Patient Dissatisfaction Research Articles

Factors influencing outcome satisfaction after cataract surgery: patient-reported insights from the RayPro database

BackgroundPatient-reported outcome measures (PROMs) have become crucial in assessing cataract surgery, especially with increasing patient expectations. The RayPro database offers a platform for tracking PROMs after surgery. The purpose of this study is to investigate determinants of patient satisfaction following cataract surgery by analysing PROMs.MethodsA multicentre, retrospective, observational study was conducted analysing the PROMs recorded in the RayPro database (Rayner, Worthing, UK) from May 2019 to February 2024. Inclusion criteria were age ≥ 18 years, uneventful cataract surgery, valid consent to the study, and at least 1 questionnaire response. Email questionnaires were sent at 1 week, 3 months, and 12 months postoperatively, in which patients scored their outcome satisfaction, surgeon and hospital satisfaction, spectacle independence, and dysphotopsia on a 0–10 scale. Correlations of PROMs with outcome satisfaction were determined for the overall cohort and for eyes categorized by type of implanted intraocular lens (IOL).Results2589 patients (2589 eyes) from 119 hospitals (26 countries) were included. Outcome satisfaction showed strong to moderate negative correlation with daytime and nighttime dysphotopsia at 3 months (r=-0.522, p < 0.001; r=-0.430; p < 0.001, respectively), strengthening at 12 months (r=-0.609, p < 0.001; r=-0.541; p < 0.001, respectively). Outcome satisfaction showed weak to no correlation with spectacle independence for distance, intermediate, and near vision at 3 months (r = 0.209, p < 0.001; r = 0.160, p < 0.001; r = 0.071, p = 0.007, respectively). Similar correlations between outcome satisfaction and dysphotopsia and between outcome satisfaction and spectacle independence were observed in monofocal as well as presbyopia-correcting IOLs. In the overall cohort, surgeon and hospital satisfaction at 1 week were strongly correlated with each other (r = 0.592, p < 0.001), while both were moderately correlated with outcome satisfaction at 3 months (r = 0.344, p < 0.001; r = 0.339, p < 0.001, respectively) and 12 months (r = 0.307, p < 0.001; r = 0.314; p < 0.001, respectively).ConclusionDysphotopsia was strongly correlated with patient dissatisfaction, and the correlation strengthened over time. Outcome satisfaction was weakly correlated with spectacle independence, and moderately correlated with surgeon and hospital satisfaction. Thus, postoperative visual quality and quality of care provided by surgeon and hospital can influence patient satisfaction.

Why Cosmetic Surgery is Prevalent in Korea: A Perspective Grounded in Basic Values.

The aim of this review is to explore the reasons behind the prevalence of cosmetic surgery in Korea from the viewpoint of "basic values." In societies characterized by high levels of prejudice, the hierarchy of values from highest to lowest is as follows: (1) political, (2) economic, (3) religious, (4) social, (5) theoretical, and (6) aesthetic. Conversely, in societies with low levels of prejudice, the ranking of values from highest to lowest is: (1) aesthetic, (2) social, (3) religious, (4) theoretical, (5) economic, and (6) political. In mature societies, higher levels of stability, cultural development, emphasis on quality of life, and greater tolerance and openness drive the appreciation of aesthetic values. As Korea's economy has developed and basic needs have been met, there has been an increasing emphasis on aesthetic values, including beauty standards and self-presentation. This trend is evident in the flourishing Korean beauty industries (K-beauty). There is a growing societal focus on physical appearance, fashion, and plastic surgery, which has become normalized in certain aspects of Korean culture. Rapid modernization, shifting social norms, competitive pressures, and evolving interpretations of traditional values have normalized and even popularized cosmetic surgery in Korean society. The combination of cultural expectations, advanced medical care, and social factors has positioned South Korea as a world leader in cosmetic surgery, despite its relatively small population. To keep pace with the rapidly evolving aesthetic values of Korean society, plastic surgeons must align with contemporary beauty standards, thoroughly understand surgical anatomy, and strive to minimize patient dissatisfaction.

