Excellent Patient Satisfaction Research Articles

Preoperative factors associated with patient satisfaction after modified kinematically aligned total knee arthroplasty in varus knees

PurposeKinematically aligned-total knee arthroplasty (KA-TKA) has recently attracted significant interest because it delivers better clinical outcomes than mechanically aligned (MA)-TKA. However, the optimal preoperative factors that maximize the effectiveness of KA-TKA remain controversial. Therefore, we aimed to determine the preoperative factors that are appropriate for and might benefit from modified KA-TKA, based on patient-reported outcome measures (PROMs). MethodsThe relationships between postoperative satisfaction and other variables in 84 patients with varus-type osteoarthritis of the knee who underwent primary modified KA-TKAs were investigated using stepwise multiple regression analysis. Patients were assigned to groups that were satisfied or dissatisfied with their outcomes after KA-TKA according to the 2011 Knee Society Scores. The cutoff for preoperative advanced activities scores (AASs) for excellent satisfaction were determined by analyzing receiver operating characteristic (ROC) curves. The variables correlated with excellent satisfaction were identified using logistic regression models. ResultsA preoperative variable relevant to patient satisfaction was AAS (β ​= ​0.465). The results of the ROC curve analysis revealed eight optimal cut-offs for preoperative AASs that predicted excellent satisfaction, with a sensitivity and specificity of 0.700 and 0.625, respectively. Logistic regression analysis revealed that AASs significantly contributed to excellent patient satisfaction (odds ratio, 1.181; p ​= ​0.001). ConclusionsIndividuals who were highly active preoperatively were good candidates for KA-TKA. This modified kinematically aligned surgical technique can satisfy the demands of highly active patients.

The Health Arab Tourists’ Satisfaction Level of Services Provided: A Cross-sectional Study in Bangalore-Cross Sectional Study

Introduction: An indication of the quality of medical treatment is how satisfied patients are with the services received. Patient satisfaction is determined by how well they feel their care met their expectations. This survey was conducted in 2023 to assess how satisfied health tourists were with the services received from Bangalore Multispecialty hospitals. Method: It is a cross-sectional study was conducted from 21-3–2023 to 26-1-2023 at Multispecialty Hospital in Bangalore. : In this a cross-sectional study, 400 253 (63.2%) men and 147 (36.8%) women, the data collection instrument is a semi-structured questionnaire in this study. The respondents of this study are Arab tourists who received inpatient and outpatient services at least one day at hospitals. The hospitals were selected purposively but the potential respondents were chosen conveniently. These procedures ensure the researchers access a sufficient number of potential respondents from the hospitals for this study. Researchers of this study approached the respondents and requested they participate in this survey. The researchers informed participants that the information would be utilized only for research purposes and their support was anonymous and voluntary. The questionnaire has 56 general and specific items. Each of the specific items is scaled on five points; Very Good, Good, Moderate, Poor and very poor. In order to analyze the data both descriptive and inferential statistics were used Patient satisfaction and surgical outcomes were the main outcome measures. Results: 400 participants were included in the study (63.2% male and 36.85% Female). 79 of the surgeries were Neurosurgeries cases (19.8%) compared to 75 Oncology cases (18.8%). Regarding patient satisfaction, 96.8% of the patients regarding the quality of care. 66 % were satisfied with the hospital privacy and confidentiality measures. Conclusion: All of the Analyzed domains had excellent patient satisfaction rates, little problems, and successful surgical results in general. There is few things make patients unsatisfied like the waiting time for consultation so long, the method of payment in some hospital that there is limitation for cash payment ,and the language barrier the important factor play the major role.

