Enhance Patient Satisfaction Research Articles

Introduction of a Surgical Navigator in the Perioperative Process Improves Patient Satisfaction

Background:Patients who had received surgical services at Bellin Hospital reported anxiety with the surgical flow. This study tested the hypothesis that the introduction of a surgical navigator, someone who guided the patient and their accompanying others throughout the surgical process, would improve patient satisfaction.Methods:Ambulatory surgical patients were randomized to control and study groups. The study group patients were assigned a surgical navigator. Prior to discharge from the hospital, patients were asked to complete a patient satisfaction survey.Results:The study group had significantly higher mean scores (P value ≤ 0.026), top box scores (P value ≤ 0.021), and positive comments.Conclusion:The addition of a surgical navigator to the perioperative process significantly enhanced patient satisfaction in ambulatory surgical patients.

Predictors of Patient Satisfaction With Quality of Healthcare in University Hospitals in Ghana

Background: For over 2 decades, Ghana’s Ministry of Health (MOH) has been resolved to continuously improve the quality of healthcare in a cost-effective manner. Strategies have been adopted to enhance client satisfaction with healthcare services and delivery.Objective: The current study examined patient satisfaction with the quality of healthcare in Ghana by comparing healthcare services at the University of Ghana Hospital (UGH) and the University of Cape Coast Hospital (UCH).Methods: This cross-sectional study was conducted in 2014-2015 with primary data collected from patients at UGH and UCH. Structured questionnaires were administered based on the stratified and convenience sampling methods to select patients receiving healthcare at the outpatients departments of the 2 hospitals. Descriptive statistics and linear regression analysis were used to analyze the data with the help of SPSS version 20.Results: The findings indicated that empathy (β=0.14, P=0.003), communication (β=0.26, P=0.00), culture (β=0.17, P=0.008), tangibles (β=0.12, P=0.040), and priority (β=0.18, P=0.002) are significant predictors of patient satisfaction.Conclusion: Management at the 2 studied hospitals should streamline their quality healthcare policies based on the dimensions of effective communication, empathy, culture, tangibles, and priority to enhance patient satisfaction.

Scheduling Optimization of Home Health Care Service Considering Patients’ Priorities and Time Windows

As a new service model, home health care can provide effective health care by adopting door-to-door service. The reasonable arrangements for nurses and their routes not only can reduce medical expenses, but also can enhance patient satisfaction. This research focuses on the home health care scheduling optimization problem with known demands and service capabilities. Aimed at minimizing the total cost, an integer programming model was built in this study, which took both the priorities of patients and constraints of time windows into consideration. The genetic algorithm with local search was used to solve the proposed model. Finally, a case study of Shanghai, China, was conducted for the empirical analysis. The comparison results verify the effectiveness of the proposed model and methodology, which can provide the decision support for medical administrators of home health care.

The concept of Watson's carative factors in nursing and their (dis)harmony with patient satisfaction.

BackgroundConstant reviews of the caring behavior of nurses and patient satisfaction help to improve the quality of nursing. The aim of our research was to explore relationships between the level of nursing education, the perception of nurses and nursing assistants of Watson’s carative factors, and patient satisfaction.MethodsA questionnaire survey using a convenience sample of 1,098 members of nursing teams and a purposive sample of 1,123 patients in four health care institutions in Slovenia was conducted in August 2012. A demographic questionnaire and the Caring Nurse-Patient Interactions Scale (nurse version) were delivered to the nurses. A Hospital Consumer Assessment of Health Plans Survey was delivered to discharged patients. Data were analyzed using descriptive and inferential statistics.ResultsCarative factor sensibility was related to the level of nursing education. Patients were satisfied with the care received from nurses, nursing assistants and hospitals, although we found differences between the perceptions of nurses and nursing assistants of carative factors and patient satisfaction. By comparing only the perceptions of nurses and nursing assistants of carative factors in health care institutions, differences were found for seven out of ten carative factors.DiscussionWe did not find major significant differences between carative factors and level of nurse education, except in one carative factor. Differences in perceptions of carative factors between health care institutions are probably the result of different institutional factors. The results can be of great benefit to nurse administrators and educators, indicating the factors that must be taken into account for enhancing patient satisfaction. Emphasis on caring theories should be placed in nursing education and their application in nursing practice.