Incidence of dysphotopsia following uneventful cataract surgery [phacoemulsification] in patients implanted with different types of monofocal intraocular lenses

Background and objectives: Pseudophakic dysphotopsia is one of the major causes of patient dissatisfaction after cataract surgery. Our aim was to assess the incidence of dysphotopsia after phacoemulsification with implantation of three types of monofocal intraocular lenses. Methods: This prospective clinical study which contained 200 eyes from 195 patients was done at Dr. Aso eye hospital in Sulaimania city between June 2022 to June 2023. Those 200 eyes (participants) were divided into three different groups according to their IOL types were followed-up for 6 months to estimate the incidence and symptoms of dysphotopsia. Results: overall incidence of dysphotopsia was (22%). 34 cases (17%) reported their symptoms in the first three weeks of follow-up. This figure decreased to (4% and 1%) after 3 and 6 months, respectively. The most common phenomenon noted was temporal shadow/darkness; declared by 34.09% of patients who reported dysphotopsia. Optical phenomena occurred more frequently in patients with Acryfold lens group. The great majority of the patients (94.5%) were satisfied with their post-operative visual function. Both, overall incidence of dysphotopsia and its higher rate in the 1st group (Acryfold) were statistically significant values (p= 0.0399 and 0.0418), respectively. Conversely, there was no statistically significant difference between Rayner and Acrysof lenses in terms of dysphotopsia occurrence (p-value= 0.053). Conclusion: Although monofocal intraocular lenses showed significant rates of dysphotopsia, they were still associated with high patient satisfaction level because majority of the symptoms were mild and went away with time.

Repeat surgeries using anterior abdominal wall flaps after single-stage breast reconstruction (literature review)

Immediate breast reconstruction using endoprostheses is the most commonly performed reconstructive breast procedure in both the UK, USA and Russia, reaching 80% of all types of reconstruction. Tertiary reconstruction after previous breast surgeries may be required in case of complications of failed breast reconstruction or recurrence of disease. In foreign literature, the term tertiary reconstruction is commonly used for repeat reconstructive surgery. A literature review was conducted using the keywords: “одномоментная реконструкция молочной железы”, “reoperation in breast reconstruction”, “secondary reconstruction after immediate breast reconstruction”, “tertiary reconstruction with autologous tissue”.It has been established that repeated operations using anterior abdominal wall flaps after one-stage breast reconstruction have a good healing outcome and satisfy the aesthetic needs of patients.Conclusion. Tertiary reconstruction after a long period of implant placement is motivated by undesirable symptoms (breast pain, psychological discomfort), cosmetic dissatisfaction of patients, late infections, development of cancer of the contralateral breast or recurrence of the disease on the side of reconstruction.

Research

The December 2024 Research Roundup360 looks at: Skeletal muscle composition, power, and mitochondrial energetics in older men and women with knee osteoarthritis; Machine-learning models to predict osteonecrosis in patients with femoral neck fractures undergoing internal fixation; Aetiology of patient dissatisfaction following primary total knee arthroplasty in the era of robotic-assisted technology; Efficacy and safety of commonly used thromboprophylaxis agents following hip and knee arthroplasty; The COVID-19 effect continues; Nickel allergy in knee arthroplasty: does self-reported sensitivity affect outcomes?; Tranexamic acid use and joint infection risk in total hip and knee arthroplasty.

The impact of dentofacial characteristics and malocclusions on dissatisfaction with dentofacial appearance.