Endoscopic Primary Breast Augmentation With Loco-Regional Anesthesia: Preliminary Experience of 200 Consecutive Patients

Abstract Background breast augmentation with implants recorded over 1.6 billion procedures globally in 2022. To reduce surgical trauma and complications and facilitate a fast recovery, we employ an ultrasound-guided local-regional anesthesia technique, the creation of a partial sub-muscular implant pocket by a direct endoscopic visualization and a minimal skin access on the mammary fold. Objectives The aim of the study is to evaluate whether the breast augmentation performed in endoscopy under local-regional anesthesia reduces post-operative recovery time, reduces complications and increases patient satisfaction. Methods Patients provided their consent through a signed form. We set strict inclusion and exclusion criteria. We prospectively evaluate postoperative pain and recovery times, rate of complications and patient satisfaction at 12 months post-surgery. Results Between January 2021 and September 2022, 200 patients met the inclusion criteria. The average operation time was 54.2 minutes. Patients were discharged from the hospital within 2 to 3 h. Eighty-nine % of patients expressed great satisfaction with the result. None of the patients experienced post-surgical complications. Conclusions our initial study showed that endoscopic breast augmentation conducted under localized anesthesia is safe. It allows for quick recovery post-surgery and swift resumption of everyday activities. The overall complication risk is less than what has been reported in scientific studies for the classic dual-plane technique. Moreover, this approach yields excellent patient satisfaction. Additional prospective and randomized studies will be required to enhance the scientific validity of this technique. Moreover, a larger patient cohort will be essential to stratify the risks associated with varying prosthetic volumes.

Distal Biceps Tendon Repair Using a Double Intracortical Button Anatomical Footprint Repair Technique

Distal biceps tendon repair is usually performed via a double-incision or single-incision bicortical drilling technique. However, these techniques are associated with specific complications and usually do not allow for anatomical footprint restoration. It was the aim of this study to report the clinical results of a double intracortical button anatomical footprint repair technique for distal biceps tendon tears. We hypothesized that this technique would result in supination strength comparable to the uninjured side with a low re-rupture rate and minimal bony or neurological complications. This was a retrospective, single-surgeon cohort study of a consecutive series of 22 patients with a mean (SD) age of 50.7 (9.4) years and at least 1-year follow-up after distal biceps tendon repair. At final follow-up, complications, range of motion (ROM), the Patient-rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS) for pain, patient satisfaction and supination strength in neutral as well as 60° of supination were analyzed. Radiographic evaluation was performed on a CT scan. One patient (4.5%) experienced slight paresthesia in the area of the lateral antebrachial cutaneous nerve. Heterotopic ossification was seen in one patient (4.5%). All patients recovered full ROM except for one who had 10° of loss of flexion and extension. Median PREE score was 4.6 (0-39.6), median MEP was 100 (70-100) and median DASH was 1.4 (0-16.7). All but one patient were very satisfied with the outcome. The affected arm had a mean of 98% (± 13) of neutral supination strength (p=0.633) and 94% (± 12) of supination strength in 60° (p=0.054) compared to the contralateral, unaffected side. There were four cases (18.2%) of cortical thinning due to at least one button and one case of button pull-out (4.5%). The double intracortical button anatomical footprint repair technique seems to provide reliable restoration of supination strength, excellent patient satisfaction while minimizing complications, particularly nerve damage and heterotopic ossification.

The "fascia taco" for nasal septum perforation closure-A retrospective Cohort study on success rates and patient reported outcomes.

Nasal septum perforation (NSP) is a common condition affecting ~1.2% of the general population and is still considered challenging to treat. Therapeutic strategies range from conservative local treatments and septal button closures to over 40 different surgical approaches. This study aimed to present a novel secure approach. We describe our novel and unique NSP closure approach using a "fascia taco," in which conchal cartilage is enveloped by temporalis fascia like a taco and splints are left in place for 6-8 weeks. A review of patient charts was conducted and questionnaires including the German-SNOT-22 and D-NOSE were sent by mail to all eligible patients who received a fascia taco between 2016 and 2021. Thirty-three patients were identified. The questionnaire response rate was 54.5%. The mean operative time (cut to sew) for all patients who only underwent NSP closure was 90.4 min. The overall success rate in terms of postoperative NSP closure was 81.8%. We found an apparent but nonsignificant association between closure failure and smoking (failure rate 66.6% in smokers vs. 15.4% in nonsmokers; X 2 = 3.4188, p = .064). Questionnaire analysis showed a significant postoperative reduction of mean values in D-NOSE from 60.8 to 33.1 (p = .009) and in German-SNOT-22 from 38.6 to 21.2 (p = .005). The fascia taco technique is an easy-to-apply, safe procedure for NSP closure that is short in duration and associated with a low morbidity, resulting in excellent patient satisfaction. 4.