Acute Postoperative Pain

Inadequate management of acute postoperative pain increases morbidity and mortality. Poorly controlled pain results in delayed hospital discharge and may lead to the development of chronic pain. Current evidence supports the implementation of a multimodal analgesic regimen, where different pharmacologic and nonpharmacologic interventions are used. The selection of the different components of this multimodal analgesic approach should consider their potential benefits and limitations, as well as the unique patient characteristics and the surgical procedure. It is the responsibility of the perioperative health care provider to formulate an optimal pain management strategy to ultimately enhance patient satisfaction and improve short- and long-term outcomes.

Sizing Penile Prosthesis Length as per the Erect Penile Length: Experience from Cases of Unresolved Ischemic Priapism

Introduction: Among the reasons for patient dissatisfaction following penile prosthesis implantation (PPI) is decreased length, possibly due to implantation as per the flaccid stretched length, which is shorter than the erect length.Aim of Study: To examine safety of sizing implant length as per the erect state, and its efficacy in enhancing patient satisfaction, by evaluating outcome of implantation in patients with refractory ischemic priapism operated upon early enough before fibrosis sets in.Patients and Methods: Patients for the study were recruited in the past 2 years. Nineteen post-priapism patients comprised the study group (SG), and 21 non-priabitic cases comprised the control group (CG) who were treated for ED refractory to oral medication and intr-cavernosal injection. PPI was performed as per the erect length for the SG and the flaccid stretched length for the CG. At final follow up (46 ± 12.4 months), subjective patient’s impression of length compared to his recall of erect pre-ED/pre-priapism length was recorded as either “almost the same”, “shorter” or “longer”, and patient’s satisfaction with length was recorded on a 5-point Lickert scale. Complications were reported.Results: In the CG all patients reported a shorter length (100%), in contrast to 5.3% in the SG .Satisfaction with length was 57.1 % higher in the SG compared to CG (mean satisfaction 5, and 2.1 ± 0.96 respectively, p=0.048). None of the cases in either groups encountered anterior or posterior perforation/extrusion) or persistent pain beyond 2 months post-operatively. Clinical Implications: Penile prosthesis implantation as per the erect length and not the flaccid stretched length may be safe and effective in preserving length.Conclusion: Penile prosthesis implantation in the erect state post-priapism was safe and offered higher satisfaction with length, and it is therefore safe and favorable to implant prostheses as per the erect length in other cases

Immediate Implant Placement with Simultaneous Regenerative Procedure in Fresh Extraction Socket

ABSTRACT Aim The aim of this case report was to reconstruct the alveolar buccal bone plate lost in consequence of a root fracture in the maxillary central incisor area after immediate implant placement (IIP). A 48-year-old patient was referred to our office with the chief complaint of spontaneous bleeding in his left central incisor. After careful examination, the following comprehensive treatment approach was carried out: (1) Atraumatic tooth extraction, (2) IIP, (3) provisional prosthesis installation, (4) alveolar buccal bone plate reconstruction with autologous bone collected from the maxillary tuberosity, (5) gingival augmentation procedure with connective tissue graft removed from the palate, and finally (6) adjustment of the provisional restoration. After 1-year postoperative, an adequate esthetic outcome was achieved with lower cost, reduced morbidity to the patient, and lower treatment time. This approach was able to improve gingival architecture and bone volume with adequate thickness and width, enhancing patient esthetics and satisfaction. In conclusion, when proper diagnosis, precise surgical techniques, and appropriate multidisciplinary approach are employed, IIP followed by immediate dentoalveolar restoration might be considered a safe procedure to restore the peri-implant bone and gingival recession favoring the achievement of appropriate esthetic outcomes. Clinical significance The treatment planning employed was able to improve gingival architecture and bone volume with sufficient width and thickness enhancing patient esthetics and satisfaction in one single-stage procedure. How to cite this article de Molon RS, de Avila ED, Barros- Filho LAB, Cirelli JA, Borelli-Barros LA. Immediate Implant Placement with Simultaneous Regenerative Procedure in Fresh Extraction Socket. World J Dent 2017;8(3):231-238.