To assess how, and to what extent, dentofacial features and malocclusions affect the perceived dissatisfaction with the appearance of dentofacial region in different age groups. Dissatisfaction with dental appearance (DDA) and facial appearance (DFA) of 430 patients were assessed using self-reported 5-point Likert scores (1: very satisfied - 5:very dissatisfied). Number of decayed, filled, and missing teeth, oral hygiene status, crowding in the upper/lower arches, molar relationship, overjet, overbite, posterior-crossbite, upper/lower midline deviations, face type, profile, nasal tip and chin deviations were assessed by an experienced orthodontist. Ordinal logistic regression analysis was performed to determine how the examined variables affected DDA and DFA scores. The median age of the 430 patients (271 female, 159 male) was 23.0 years. 60.9% of the patients had Angle Class I, 32.3% had Angle Class II, and 6.7% had Angle Class III molar relationship. According to the IOTN (DC), 37.4% of the patients had grade 4 and grade 5. Gender had no impact on DDA and DFA. Being young (teenagers OR = 4.78, CI:2.43-9.40, young adults (OR = 3.15, CI: 1.70-5.83), having poor oral hygiene (OR = 2.32, CI: 1.37-3.92), missing teeth (OR = 1.19, CI:1.10-1.29), convex profile (OR = 1.94, CI:1.03-3.67), diastema (OR = 3.18, CI:1.33-7.61), crowding in the upper arch (moderate: OR = 2.10, CI:1.30-3.68, severe: OR = 5.94, CI:3.15-11.19) affected the DDA scores negatively. Class III malocclusion (OR = 5.60, CI:1.85-16.91), decreased overbite (OR = 2.44, CI:1.21-4.89), and increase in DDA scores (OR = 1.88, CI: 1.50-2.35) all increased the DFA scores. Certain dentofacial characteristics and age of the patients significantly affect self-reported dissatisfaction with dental and facial appearance levels, with varying degrees of severity. Awareness of the impacts of malocclusions and dentofacial features that result in patient dissatisfaction among those who apply for dental treatment at the clinic enables a deeper understanding of the patient's priorities, expectations from orthodontic treatment, and satisfaction with the outcome.

Association between distal tibial rotation and clinical outcomes of medial open-wedge high tibial osteotomy

BackgroundThe purpose of this study was to evaluate the association between changes in knee joint geometry after medial open-wedge high tibial osteotomy (MOWHTO) and clinical outcomes. MethodsThis was a retrospective study of patients who underwent MOWHTO (101 knees) at our hospital between January 2015 and February 2022 and who were followed up for > 2 years. Radiological and functional outcomes were compared between those who were satisfied with surgery (satisfaction group) and patients who were dissatisfied with surgery (dissatisfaction group). Multiple regression analysis was performed to analyze factors affecting the radiological parameters that significantly differed between the two groups. ResultsThe average follow up period was 38.0 ± 15.4 months. There were no significant differences regarding demographic characteristics and preoperative radiological parameters between the satisfaction and dissatisfaction groups. There was a significant intergroup difference with respect to postoperative distal tibial rotation and change in distal tibial rotation (13.5 ± 4.8° and 9.5 ± 4.3°, respectively; P < 0.001). The difference in tibial rotation before and after surgery was 4.3 ± 2.3° and 1.7 ± 1.8° in the dissatisfaction and satisfaction groups (P < 0.001) Multiple regression analysis showed that the correction angle affected the distal tibial rotation in MOWHTO (R2 = 0.079, ß = 0.165, P = 0.038). ConclusionsIn MOWHTO, an increase in distal tibial rotation was associated with patient dissatisfaction. Because the increase in distal tibial rotation is associated with a large correction angle, excessive distal tibial rotation should be avoided when MOWHTO requires a large correction angle.

Comparing commercial pharmacogenetic testing results and recommendations for antidepressants with established CPIC guidelines.