A comparative study on the cosmetic outcomes of ultrasound-guided versus palpation-guided conservative breast surgery in patients with early palpable breast cancer

Background In conservative breast surgery, a larger volume of resected breast tissue is associated with a poorer cosmetic outcomes. Therefore, the introduction of ultrasonography in the excision of palpable breast cancer aims to minimize the excision of healthy tissue ensuring oncologically safe excision, and hence, a better cosmetic outcome compared with palpation-guided surgery (PGS). Aim To compare ultrasound-guided surgery (UGS) for palpable breast cancer with PGS in terms of safety margin, re-excision rate, and cosmetic outcome. Patients and methods This is a prospective, randomized, controlled study conducted on 79 female patients with early palpable breast cancer. Patients were randomized to undergo either UGS or PGS. The mean distance between the tumor and the resection margin, re-excision rate, operative time, cosmetic outcome, and patient satisfaction were assessed. Statistical analysis used Data management and statistical analysis were done using SPSS, version 28. Quantitative data were assessed for normality using the Shapiro–Wilk test and direct data visualization methods. According to normality, quantitative data were summarized as means and SDs. Categorical data were summarized as numbers and percentages. Quantitative data were compared between the studied groups using independent t test. Categorical data were compared using the χ 2 test. Multivariate logistic regression analysis was done to predict good to excellent patient satisfaction. All statistical tests were two-sided. P values less than 0.05 were considered significant. Results The UGS group showed significantly higher excellent panel evaluation (48.7 vs. 22.5%, P=0.028) and patient satisfaction (61.5 vs. 30%). The UGS group demonstrated significantly longer operative time but significantly lower re-resection rate and distance from tumor to resection margin (0.62±0.16 vs. 1.72±0.35 cm, P<0.001). The predictors of the outcomes were tumor T stage (T2 stages associated with less satisfaction), tumor to resection margin distance (the more distance the less satisfaction), and ultrasound use. Conclusion The UGS proves to be superior to PGS as it significantly decreases re-excision rates and improves overall cosmetic outcome and patient satisfaction.

WALANT office based endoscopic cubital tunnel release

Background: Cubital tunnel syndrome is a common condition caused by compression of the ulnar nerve around the medial elbow. Surgical treatment usually involves open in situ ulnar nerve decompression unless ulnar nerve instability is noted. Endoscopic techniques for cubital tunnel release have been developed and implemented with excellent patient and surgeon satisfaction. Endoscopic cubital tunnel release can be performed in an office based procedure room under wide awake local anesthesia no tourniquet principles. We present our setup and technique for performing an endoscopic cubital tunnel release procedure in an office based setting under local anesthesia. Methods: Local anesthesia is injected along the course of the ulnar nerve on the medial arm and forearm extending 10 cm proximal and distal to the medial epicondyle. After allowing approximately 30 min for appropriate vasoconstriction, the patient is placed in a supine position with the arm abducted and externally rotated position. The endoscopic cubital tunnel release is then performed. Discussion: Our described technique eliminates the need for placement of a prophylactic tourniquet and thereby the need for the procedure to be performed within an OR setting. It also utilizes a single-stage anesthetic administration, which facilitates ease of completion and performance in an office based setting. There is a significant cost savings when endoscopic cubital tunnel release is performed in an office-based procedure room compared to in the operating room. Conclusions: Office-based endoscopic cubital tunnel release can be safely performed utilizing WALANT techniques, leading to high patient satisfaction and decreased overall cost of care. Level of Evidence: Therapeutic IV

Tips, Tricks, and Pearls for a Superior Patient and Surgeon Experience for Wide-awake Dupuytren Surgery.

Fasciectomy for Dupuytren disease is a common procedure traditionally performed with a tourniquet under general or regional anesthesia. Since the year 2001, the wide-awake local anesthesia no tourniquet (WALANT) approach has been applied successfully to Dupuytren surgery, with current excellent surgeon and patient satisfaction. However, using WALANT for Dupuytren surgery may be intimidating for hand surgeons who want to begin using this method. The purpose of this article is to offer a series of tips and tricks the authors have learned after having performed hundreds of WALANT fasciectomies, to make this technique easier for surgeons and a more pleasurable experience for patients.