Implementing a Life Cycle Approach through Establishment of a Multipurpose Behavior Therapy Room in PGIMER, Chandigarh for Enhancing the Fitness Level of Women

ABSTRACT Introduction In India, women in their natural role as mothers, sisters, wives, and daughters have been accepted as the principal providers of good health to their families and indirectly to the community. Yet, when it comes to their own health, it receives low priority. Health and fitness of women is compromised by gynecological morbidities that they consider as ‘normal' and part of their destiny. For example, in dysmenorrhea, girls remain grounded for 3 to 4 days. Uterine prolapse and urinary leakage compromise quality of women's life. Many of these problems of women can be resolved by nonmedicinal interventions. Therefore, every woman should have the opportunity to learn about the self-care of problems they experience. However, the doctors in the outpatient departments, particularly Obstetrics and Gynecology (OPG–OPD) are usually overworked to explain this to patients. Objective To document the feasibility and impact of instituting a health promotion orientation package in OPG–OPD in an apex hospital of North India. Materials and methods A health promotion orientation package of services was instituted in OPG–OPDs in an apex hospital of north India through a multipurpose behavior therapy (MPBT) room in December 2012. After referral from main OPD, patients of pregnancy, infertility, prolapse, urinary incontinence (UI), menopause, and dysmenorrhea were advised nonmedicinal interventions, such as dietary modifications, lifestyle changes, and simple exercises/yoga. Unlike main OPG–OPD, here patients were attended along with their husbands and other family members. Here patients shared their queries without hesitation. Patients were also given booklets (available in Hindi, English, Punjabi) and other IEC material on related problems free of charge. Results Favorable results of nonmedicinal interventions were reported. Around 5000 patients were successfully managed through this approach in three years. Out of 100 menopausal patients referred to the MPBT room, 64 were successfully followed up. Among 759 UI and prolapse of pelvic organs patients visiting the room, 66% reported total relief in symptoms and 26% patients reported partial relief after following behavior therapy instructions. Around 3000 antenatal care patients counselled reported relief in symptoms and satisfaction with the quality of counselling. They were also happy that they are being listened to patiently. Patients of polycystic ovarian disease, infertility, and dysmenorrhoea were also advised simple exercises, dietary changes, and lifestyle modifications. Conclusion Establishing a counseling room/MPBT room in hospital, OPDs has a potential to help women cope better with the issues related to their health. Replication of this model in other medical colleges will also help in reducing the load on doctor while simultaneously enhancing patient satisfaction. How to cite this article Sharma R, Dhaliwal LK, Suri V, Kaushal P, Singhal N, Rana AK, Singh AJ. Implementing a Life Cycle Approach through Establishment of a Multipurpose Behavior Therapy Room in PGIMER, Chandigarh for Enhancing the Fitness Level of Women. J Postgrad Med Edu Res 2017;51(3):115-122.