Increasingly, pharmacogenetic testing helps providers with medication selection based upon patient-specific DNA results. While several government-funded organizations work towards consensus and standardization for testing and interpretation, compliance to these best practices remains inconsistent. Pharmacogenetic testing companies often develop proprietary practices for interpreting and reporting, which can lead to incongruency of reported results among companies and potential discrepancies in interpretation. To identify the differences of commercial pharmacogenetic testing vendors' interpretation of genotype-to-phenotype translations and medication recommendations from the Clinical Pharmacogenetic Implementation Consortium (CPIC) guidelines, a retrospective manual chart review was completed in a large rural healthcare system that utilizes two institution-approved pharmacogenetic vendors. One hundred patients were evaluated: 50 who completed testing through Company A and 50 who completed testing through Company B. Genes of interest for genotype-to-phenotype translation included CYP2B6, CYP2C19, and CYP2D6. Comparison of medication recommendations for drug-gene pairs sertraline (CYP2B6 and/or CYP2C19), escitalopram (CYP2C19), and paroxetine (CYP2D6) were compared with recommendations from CPIC, with consideration of the CPIC Serotonin Reuptake Inhibitor Antidepressants (SSRI) guideline 2023 update. This was accomplished via a novel binning process to enable comparison of company-provided binned medication recommendations with CPIC guideline recommendations. Briefly, the binning system included three categorizations based upon the relevant CPIC guideline recommendations-no action needed (green), recommend monitoring (yellow) and therapeutic intervention or alternative recommended (red). There were 32/250 (12.8%) genotype-to-phenotype translation discrepancies from CPIC guidelines, all from Company A. Of 266 evaluated binned medication recommendations, there were 114 (42.9%) discrepancies between the pharmacogenetic testing companies (Company A: 93 discrepancies, Company B: 21 discrepancies) and CPIC's guideline based upon comparison with the novel binning system. Significant differences were observed between testing companies' interpretations and recommendations, which is concerning as these discrepancies could lead to providers making medication decisions that are not supported by CPIC's clinical practice guidelines. This may result in suboptimal outcomes for patients, leading to patient and provider dissatisfaction and erosion of trust with pharmacogenetic testing. A proposed resolution for the discrepancies in company-to-company interpretation is adherence to the CPIC guidelines and transparency in interpretation practices.

Dentists' knowledge, attitude and practice towards silver diamine fluoride therapy in Hong Kong: a mixed-method study.

This study explored the knowledge, attitude, and practice towards silver diamine fluoride (SDF) therapy among dentists in Hong Kong. The quantitative component was an online closed-ended questionnaire survey through the Society of Preventive Dentistry of Hong Kong. The qualitative component involved individual in-depth interviews with selected dentists. Descriptive analysis was performed on the quantitative data, whereas thematic analysis was performed on the qualitative data. The quantitative study invited 173 dentists, and 86 completed the questionnaire survey (86/173; 50%). All respondents were familiar with SDF and 73 (73/86; 85%) used SDF. They agreed that SDF therapy was simple (84/86; 98%), non-invasive (84/86; 98%), timesaving (82/86; 96%), effective (81/86; 94%), and painless (79/86; 92%). However, they expressed concerns about SDF's unaesthetic staining (81/86; 94%) and used it for primary teeth (77/86; 89%). The qualitative study conducted 12 individual interviews. Dentists asserted that SDF therapy is an evidence-based practice for arresting caries, including root caries. They acknowledged SDF therapy is straightforward and cost-effective. It is particularly useful for children or people with disabilities and can be used in community service. They considered the application skills, close monitoring and maintaining good oral hygiene to be vital for the success of SDF therapy. However, they noted that black staining of the carious lesions could cause patient dissatisfaction. They suggested that a guideline is warranted for SDF use. Hong Kong dentists are aware of the indications, merits and limitations of SDF therapy. They use SDF therapy for caries control, especially for children, elderly and those with disabilities, and consider it cost-effective for community dental care.

Reviewing “Nil Per Os” Guidance for Clear Fluids in Children Before Anesthesia: Survey of the Pediatric Anesthesia Leadership Council