The 50% effective dose of hydromorphone and morphine for epidural analgesia in the hemorrhoidectomy: a double-blind, sequential dose-finding study

BackgroundAlthough previous studies have showed that epidural morphine can be used as a complement to local anesthetics for analgesia after postcesarean delivery under spinal anesthesia, there is little known about the analgesic dosage of epidural morphine and hydromorphone for hemorrhoidectomy. Therefore, we conducted this study to examine the potency ratio of hydromorphone to epidural morphine as well as effective analgesic dose for 50% patients (ED50) undergoing elective hemorrhoidectomy.Methods80 patients under elective hemorrhoidectomy with combined spinal and epidural anesthesia(CSEA) in department of anesthesia, Dongguan Tungwah hospital. To assess the ED50, patients were treated with epidural morphine or epidural hydromorphone randomly using a biased coin method-determined dose with a sequential allocation procedure. Following surgery, standardized multimodal analgesia was administered to all patients. A pain response score of ≤ 3 (on a scale of 0–10) was determined to be the effective dose after 24 h following CSEA. The ED50 in both groups were determined using the probit regression and isotonic regression method. We also measured pain intensity by patient interview using a 10 point verbal numeric rating scale prospectively at 6, 12 and 24 h after CSEA, and adverse effects were also noted.ResultsThe ED50 was 0.350 mg (95% CI, 0.259–0.376 mg) in hydromorphone group and 1.129 mg (95% CI, 0.903–1.187 mg) in morphine group, respectively, estimated by isotonic regression method. Regression analysis with the probit, the ED50 of epidural hydromorphone was 0.366 mg (95% CI, 0.276–0.388 mg) and epidural morphine was 1.138 mg (95% CI, 0.910–1.201 mg). Exploratory findings showed that there was no difference between the most frequent dosages of epidural hydromorphone or epidural morphine in the occurrence of nausea, vomiting and pruritus. When administered with epidural opioids at ED50 doses or higher, 97.5% (39/40) of epidural morphine patients and 97.5% (39/40) epidural hydromorphone of patients were satisfied with their analgesia.ConclusionEffective hemorrhoidectomy analgesia requires a 3:1 ratio of epidural morphine to epidural hydromorphone. Both drugs provide excellent patient satisfaction.

Patients with transobturator tape: a retrospective observational study of ten-year follow-up

Stress urinary incontinence (SUI) may result from intrinsic sphincter weakness or urethral hypermobility brought on by weakened muscles in the pelvic floor that sustain the urethra and bladder. The amount of mid-urethral support is increased by the mid-urethral tape's function to serve as an anchored pubo-urethral neo-ligament. This study's objective is to assess the safety and effectiveness of transobturator tape (TOT) for SUI after a 10-year follow-up period. There were 103 patients included in this retrospective observational single-arm research. Only 95 participants were included in the trial since 8 patients were lost to follow-up. Patients who had TOT between 2010 and 2013 were monitored until December 2022. The effectiveness of the tape was assessed at 10 years for both early and late surgical problems in the patients. Those diagnosed with SUI were 52.27 years old on average (standard deviation ±8.48). 24% of patients (n=21) experienced mixed urinary incontinence (MUI), compared to 79.61% (n=82) of patients who had just pure stress incontinence. At 10 years, the success rate in our research was 97.09%. Demand incontinence was healed in 57.14% (n=12) of the 21 MUI patients. 7.69% of de novo urgency was noted (n=7). There were no significant side effects including mesh erosion, bladder and intestine perforation, or vascular hemorrhage. Excellent patient satisfaction was rated in 43% of cases (n=44), good in 54% of cases (n=56), and low in 3% of cases (n=3). At 10 years, TOT for SUI shows an impressive cure rate and excellent effectiveness. When the treatment is carried out by experienced hands, there are no significant difficulties.