The Asssociations between Accreditation Status, Patient Socio-Economic Factors, Insurance Type, Patient Perceived Quality of Service, and Satisfaction at Community Health Center

Background : Being one of the most important elements in healthcare system, Community Health Center has been promoted to improve its quality and capacity of services. Accreditation is a method that can be used to improve and measure the quality of health service. Quality service improvement is expected to enhance patient satisfaction. This study aimed to investigate the asssociations between accreditation status, patient socio-economic factors, insurance type, patient perceived quality of service, and satisfaction at Community Health Center. Subje cts and Met h od: This was an analytic observational study with cross-sectional design. This study was conducted at Community Health Center in Surakarta, Central Java from June to July 2017. A total of 8 Community Health Centers with different accreditation status (not accredited, lowest, medium, and highest) were selected for this study. A sample of 200 patients were selected from the 8 Comunity Health Centers by proportional random sampling. The independent variables were accreditation status, patient education level, family income, and insurance type. The dependent variables were perceived quality of service and patient satisfaction. The data were collected by a set of pre-tested questionnaires. Accreditation status was identified from the record at District Health Office. Data were analyzed by path analysis. Results : Patient satisfaction was associated with Commuity Health Center acrreditation status (b=0.39; SE=0.22; p=0.069), perceived quality of service (b=0.05; SE=0.02; p=0.022), patient education level (b=-1.16; SE=0.48; p=0.017), and insurance type (b=0.61; SE=0.31; p=0.044). Perceived quality of health services was associated by accreditation status (b=2.22; SE=0.74; p=0.003), patient education level(b=-4.51; SE=1.68; p=0.007), and insurance type (b=2.79; SE=1.06; p=0.008). Family income did not show statistically significant association with perceived quality of health service (b=-0.17; SE=0.11; p=0.123). Conclusion : Patient satisfaction is associated with Commuity Health Center acrreditation status, perceived quality of service, patient education level, and insurance type. Perceived quality of health services is associated with accreditation status, patient education level, and insurance type. Keywords : patient satisfaction, perceived quality of service, accreditation status, Commuity Health Center Correspondence : Farahdila Mirshanti. Masters Program of Public Health, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta, Central Java. Email: fmirshanti@gmail.com. Mobile: +628121534393. Journal of Health Policy and Management (2017), 1(1): 91-101 https://doi.org/10.26911/thejhpm.2017.02.01.08

Effects of music therapy under general anesthesia in patients undergoing abdominal surgery

ABSTRACTBackground: Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness.Methods: This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient’s satisfaction, and awareness incidence during anesthesia were recorded.Results: One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10–3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10–3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10–3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant.Conclusion: Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients’ embarrassing experiences related to perioperative stress, pain, and awareness.

"Tailoring" Hematopoietic Progenitor Cell Collection: Impact of a Data-Driven Prediction Algorithm for Blood Volume Processing in Large Volume Leukapheresis