BACKGROUND: Several international pediatric anesthesia societies have endorsed a change in the traditional nil per os (NPO) cutoff of clear fluids (CF) from 2 hours to 1 hour. These recommendations were compiled from large-scale outcomes, gastric ultrasound, and quality improvement studies. The American Society of Anesthesiologists (ASA) recently published their updated guidelines. Despite the lack of prospective randomized studies with conclusive outcomes, several major children’s health systems in North America have already implemented or are modifying their institutional guidelines for CF. The objectives of this survey were to evaluate the current practices, changing trends, perceived benefits, and barriers in reducing the NPO times for CF in children presenting for anesthesia. METHODS: After approval from the Penn State University Institutional Review Board, an electronic survey of the Pediatric Anesthesia Leadership Council (PALC, consortium of Pediatric Anesthesiology Chairs and Division Chiefs across the United States) members was conducted by the Society for Pediatric Anesthesia Quality and Safety Committee (SPA-QS) NPO Clears Task Force between June 2023 and October 2023. Inclusion criteria were PALC membership and single response from each institution. RESULTS: A total of 88 member institutions were represented by the PALC group. The final response rate was 75 of 88 (85.2%) from across 33 states. Eighty-eight percent of the respondents belonged to a tertiary pediatric center, and 94.7% belonged to an academic setting. At the time of the survey, 8 out of 75 (10.6%) responding institutions followed 1-hour CF cutoff, 7 (9.3%) were in the process of changing to 1-hour and 60 (80%) followed a 2-hour cutoff. 55(73%) respondents actively encouraged CF up to the time they had to be NPO. 46.7% of the respondents reported significant issues (hypoglycemia, dehydration, difficulty in establishing intravenous access, patient and parental dissatisfaction) with prolonged fasting in children. The survey responses included multiple comments in favor of changing guidelines to 1 hour for CF in healthy young children. The overarching concern for implementation of 1-hour cutoff for CF was the potential medicolegal ramification of a policy change in the absence of an official statement from national professional societies. CONCLUSIONS: The survey demonstrates growing trends toward implementing the reduced NPO time for CF to 1 hour nationally. Based on the current ASA guidelines, the SPA-QS committee recommends close attention to NPO times and strongly encourages CF consumption up to the recommended cutoff time. It appears reasonable to follow a 1-hour cutoff for CF as deemed appropriate by the attending anesthesiologist or the institution.

Efficacy of levothyroxine monotherapy in achieving clinical euthyroidism and its impact on weight loss in women with hypothyroidism and obesity

In light of research indicating that normal TSH levels do not necessarily reflect clinical euthyroidism in hypothyroid patients, and given the patient dissatisfaction with levothyroxine (LT4) monotherapy, we evaluate the response to weight loss treatment in patients with obesity and primary hypothyroidism who are euthyroid under LT4 therapy, with a focus on weight and metabolic parameters. The retrospective study included 138 subjects with obesity (BMI ≥ 30 kg/m2), 69 women with hypothyroidism on levothyroxine, and 69 age- and BMI-matched women without thyroid disease. Secondary causes of obesity, medications that may affect thyroid functions and metabolic parameters, chronic and oncological disease, pregnancy, TSH outside the reference range, follow-up periods of less than one year, and bariatric surgery were the exclusion criteria. Patients’ characteristics and metabolic responses to weight reduction treatment consisting of calorie restriction, moderate exercise, and metformin if needed were evaluated. TSH and fT4 levels were higher, and fT3 and T3/T4 ratios were lower all within the reference ranges in hypothyroid women. They were less insulin resistant. Both patient’ groups experienced a significant decrease in body weight, BMI, and atherogenic index of plasma (AIP) during the follow-up (p = 0.001). Insulin resistance was not changed. The groups’ body weight, BMI, HOMA-IR, and AIP changes were similar at the end of the study (p = 0.876, p = 0.850, p = 0.555, p = 0.293). The results suggest that achieving euthyroid status via levothyroxine monotherapy in hypothyroid women leads to weight loss responses comparable to those in women with normal thyroid. This supports the effectiveness of current hypothyroidism treatment strategies, emphasizing TSH level normalization, in achieving clinical euthyroidism concerning weight loss outcomes.

From Detached Concern to Love: Reconsidering Physician-Patient Boundaries

Abstract Developing appropriate professional boundaries is part of becoming a mature clinician. Boundaries help physicians fulfill their duties in relationally complex and emotionally fraught situations. The concept of “detached concern” has been used to characterize physician-patient relationships in which physicians show empathy and concern while maintaining due emotional distance. However, if the default tendency of trainees and clinicians is toward detachment, then emphasis on professional boundaries may do less to promote proper detachment than to diminish human connections with patients, thereby leading to clinician disenchantment and patient dissatisfaction. The authors propose that the physician-patient relationship is better characterized by love—specifically the kind of ordered love described by the fourth- and fifth-century bishop and philosopher Augustine of Hippo. Augustine’s vision of love has influenced many social reformers through the centuries, including, notably, Martin Luther King Jr. Importantly, such love is consistent with safeguards for which professional boundaries in the clinical context are corollaries, including guarding against forms of compassion that interfere with reasonable judgment, acknowledging humans' finite capacity to love, and recognizing potential harms of disordered love. Against a horizon of love, however, such boundaries are transformed from walls that prevent human connection and concern to walls that create spaces for and encourage any human connection that does not hinder healing and the patient’s good. By shifting their emphasis from detached concern to love, medical educators can re-enchant medicine for trainees by encouraging the human connections that make the practice of medicine its own reward.