Effectiveness of fractionated microneedle radiofrequency in treatment of seborrheic dermatitis

Abstract Introduction: Seborrheic dermatitis (SD) is a chronic, relapsing skin illness that causes erythematous, scaly patches and plaques on sebaceous-rich regions including the scalp, face, and chest. Fractionated microneedle radiofrequency (FMR) manages SD symptoms, reduces inflammation, controls sebum production, and improves skin quality and appearance, increasing patient satisfaction. Objective: The aim of this research is to determine the effectiveness of FMR in treating SD. Materials and Methods: Cross-sectional study. Group A included 20 SD patients. They are treated with combination medicine therapy (isotretinoin pill 10 mg on alternative days with topical emollient cream) and FMR single section each month, with an average of two sections per patient (1–4 section). Group B included 20 SD patients. Group B received isotretinoin tablets of 10 mg on alternative days and a topical emollient cream. Results: Group A (mean age = 31.5 ± 7.6 years, 25% females, 75% males) showed a greater reduction in SD grades after treatment compared to group B (mean age = 31.6 ± 8.7 years, 35% females, 65% males). Group A also had a higher percentage of non-relapsing SD cases (63%) and higher satisfaction levels (73.7%) post-treatment, with no significant association between gender, age, and satisfaction. Clear SD grade correlated with higher satisfaction (72.7%) and lower relapse rates (81.1%). Conclusion: FMR and topical therapy dramatically decrease SD severity and recurrence rates, with excellent patient satisfaction across all ages and genders. These encouraging outcomes need larger studies.

Evaluation of Conservative Breast Surgery After Neoadjuvant Chemotherapy in Early Breast Cancer

Background: The breast cancer is a frequent type of cancers. It is associated with high mortality related to cancer in women. The treatment options transferred from radical surgery to less invasive operations. This was attributed to surgical advance and available neoadjuvant chemotherapy. Objective: This work aimed to evaluate the conservative breast surgery feasibility and outcome for early breast cancer received neoadjuvant chemotherapy (NACT) for downstaging. Patients and Methods: Thirty women (30) with early breast cancer were included between November 2022 and May 2023. All women were assessed in systematic manner by history, clinical, laboratory and radiological investigations before chemotherapy, before and after surgery. A true cut biopsy was drawn to estimate the histopathological nature. All surgeries were performed one and half months after the last session of NACT. A regular postoperative follow up was carried out up to six months. Any complications were recorded. Effect of NACT on the tumor grading was the primary outcome, while cosmetic results and patient satisfaction were the secondary outcomes. Results: Complications were in the form of wound infection, seroma and hematoma in 6.7%, 13.3% and 3.3% respectively. These were mild and treated conservatively. The excellent cosmetic result was achieved for 80.0% and excellent patient satisfaction was recorded for 60.0%. The effect of chemotherapy showed significant improvement of clinical and pathological post chemotherapy tumor size values when compared to clinical tumor size values before chemotherapy, the T1 grade (≤2cm) increased from 50% to 66.7%, while the T2 grade (> 2cm <5 cm) decreased from 50% to33.3%. Conclusion: NACT was associated with excellent response regarding tumor size reduction, negativity of lymph nodes as well as pathological response of early breast cancer, before breast conservation surgery (BCS). The BCS after NACT could be considered as a safe option with acceptable aesthetic outcome.

Paradigm Shift from Linear Strip to Follicular Unit Excision in Hair Restoration Surgery.