Background:The predominant source of hematopoietic progenitor cells (HPCs) for hematopoietic stem cell transplantation (HSCT) is peripheral blood (PB). HPCs are collected for HSCT using large volume leukapheresis (LVL) that typically involves processing >4 blood volumes to ensure adequate yield of HPCs. LVL is time-intensive, causes volume overload and hypocalcemia, and in small children, requires prolonged sedation. The purpose of this quality improvement project was to assess whether a collection efficiency-based, data-driven prediction algorithm for HPC collection can meaningfully decease the volume of blood processed in well-mobilized patients.MethodsWe evaluated the CD34+ cellular collection efficiency 2 (CE2; see below) in 240 consecutive adult autologous (A-auto), 59 adult allogeneic (A-allo), and 23 pediatric autologous (P-auto) collections ("training set"). In the training set, mean (1SD) CD34+ CE2s in A-auto, A-allo and P-auto collections were 47% (16%), 51% (14%), and 59% (32%), respectively (Fig. 1).CD34 Collection Efficiency 2 (CE2) was calculated as below:CD34+ CE2= CD34+ yield/[BVP x Precollection PB CD34 count]Blood Volume to be processed (BVP) was calculated as below:BVP= CD34+ cell target/ [CD34+ CE2 x Precollection PB CD34+ count]In order to have a high level of confidence that the targeted dose of CD34+ cells will be collected with implementation of the prediction formula, the CD34+ CE2 was set at the 3rd percentile (30%) in the A-auto group, and lowest attained CD34+ CE2 in the A-allo (30%) and P-auto groups (25%) for the A-auto, A-allo and P-auto prediction formulae, respectively. These CD34+ CE2s were used to calculate the BVP in a large cohort of consecutive patients from Froedtert Memorial Lutheran Hospital and the Children's Hospital Wisconsin which included 461 A-Auto, 90 A-Allo and 16 P-Auto collections over a period of 16 months (2/2015- 5/2016). Data was collected from both prediction-driven truncated and standard non-truncated LVLs and comparisons were made with regards to blood volume processed, duration of LVL, financial impact and time to neutrophil and platelet engraftment.ResultsAfter implementation of the BVP prediction formula, 91 truncations were performed in 42 (9%), 41 (46%) and 8 (50%) of 461 A-auto, 90 A-allo and 16 P-auto collections, respectively, representing an overall truncation rate of 16% (Fig. 2). Of the 91 total procedures truncated, 4 procedures (all A-Auto) failed to reach the CD34+ collection target, however, cell yields were extremely close to targets and were not deemed to be prediction failures (Table 1). In truncated LVL procedures, reduction in volume of blood processed was 34% overall, with average decreased processing of 31%, 36% and 46% (of 4 blood volumes) in A-auto, A-allo and P-auto collections, respectively (Fig. 3). The average time for a randomly selected group of 20 standard 4BV collections was 4 hr 49 mins. A 34% truncation in BVP would result in the procedure concluding 1 hr 38 mins earlier and this prediction formula based intervention is predicted to save on average $132 per patient ($35/hr Nursing time; $25/hr Cell Processing technologist time, and 35% overhead) and total savings of $12,039 over 91 truncated procedures during the 16 month period assessed. Median neutrophil and platelet engraftment were not significantly different in autologous HSCT patients with truncated vs. non-truncated procedures (10 days each for neutrophil engraftment, and 20 days vs. 19 days in truncated vs. non-truncated procedures for platelet engraftment).ConclusionThe use of a data-driven HPC prediction algorithm resulted in the truncation of 16% of all LVL procedures. The volume of truncation was significant in most cases and did not adversely impact the ability to collect the desired number of stem cells and resulted in comparable neutrophil and platelet engraftment time. This approach may be particularly important in mitigating risks of LVL in populations with higher concern for adverse events such as children, and patients with poor tolerance for LVL-induced volume overload. Finally, in our experience, this approach has resulted in enhancing patient satisfaction associated with shorter procedures and promotes optimal use of healthcare resources by limiting costs. [Display omitted] DisclosuresPadmanabhan:Bloodcenter of Wisconsin: Patents & Royalties: A patent application has been filed on a Method of detecting platelet activating antibodies that cause heparin-induced thrombocytopenia/thrombosis; PCT/US14/62591; Terumo BCT: Consultancy, Honoraria; Schlesinger & Associates: Consultancy, Honoraria; LEK Consulting: Consultancy, Honoraria; Mallinckrodt Pharmaceuticals: Consultancy, Honoraria; Fenwal (Fresenius Kabi): Research Funding.

Seamless Service? On the Role and Impact of Service Orchestrators in Human-Centered Service Systems

How can value cocreation in complex human-centered service systems (HCSSs) like health care be facilitated? We address this question by introducing the novel role of service orchestrators as dedicated actors who facilitate and orchestrate resource integration, and thereby value cocreation, between other interdependent actors in HCSSs. Specifically, we draw on findings from four complementary studies that investigate the role and impact of case managers, an ideal-typical service orchestrator in health care, through the perspectives of HCSS actors (i.e., patients in Study 1 and clinical staff in Study 2) and structures (i.e., clinical departments in Studies 3 and 4). Our findings indicate that orchestrating value cocreation through case managers enhances patient satisfaction as well as the financial and operational performance of clinical departments. Service orchestration also increases the perception of clinical staff that patients are actively involved in the cocreation of their own health service but surprisingly not that of patients themselves. As such, introducing service orchestrators might contribute to reconciling the growing tension between the quality and cost of health care. We conclude by outlining how our work serves as a possible starting point for a novel research stream on effective coordination mechanisms for value cocreation in complex HCSSs.