Pericapsular nerve group block reduces opioid use and pain after hip surgery: A systematic review and meta-analysis of randomized controlled trials.

While the pericapsular nerve group (PENG) block has become increasingly popular for managing pain after hip surgery, its efficacy remains controversial. We systematically searched Pubmed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials to assess current evidence about the efficacy of the PENG block. Patients who received PENG block were compared to those who received sham/no block in terms of opioid consumption and pain within 24h after surgery, time to first opioid requirement, functional recovery, risk of nausea and vomiting, and patient dissatisfaction. The quality of evidence was assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system. We meta-analyzed six trials involving 416 patients who received preoperative PENG block and 415 who received sham/no block. Patients did not receive any other type of multimodal analgesia. Within 24 h after hip surgery, PENG block significantly reduced postoperative opioid consumption (MD = -12.03, 95% CI: -21.47 to -2.59, P < 0.01, I2 = 97%), particularly in subpopulations undergoing hip replacement, hip fracture, or who had spinal anesthesia, and it significantly decreased dynamic pain scores, but not static scores, without increasing risk of nausea or vomiting or patient dissatisfaction. Individual studies suggested that the PENG block can prolong the time to the first opioid requirement and can improve functional recovery. Most meta-analyses provided evidence of moderate quality according to the GRADE system. The available evidence indicates that preoperative PENG block can significantly decrease opioid consumption and pain early after hip surgery, and it may also promote early functional rehabilitation. However, the limited number of included studies and sample size make it difficult to draw firm conclusions. The decision on whether to apply the PENG block should take into account the patient's age and the type of surgery and anesthesia.

NURSES’ EXPERIENCE OF BURNOUT SYNDROME WHILE WORKING IN ONCOLOGY DEPARTMENTS

When experiencing burnout, the emotional and physical health of nurses deteriorates, the quality of work decrea­ses, and patient dissatisfaction increases. Nurses working in oncology units, due to the nature of their specialty, face those with a cancer diagnosis, which causes a lot of fear and uncertainty. The aim of the study is to reveal the burnout experienced by nurses working in oncology departments. The Copenhagen Burnout Questionnaire was used to implement the quantitative study. The results of the study revealed that nurses working in oncology departments had the strongest personal and work-rela­ted burnout. The most common factors leading to bur­nout were lack of feedback from patients and decreased energy. The relationships between demographic indica­tors and burnout components were used to analyze the research results. Methodology. Analysis of scientific literature; question­naire; descriptive analysis of research data using IBM SPSS 22.0 computer program statistics package and MS Excel 2021 computer program. After analyzing the scien­tific literature, a descriptive quantitative research met­hod was chosen for the research. A questionnaire survey aimed at analyzing the burnout experienced by nurses working in oncology departments. The research was con­ducted in October-November 2023, the respondents were nurses working in the city of Klaipeda (Lithuania). Re­search object: burnout experienced by nurses working in oncology departments. The questionnaire survey was created on the website online. The survey instrument consists of demographic indicators and the “Copenhagen Burnout Questionnaire”. The sample consisted of 143 respondents. Selection criteria: age, seniority, education, marital status, distribution of working time, workload and workplace. Respondents were selected by convenient non-probability sampling, respondents could choose the right place and time when answering questionnaire qu­estions, because the survey was conducted online, and the duration of the survey was not limited. Conclusions. after examining the manifestation of bur­nout syndrome, it became clear that nurses with personal burnout usually experience frequent fatigue and emotio­nal exhaustion. Burnout caused by work was most stron­gly related to emotionally exhausting work and fatigue at the end of the working day, and burnout caused by work with patients was most strongly determined by decrea­sed energy due to work with patients, lack of feedback from patients. The least burnout caused by working with patients was caused by irritation while working with pa­tients and difficult work with patients.

A Complete Functional Characterization of Patients with Severe Knee Osteoarthritis in Need of Total Knee Replacement.

