1, 95% confidence interval [CI]: [1.9, 34.4]) and the possibility to talk about private matters with medical team (very good experience vs. bad OR = 3.5, 95% CI: [1.1, 10.4]) during the last stay in hospital were reflected in the higher satisfaction with the healthcare system. By contrast, the involvement of patients in the decision-making process (very good experience vs. bad OR = 3.6, 95% CI: [1.8, 6.7]) or access to outpatient health care (based on developed index OR = 1.02, 95% CI: [1.01, 1.02]) were found to be significant determinants of satisfaction with the healthcare system in Poland. Other factors associated with satisfaction with hospital stay were gender and changes in health conditions, whereas achieving the expected outcome was related to satisfaction with outpatient care, and the expenditure for medicines and medical services – to satisfaction with the heathcare system. ConclusionThe investigation confirms an important role of doctor-patient communication skills in improving older patient satisfaction and highlights the need for identifying the psychosocial dimension of patient-doctor relationships as an important part of health care.

Determining patient satisfaction with an upper and lower extremity orthotic intervention using the QUEST 2.0: A systematic review

BACKGROUND: People with musculoskeletal conditions or other physical disabilities can experience decreased performance due to impaired functional capacity, and orthotics are often prescribed to treat these patients. A common barrier for orthotic provision is patient adherence, further studies are w arranted to better understand the relevant causes of abandonment. OBJECTIVE: To identify patient-reported determinants of satisfaction with their orthotic device in studies that used the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0) to determine patients’ perspective regarding the device and the service provision. METHODS: The two authors carried out the review independently using three databases (PubMed, CINAHL, and Semantic Scholar) and various medical subject headings (MeSH). RESULTS: Nine total articles for the final systematic review. The QUEST 2.0 scores ranged from 3.7–4.53 for the device subscale, 3.7–4.71 for the service subscale, and 3.7–4.61 for the total score. The top three patient-reported items were effectiveness, comfort, and ease of use. The most common reasons for orthotic abandonment were pain, discomfort, wounds, or skin irritation. CONCLUSION: Clinicians should address the needs of the patient when it comes to orthotic interventions to decrease orthotic abandonment, improve functional outcomes, and promote patient-centered practice.

Evaluation of the design-driven prediction of removable partial denture retention

Statement of problemRemovable partial dentures (RPDs) are a cost-effective treatment designed to replace missing teeth for partially edentulous patients. However, RPDs often have insufficient retention, which results in treatment failure and patient dissatisfaction. PurposeThe purpose of this clinical study was to investigate the factors related to RPD retention that affect patient satisfaction, to clinically validate a newly published model for predicting RPD retention based on the number and position of missing teeth and clasps, and to identify the predictions of patient satisfaction to improve the guidelines for RPD design. Material and methodsSeventy-five patients treated with 107 RPDs delivered at the McGill University Dental Clinic (Montreal, Canada) and Estaing University Hospital (Clermont-Ferrand, France) participated in this study. Data on the RPD design were collected from the clinical records, and the retention of each RPD was tested with the mathematical model designed for predicting RPD retention. Data on patient satisfaction with their RPDs were collected by using a standardized questionnaire (McGill Denture Satisfaction Instrument). Statistical analysis of factors related to RPD retention and patient satisfaction was performed by using the chi-square test and Mann-Whitney test, while the developed model for predicting RPD retention was evaluated by using sensitivity and specificity analysis. ResultsThe average satisfaction score for all RPDs was 8.2 ±1.7 out of 10. Patients were more satisfied with RPDs in the maxillary arch, tooth-supported, or retained by ≥3 clasps than with RPDs in the mandibular arch, with distal extension bases, or retained by <3 clasps. The materials used for RPD fabrication (metal-based or acrylic resin-based), the number of missing teeth, and the presence of indirect retention were not associated with patient satisfaction. Participants were significantly more satisfied with RPD designs predicted by the developed mathematical model to have enough retention than with RPD designs predicted to have insufficient retention. The mathematical model for predicting the RPD retention showed a clinical specificity of 83% in predicting patient satisfaction. ConclusionsRPD retention predicted from the number and position of clasps and missing teeth might help to determine patient satisfaction. In addition, patient satisfaction with RPDs was influenced by the arch type, the presence of a distal extension base, and the number of clasps.

Management Strategies and Satisfaction Levels in Patients with Sickle Cell Disease: Interim Results from the International Sickle Cell World Assessment Survey (SWAY)

Management Strategies and Satisfaction Levels in Patients with Sickle Cell Disease: Interim Results from the International Sickle Cell World Assessment Survey (SWAY)