Preoperative and Postoperative Photographs and Surgical Outcomes of Patients With Kyphosis.

A retrospective clinical study was performed. The aim of the study was to show patients their pre- and postoperative body photographs, and determine the effect on postoperative patient satisfaction for thoracic and thoracolumbar sharp and round angular kyphosis. Previous studies have reported the normative values of pelvic sagittal parameters and the classification of normal patterns of sagittal curvature, but no study has investigated and compared the clinical photographs of sharp and round kyphosis. In patients who underwent surgery for thoracic and thoracolumbar sharp and round angular kyphosis, whole spine anteroposterior and lateral radiographs, and clinical photographs were obtained preoperatively and at the final follow-up. Pelvic and spinal parameters were measured, and the pre- and postoperative photographs were shown to patients. The Scoliosis Research Society 22r (SRS22r) and Short Form 36 surveys were administered to all patients, and the scores were analyzed. Thirty-eight patients diagnosed with kyphosis (mean age 19.6 yr, mean follow-up duration 26.4 mo) were divided into two groups: sharp (18 patients, mean age 20.1 yr) and round (20 patients, mean age 19.6 yr) kyphosis. There was no difference between values in the sharp and round groups in terms of age, follow-up duration, and Risser score (P > 0.05). In both groups, the subscores for pain, self-image, mental health, and satisfaction, except for the function/activity score, and the total score of the SRS22r survey were, however, significantly different between pre- and postoperative photographs. In addition, there was no significant difference between the two groups in any SRS22r domain and Short Form 36 scores. The surgical treatment of kyphosis was uniformly associated with improved quality of life, regardless of the kyphosis type. Thus, showing patients their pre- and postoperative photographs may enhance patient satisfaction, as measured by SRS22r scores. 4.

Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial.

To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months. In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months. From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4-5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P=.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment. Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy. ClinicalTrials.gov, https://clinicaltrials.gov, NCT01902485.

Enhancing healthcare quality by promoting work-life balance among nursing staff

Nurses are fundamental to the functioning of any healthcare organization. However, nursing is a demanding and stressful profession. Excessive occupational stress can cause work-life conflict, decrease quality of care, and increase nurse resignation. It is essential that healthcare providers examine their organizational culture to ensure a supportive climate to maximize the well-being and work-life balance of nurses. With the improvement of the organizational culture, nurses will be able to provide top quality medical care, be more productive, and enhance patient satisfaction.

Day surgery nurses' selection of patient preoperative information.

To determine selection and delivery of preoperative verbal information deemed important by nurses to relay to patients immediately prior to day surgery. Elective day-case surgery is expanding, patient turnover is high and nurse-patient contact limited. In the brief time-frame available, nurses must select and precisely deliver information to patients, provide answers to questions and gain compliance to ensure a sustained, co-ordinated patient throughput. Concise information selection is therefore necessary especially given continued day surgery expansion. Electronic questionnaire. A survey investigating nurses' choice of patient information prior to surgery was distributed throughout the UK via email addresses listed on the British Association of Day Surgery member's website (January 2015-April 2015). Participants were requested to undertake the survey within 2-3weeks, with 137 participants completing the survey giving a 44% response rate. Verbal information deemed most important by nurses preoperatively was checking fasting time, information about procedure/operation, checking medication, ensuring presence of medical records/test results and concluding medical investigations checks. To a lesser extent was theatre environment information, procedure/operation start time and possible time to discharge. Significant differences were established between perceived importance of information and information delivery concerning the procedure/operation and anaesthesia details. Nurses working with competing demands and frequent interruptions, prioritised patient safety information. Although providing technical details during time-limited encounters, efforts were made to individualise provision. A more formal plan of verbal information provision could help ease nurses' cognitive workload and enhance patient satisfaction. This study provides evidence that verbal information provided immediately prior to day surgery may vary with experience. Nurse educators and managers may need to provide greater guidance for such complex care settings as delivery of increasingly technical details during brief encounters is gaining increasing priority.