The current literature lacks objective criteria to correctly identify patients in need of a total knee replacement. Surgery indication can be challenging for orthopedic surgeons, which may lead to high levels of patient dissatisfaction. The objective of this study is to describe a complete set of functional characteristics to identify patients with end-stage knee osteoarthritis in need of a total knee replacement, correlating data from strength and performance tests with pain, function, and quality of life questionnaires. This was a cross-sectional study evaluating patients with end-stage knee osteoarthritis in a waiting list for total knee replacement at a University Hospital. The patients responded to subjective self-reported questionnaires and performance-based functional tests. Anthropometric data were also collected. The main outcome measures were Western Ontario and McMaster Universities Index (WOMAC), visual analog scale (VAS), Short Form-36, knee range of motion, thigh perimeter measurement, maximum voluntary isometric contraction, and 6-min walk test. We analyzed 122 patients (89 female). The functional profile of patients with severe knee osteoarthritis awaiting total knee replacement was described. Quadriceps strength (extensor torque) had a negative correlation with WOMAC (r = -0.3102; p < 0.05), VAS (r = -0.3247; p < 0.05), and a positive correlation with SF-36 Functional Capacity subscale (r = 0.321; p < 0.05). Poorer performance in the 6 min walk test also correlated with worse scores in the WOMAC (r = -0.35; p < 0.05), VAS (r = -0.48; p < 0.05) and SF-36. The present article established a functional profile of patients with severe knee osteoarthritis with indication for total knee replacement, which may help orthopedic surgeons in their decision process. We also identified quadriceps strength and a 6 min walk test as the two most important functional parameters that correlate with knee osteoarthritis severity.

Enhancing patient understanding in obstetrics: The role of generative AI in simplifying informed consent for labor induction with oxytocin.

Informed consent is a cornerstone of ethical medical practice, particularly in obstetrics where procedures like labor induction carry significant risks and require clear patient understanding. Despite legal mandates for patient materials to be accessible, many consent forms remain too complex, resulting in patient confusion and dissatisfaction. This study explores the use of Generative Artificial Intelligence (GAI) to simplify informed consent for labor induction with oxytocin, ensuring content is both medically accurate and comprehensible at an 8th-grade readability level. GAI-generated consent forms streamline the process, automatically tailoring content to meet readability standards while retaining essential details such as the procedure's nature, risks, benefits, and alternatives. Through iterative prompts and expert refinement, the AI produces clear, patient-friendly language that bridges the gap between medical jargon and patient comprehension. Flesch Reading Ease scores show improved readability, meeting recommended levels for health literacy. GAI has the potential to revolutionize healthcare communication by enhancing patient understanding, promoting shared decision-making, and improving satisfaction with the consent process. However, human oversight remains critical to ensure that AI-generated content adheres to legal and ethical standards. This case study demonstrates that GAI can be an effective tool in creating accessible, standardized, yet personalized consent documents, contributing to better-informed patients and potentially reducing malpractice claims.

Addressing Patient Concerns at the University of Michigan Dental School

Effective communication between patients and dental providers is crucial for successful dental appointments, fostering trust and comfort. However, patients often carry unspoken concerns into dental clinics that significantly influence their experiences. The dental profession needs a standardized approach to record and address these concerns, leading to inconsistencies in how patient feedback is collected and acted upon. This can result in unresolved issues and patient dissatisfaction. Recognizing this problem, the University of Michigan School of Dentistry thought to improve how patient concerns are documented and addressed.

Litigation Following Surgery for Acute Traumatic Facial Injuries.