Predictors of patient satisfaction after reverse shoulder arthroplasty

The aims of this study were to determine patient satisfaction and to identify predictors of satisfaction after reverse shoulder arthroplasty (RSA). We hypothesized that the majority of patients would be satisfied after RSA and that patients with worse preoperative mental and physical health would be less satisfied. Satisfaction was assessed 2 years after primary RSA with domains for pain, work, activities, quality of life, and overall satisfaction. Preoperative and postoperative patient-reported factors were measured using the American Shoulder and Elbow Surgeons (ASES) shoulder score, Shoulder Activity Scalescore, Short Form 12 (SF-12) mental and physical component summary scores, and visual analog scale (VAS) pain, fatigue, and general health scores. Pearson correlations were used to determine the relationship between patient-reported factors and satisfaction. Multivariate regression was performed to control for potential confounding variables. A total of 161 patients were evaluated at 2 years postoperatively. Patients were "very satisfied" in an average of 3.3 of the 5 domains. Improvements in ASES, Shoulder Activity Scale, VAS pain, and SF-12 physical component summary scores were associated with higher satisfaction, with correlation coefficients ranging from 0.27 to 0.49. On multivariate analysis, patients with higher preoperative ASES scores were less satisfied after surgery (P = .005). In addition, patients with worse VAS fatigue (P = .011) and SF-12 mental (P = .034) and physical (0.011) component summary scores preoperatively had lower satisfaction. Improvements in pain and outcome scores are associated with increased satisfaction. Patients with higher shoulder function, worse physical health, and worse mental health prior to surgery are more likely to have lower satisfaction after RSA.

Patient Satisfaction with Physicians and Nurse Practitioners in Multiple Sclerosis Centers.

With the predicted shortage of neurologists, care of patients with multiple sclerosis (MS) may be affected. Nurse practitioners (NPs) have successfully filled the provider gaps in a variety of care settings, with positive effects on care outcomes, including patient satisfaction. The purpose of this study was to determine patient satisfaction with physicians (MDs) and NPs in MS centers. This is a cross-sectional pilot study wherein a convenience sample was recruited from two MS centers. Demographic data were collected previsit, and satisfaction surveys were completed postvisit using the Patient Satisfaction Questionnaire Short Form (PSQ-18) and the Visit-Specific Satisfaction Instrument (VSQ-9). Different attributes of satisfaction and visit times were analyzed. Patient satisfaction with both types of providers was high. All attributes of satisfaction were comparable for NPs and MDs, and they spent similar amounts of time with their patients, often exceeding the scheduled office visit duration. Encounter length was a strong determinant of patient satisfaction: VSQ-9 scores were significantly lower (P = .01) when duration was less than 20 minutes. Satisfaction was higher (P = .011) in patients who were diagnosed as having MS for 10 years or longer or had progressive MS, irrespective of provider type. This pilot study showed that use of standardized questionnaires to determine patient satisfaction with NPs and MDs was feasible. With the impending neurologist shortage and the increased MS prevalence, a collaborative team approach between NPs and MDs may improve access to care in MS centers without compromising patient satisfaction.

Acceptability of intravenous propofol sedation for adolescent dental care

PurposePropofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixed-method prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment.MethodsDemographics were recorded including age, gender, ASA Classification and Children’s Fear Survey Schedule—Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised.Results55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation.ConclusionPropofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.

Hallux Valgus Correction Using a Novel 3D Printed Plate: Retrospective Case Series with Two Year Follow-Up Data: Surgical Technique Guide and Outcomes

Category:BunionIntroduction/Purpose:Over 130 techniques have been described for the treatment of hallux valgus, ranging from bunionectomies, osteotomies, and arthrodesis. Modern attempts at bunion correction with less invasive joint sparing approaches, such as suture-button techniques, have introduced additional complications like second metatarsal fracture. Suture fixation techniques have evolved in an attempt to avoid these complications. We present our results, with up to 26 months of radiographic follow up including initial correction and complications, with a novel device which utilizes a 3D printed titanium plate on the lateral cortex of the second metatarsal without bony violation, and reduces the 1-2 intermetatarsal angle using suture tape passed through drill holes in the first metatarsal with PEEK interference screw fixation.Methods:This study includes 33 feet in 31 patients. A single board certified and fellowship trained orthopedic foot and ankle surgeon performed all operations over the course of 18 months at a single institution. He utilized a dual incision approach and followed previously described surgical technique for the application of the device. We retrospectively reviewed radiographs including pre-operative AP, lateral, and oblique images, along with another set at the two and six week post operative periods, and another at the last available follow up visit. Using standard technique we measured the 1-2 intermetatarsal angle (IMA), as well as the hallux valgus angle (HVA), which were used as the primary outcomes. Chart review was performed to determine patient satisfaction with the outcome. All secondary procedures and complications were recorded based on the chart review and radiographs.Results:Average radiographic follow up was 15 months. The average initial HVA was 31.4º and IMA was 16.0º. Two-week average HVA was 11.3º and IMA was 7.1º. At six weeks, weight-bearing radiographs showed an average HVA 14.5º and IMA 8.2º. Final radiographic measurements, accounting for either the latest available image or the final image prior to revision, showed average HVA of 24.3º and IMA of 13.7º. Six patients had revision for recurrence or fracture. One underwent removal of symptomatic hardware. Seventeen patients had at least mild radiographic recurrence, without revision. Two patients had an intraoperative fracture of the first metatarsal, and one had an intraoperative fracture of the second metatarsal shaft. There were no infections or wound healing issues.Conclusion:Although this device allows a minimally invasive hallux valgus correction, and provides a powerful initial correction with little bony manipulation, results presented in this study suggest a high rate of radiographic recurrence, and relatively high rates of intra-operative complication, post-operative complication, and revision surgery. We found that more severe deformity had a higher rate of recurrence, suggesting it may be more beneficial in mild deformity, but even in many of these patients we found recurrence and other complications. As a result, this technique has since been abandoned at our local institution with the last procedure being performed in 2016.