Factors associated with acute postoperative pain following breast reconstruction

IntroductionPostmastectomy breast reconstruction has become an increasingly important component of breast cancer treatment. Unfortunately, some patients experience severe postoperative pain, placing them at risk for increased clinical morbidity and the development of disabling chronic pain. To identify patients at risk, we prospectively evaluated patient characteristics and medical/surgical variables associated with more severe acute post-reconstruction pain. MethodsWomen (N = 2207; 1-week 82.8% response rate) undergoing breast reconstruction were assessed for pain experience, anxiety, depression, and sociodemographic characteristics before surgery. Pain assessments were made preoperatively and postoperatively at 1 week using validated survey instruments including the McGill Pain Questionnaire-Short Form (MPQ-SF), Numerical Pain Rating Scale (NPRS), and BREAST-Q Chest and Upper Body scale. Depressive symptoms and anxiety severity were assessed by the Patient Health Questionnaire and Generalized Anxiety Disorders Scale, respectively. Mixed-effects regression modeling was used to examine the relationships between patient characteristics and medical/surgical variables and 1-week postoperative pain. ResultsYounger age; bilateral reconstruction; and severity of preoperative pain, anxiety, and depression were associated with more severe acute postoperative pain on all the pain measures and BREAST-Q. Surgical procedure type indicated less severe postoperative pain for PTRAM, DIEP, and SIEA reconstructive surgery when compared with tissue expander/implant reconstruction. ConclusionsThis study identifies patients at risk for severe acute postoperative pain following breast reconstruction. These findings will allow plastic surgeons to better tailor postoperative care to improve patient comfort, reduce clinical morbidity, and enhance patient satisfaction with their surgical outcome.

The Role of Trust in Doctor-Patient Relationship: Qualitative Evaluation of Online Feedback from Polish Patients

JEL Classification: I11ABSTRACT. Apart from the fact that trust between doctors and patients is a source of sustainable relations, affecting the behaviour of both parties, it also has its therapeutic value. Therefore, this paper aims to construct a model of trust in the doctor-patient relationship based on qualitative research (analysis of the contents of Internet message boards). The study has revealed that trust towards doctors is a result of overlapping and interpenetration of two levels of trust: macro- and meso-. Macro-trust can be seen as a context in which all the dimensions of institutional trust are 'embedded'. Whereas meso-trust (institutional) is described in terms of three dimensions: benevolence, competence and integrity.Keywords: system trust, institutional trust, doctor-patient relationship, Poland.IntroductionTrust in various social and economic relations has recently become a subject of wide debate. Trust between doctors and patients, apart from being a source sustainable relations and having an influence on the behaviour of both partners, is also of therapeutic value (Gilson, 2003). Trust, or lack thereof, is a result of actual experience which arises from some sort of social context and requires a stable institutional background (Strategia Rozwoju Kapitalu Spolecznego 2011-2020). Surveys reveal that in Poland the level of trust towards doctors is lower than in other European countries. More in-depth research is called for to clarify the nature of the complex and multi-faceted issue of trust between doctors and patients. Therefore, the aim of this paper is to put forward a conceptual model of doctor-patient trust on the basis of qualitative research: analysis of comments published online on message boards.1.The circles of doctor-patient trustTrust is an integral element of every satisfying relationship (Morgan, Hunt, 1994). Luhmann describes it as a mechanism which reduces social complexity (Skytt, Winther, 2011). Trust can be defined as the belief that one's partner will act in the common interest (Gilson, 2003), and that neither party will ever attempt to harm their partner by taking advantage of their weaknesses (Morgan, Hunt, 1994). It also means the willingness to invest one's resources in a relationship with another party. Trust stems from a certain positive image established on the basis of previous mutual relations (Brockner et al., 1997), as well as from the perceived degree of reliability of partners. Moreover, trust acts as a mechanism which reduces opportunist behavior (Skytt, Winther, 2011).Patient trust in physician is a multidimensional construct that has different definitions between and within disciplines. Thom et al. (2002) define patient trust in physician as a set of beliefs or expectations that a care provider will perform in a certain way, while Pearson and Raeke (2000) define trust as an emotional characteristic, where patients have a comforting feeling of faith or dependence in a care provider's intentions (Montague, 2010).Patients need trust at each and every stage of building relationships with their doctors. It plays a key role in these relationships, but also positively affects treatment outcomes (Hillen et al., 2011). As Calnan and Rowe point out, a relationship based on trust brings therapeutic benefits, enhances patient satisfaction and, consequently, improves the results of the treatment (Calnan, Rowe, 2006). Research also demonstrates that in a patient-doctor relationship, it is essential that a period of time is reserved to make it possible for some degree of trust to emerge, so that the patient can fully benefit from doctor's advice, or make changes in his or her lifestyle, if so recommended (Peilot et al., 2014).Trust can be studied on several overlapping levels. According to Sztompka, there exist gradually expanding concentric circles of trust: from the most tangible personal relations to more abstract attitudes towards social structures and institutions (Sztompka, 2007). …