The knowledge of malpractice claims after surgery for acute traumatic facial injuries can inform surgeons about potentiallitigation risks, case complications, and reasons for patient dissatisfaction. The Westlaw Campus Research and LexisNexis legal databases were searched for all available court decisions associated with cases brought to suit following surgery for traumatic facial injuries. The plaintiff characteristics, date, location, specialty of the defendant, allegations, and adjudicated case outcomes were obtained from case documents and analyzed. There were 27 relevant judicial cases included between 1985 and 2023. The cases were tried in 16 different states, with New York having the greatest number of cases (25.9%). About half of the plaintiffs were male (51.9%), but the age was unknown in 55.6% of cases, while 29.6% were >18 years oldand 14.8% were pediatric patients. The most common method of injury was a motor vehicle accident (44.4%), followed by assault (14.8%). Otolaryngologists were cited in 22.2% of cases, while 33.3% of cases involved a plastic surgeon. The most common reasons for negligence were malocclusion resulting from a fracture (nine cases, 33.3%) and poor post-operative management (six cases, 22.2%). Twelve (44.4%) adjudicated cases were decided in favor of the surgeon. The most common reasons for litigation following acute traumatic facial injuries were malocclusion and issues during post-operative management, such as surgical site infections. The majority of cases identified and analyzed in this study were adjudicated in favor of the patient.

Beyond Empathy: Examining the Complexities of Outpatient Satisfaction in a Resource-Constrained Setting

Patient satisfaction is a critical indicator of healthcare quality, particularly in resource-constrained settings where efficient and effective care is paramount. This study aimed to explore the multifaceted nature of outpatient satisfaction at a private Indonesian hospital, moving beyond the traditional focus on empathy to understand the interplay of various service quality dimensions. A mixed-methods sequential explanatory design was employed. The quantitative phase involved a survey of 400 outpatients, measuring their satisfaction with five service quality dimensions: tangibles, reliability, responsiveness, empathy, and assurance. Data were analyzed using descriptive statistics, Importance-Performance Analysis (IPA), and gap analysis (suitability index). The qualitative phase utilized in-depth interviews and focus group discussions with patients, staff, and management to provide context and depth to the quantitative findings. While overall patient satisfaction was 82.9%, a gap analysis revealed substantial discrepancies between patient expectations and perceptions across several service quality dimensions. Tangibles, reliability, and responsiveness emerged as key areas requiring improvement. Qualitative findings highlighted extended wait times, inconsistent staff communication, and concerns about the physical environment as significant contributors to patient dissatisfaction. Achieving high levels of patient satisfaction in resource-constrained environments necessitates a comprehensive approach that addresses systemic inefficiencies and communication gaps alongside interpersonal factors like empathy. These findings underscore the need for targeted interventions to optimize resource allocation, streamline processes, and enhance staff communication skills to improve the patient experience.

Evaluation of a novel robotic testing method for stability and kinematics of total knee arthroplasty.

This work developed a novel preclinical test of total knee replacements (TKRs) in order to explain TKR instability linked to patient dissatisfaction. It was hypothesized that stability tests on the isolated moving prostheses would provide novel comparative data on the stability and kinematics among TKR designs. Three TKR designs, DePuy Synthes Attune MS, Stryker Triathlon and Zimmer Biomet Persona MC, were assessed using a robotic arm while flexing-extending 0-140°. Tests imposed 710 N body weight combined with three tibial loads: no anterior-posterior (AP) force, 90 N anterior or 90 N posterior force. Other load effects were minimized and the kinematics was recorded. Each implant was tested six times to investigate the repeatability of the method. Data were analysed using statistical parametric mapping with one-way analysis of variance (ANOVA). If significance was found (p < 0.05), post hoc t tests with Bonferroni correction were used to contrast groups. Significant differences were found throughout flexion-extension. Femoral rollback, AP stability, coupled internal-external rotation and AP position (roll-back) were all influenced by implant design. AP stability of the TKRs reduced with flexion reaching Attune 15 mm, Persona 13 mm and Triathlon 21 mm at 140° flexion. Tractive rolling significantly affected kinematics in the less congruent Triathlon design, with 6 mm different paths between flexion and extension motion (p < 0.05 across 5-100°). Paradoxical anterior femoral sliding in early flexion (0-40°) occurred in Persona and Triathlon designs. The novel testing technique provides, for the first time, comparative data on the inherent stability and kinematics of the TKR implants themselves across the arc of flexion-extension, independent of variables including soft tissue behaviour and surgical technique. The data show how much each prosthesis can contribute to the stability and motion of the implanted knee. Similar data from a wider range of designs will enable more informed decisions regarding implant design choice, aiming to reduce the prevalence of TKR instability in patients. Controlled laboratory study.