Patient satisfaction in hospital emergency services: A perspective from the Portugal.

This research paper constructs and validates a conceptual model that identifies the determinants of patient satisfaction with hospital emergency services. The conceptual model is based on an extensive review of the literature on the subject and was validated by 400 interviews in four Portuguese NHS hospital emergency services. Analysis of the data revealed that there are five statistically significant variables that influence satisfaction, whereas satisfaction itself influences the loyalty dimension of the model. Although the sample was diverse and a significant number of patients were interviewed, the study only involved NHS users from one specific region of the country. Nevertheless, it proved possible to use the model to draw several managerial implications and these were analysed for ways in which patient satisfaction with the service could be improved.

Patient Satisfaction with Health Care Services; An Application of Physician's Behavior as a Moderator.

Patient satisfaction is a measure of the extent to which a patient is content with the health care they received from their health care provider. Patient satisfaction is one of the most important factors to determine the success of a health care facility. The purpose of this study was to determine patient satisfaction with healthcare services and encompass the physician’s behavior as moderation between patient satisfaction and healthcare services. The study seeks to measure the health care services, like a laboratory and diagnostic care, preventive healthcare and prenatal care, to patient satisfaction in the public health sectors of Pakistan. A descriptive survey research design was used for this study. The target population was patients from the out-patient department (OPD) of three public hospitals from Pakistan. By using the convenient sampling technique, 290 sample participants were selected from the target population. The reliability scales were tallied by using Cronbach’s Alpha. The findings of the study are gleaned by using regression to explore patient satisfaction with the health care services, and whether or not the physician’s behavior moderates the link of patient satisfaction and healthcare services. SPSS Hayes process was used for the moderation effect of the physician’s behavior. The main results of the regression analysis validate that health care services, such as laboratory and diagnostic care, preventive healthcare, and prenatal care, have a significant and positive effect on patient satisfaction. Specifically, the study suggests that the physician’s behavior significantly moderates the effect of health care services on the satisfaction of patients. The overall opinions about the satisfaction level of patients for the availability of health services in the hospitals were good. The degree of satisfaction was satisfactory with respect to laboratory and diagnostic care, preventive healthcare, and prenatal care services. Based on the outcomes, the study confirms that the proposed hypotheses are statistically significant. Furthermore, the directions for future research of the study are offered.

Work Related Open Globe Injury

Traumatic open globe injuries are a leading cause of blindness/visual impairment in the world. A significant number of reported open globe injuries occur at the workplace and have been historically associated with non-compliance with workplace safety guidelines and not wearing eye related personal protective equipment (PPE). In this case report, we describe a 27-year-old man’s workplace related open globe injury despite wearing PPE. We explore the prognostic factors in determining final visual acuity and do a literature review of case reports with good outcomes despite poor initial prognostication in severe open globe injuries. The option of enucleation and its common indications are discussed. We also examine the factors determining patient satisfaction with ocular prosthesis along with an assessment of the role of PPEs in workplace related ocular trauma.

P78. The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice

BACKGROUND CONTEXT Most clinics collect routine data on performance metrics on physicians for outpatient visits. However, the relationship between them and the patient experience is vague. PURPOSE The aim of this study was to investigate the relationships between the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS), the current standard evaluation of the patient experience, and new performance metrics we collected in order to understand the determinants of patient satisfaction and identify targets for improving the patient experience. STUDY DESIGN/SETTING Retrospective cohort study, single academic health system. OUTCOME MEASURES CG-CAHPS scores in 3 domains – global, access and communication. METHODS All spine surgeons in our academic health system were included and the following were retrospectively reviewed from a 15-month period: demographic data, average cycle times (time in minutes from check-in to check-out), waiting-room times (check-in to being roomed), in-room times (room placement to check-out), lead times (time in days from scheduling phone call to appointment), timely note closure, timely response to patient questions and patient volume (number of new and total patients per month). Kruskal Wallis tests and univariate and multivariate mixed model regression were used to determine the relationships between these covariates and the patient-reported outcomes as measured by CG-CAHPS in 3 domains – global, access and communication. RESULTS Twenty-two surgeons were included in the study. There were 27,090 visits. Male gender and no fellowship were independently associated with higher satisfaction in global ratings (p CONCLUSIONS Excessive waiting room time affects not only access scores but also significantly colors other dimensions of the patient experience and impacts perceived communication between patients and doctors. Understanding the complex relationship between the factors that inform the patient experience will help to target effective interventions to improve clinic efficiency and patient satisfaction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.