Accelerating Ablative Fractional Resurfacing Wound Healing Recovery by Photobiomodulation

Ablative cosmetic procedures are almost inevitably followed by an acute healing phase resulting in discomfort, erythema, edema, and crusting. Since patients are constantly asking for no downtime procedures, a considerable challenge to health care providers has resulted. Recently, photobiomodulation (PBM) with light-emitting diodes has attracted attention in wound healing management via its anti-inflammatory effects and increase in skin collagen production. PBM has been shown to promote wound healing processes both in vitro and in vivo at the epidermal and dermal levels in the skin. The combined favorable anti-inflammatory and collagen metabolism effects enhance collagenesis and elastinogenesis. A growing body of clinical evidence is showing that PBM, using 600–1000 nm light wavelengths, as soon as possible post-procedure and thereafter, successfully accelerates the acute healing phase via faster wound healing so as to reduce patient downtime. This article reviews that evidence and shows that PBM applied pre- and post-ablative fractional resurfacing treatment minimizes postoperative downtime enhancing patient satisfaction. It will hopefully become part of our rapidly expanding treatment armamentarium in order to ultimately improve patient care.

Impact of Quality Human Resource in Health Care Providing Organizations

The management of human resources in health-care institution is essential to enable the delivery of efficient and effective medical services and to achieve patient satisfaction. This study aims to investigate how the impact of new technological innovation in health / medical sciences and patient care put an effect on the performance of the health-care providing institutions and to analyze how these innovations are putting an impact on performance of the health-care related human resource (employees) and that up to what extent despite of these rapid technological changes, the practicing human resources management is enable to increase the human resource performance, quality of health-care service and help themout to achieve patients' satisfaction. The exploratory methodology was applied to demonstrate and analyze the previous literatures. The study shows that effective human resources management has a strong impact on health-care quality and improving the performance of hospital's staff. The study suggests before starting performance development process as well as continuous development and training of staff performance, there is a need to measure the performance of the managers of human resources department in the health-care organizations. The purpose of this research study is to gain a deeper understanding of the impact of human resources (employees) on health sector reform, the importance of HRM in all aspects of health-care organizations, the positive impact of increased job autonomy on employee outcomes, and the dynamics of employee engagement in health-care. The literature on the link between HR system perceptions and civility towards patients, specific roles for HRM in building shared values that can serve both the care needs of patients and the business needs of health organizations, the complex linkages between employees' perceptions of human resources systems and hospital performance, and the mechanisms through which HRM can enhance patient satisfaction in health care organizations is relevant to this discussion.