Follicular unit excision (FUE) is a very effective and valuable modality for obtaining donor hair follicles using manual, motorized, or robotic devices to harvest individual donor follicular units in situ without a linear donor scar or visible scarring making it ideal for patients who wish to wear their hair short and hide signs of surgery. Over the past two decades, FUE has become increasingly popular, and the rising demand for FUE has driven the worldwide market size of hair restoration surgery (HRS) to an unprecedented height.FUE has revolutionized the HRS industry and offers excellent cosmesis and high patient satisfaction. Unfortunately, a large part of the favorable appeal of FUE is due to false claims that it is "minimally invasive," "scarless," or "not even surgery." Most patients opt-in for FUE due to these misconceptions, which are advertised by "black-market" clinics offering low-cost FUE surgery performed by amateur, nonprofessional technicians on unsuspected patients. The technique appears deceptively simple, and many neophyte surgeons falsely believe that the learning curve of FUE is short because the barrier of entry is low and no previous surgical skill is required. Nevertheless, injuries on grafts are extremely easy to occur since FUE is a blind technique and can be minimized only with excellent technique, which takes years to master.FUE actually presents unique challenges for the surgeon and carries potential long-term permanent side effects if not performed properly. The surgeon must have a thorough understanding of the nuances of the FUE surgical technique to ensure consistent graft quality and favorable cosmesis of both donor and recipient areas. Efficient FUE requires dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific knowledge, experience, and an extended learning curve.FUE is an invaluable addition to the armamentarium of a hair restoration surgeon but has to be judiciously performed.

Titanium Elastic Nail outcomes in Children with Femur Fractures

Background: Titanium Elastic Nails are commonly used in children to heal diaphyseal and metaphyseal fractures. The age of the patient, as well as the nature and location of the fracture, determine if the TEN is required. The management of femoral diaphyseal fractures in children aged 5 to 14 years is still disputed. It is a successful and acceptable treatment option in some cases of femoral diaphyseal fractures. The TEN allows for the utilisation of elastically stable intramedullary nailing. Aim of the Study: The purpose of this study was to assess the effectiveness of Titanium Elastic Nails (TEN) in paediatric femoral fractures. Methods: This study was conducted in 250 Bedded General Hospital, Pabna, Bangladesh, from January 2020 to December 2020. The study included 65 paediatric patients aged 5 to 14 years who had femoral shaft fractures and were admitted to the study institution. All acquired data was entered into a Microsoft Excel Work Sheet and analysed in SPSS 11.5 using descriptive statistics. Results: The majority of the participants (84.62%) were male. Most of the participants (78.46%) were aged 5-10 years. Sports-related injuries caused fractures in 44.62% of the participants. The fracture began in the middle of the femur in 47.69% of the cases, the proximal region in 43.08% of the cases, and the distal region in 9.23% of the cases. In this study, 58.46% of participants were hospitalised for 7-14 days, while 33.85% were hospitalised for 14-21 days. Only 7.69% of the individuals had to spend more than 21 days in the hospital. The majority of participants in this study had no post-operative difficulties. At the 12-month follow-up, 81% of participants reported excellent patient satisfaction, 17% reported satisfactory patient satisfaction, and 2% reported poor patient satisfaction. Conclusion: Titanium elastic nailing is a successful and practical therapeutic alternative in certain cases of femoral shaft fractures in children aged 5 to 14. TENS is a safe .....

Hard and soft tissue shape variation and changes in Class II division 1 malocclusion during orthodontic treatment: a geometric morphometric analysis

BackgroundThis study aims to determine the hard and soft tissue shape variation and its changes in Class II division 1 malocclusion before and after orthodontic treatment using Geometric Morphometric Analysis.MethodsThis retrospective study included 141 pre-treatment and near-end treatment lateral cephalometric radiographs of Class II division 1 malocclusion patients aged 16–40 years with a skeletal II pattern (ANB > 4o). 32 landmarks in Cartesian coordinates were created and identified using MorphoJ software to establish a shape analysis.ResultsThe vertical dimensions (hypodivergent to hyperdivergent facial profiles) showed the largest variation in the general shape of hard and soft tissue, followed by the anteroposterior dimensions (mild to severe skeletal II patterns). Variations of lip shape (long to short), lip protuberance (everted to inverted), and nasolabial angle (obtuse to acute) were present. Orthodontic treatment affected the shape of the hard and soft tissue significantly (p < 0.0001). T2 showed significant uprighting of upper incisors (17.5o) and lower incisors (3.7o), improved NLA (8o), an increase in upper lip thickness (1.5 mm), and a reduction in lower lip thickness (0.7 mm) (p < 0.05).ConclusionVertical and anteroposterior shape variations were found. Orthodontic treatment had an impact on both hard and soft tissue shapes. Hence, understanding both the hard and soft tissue shape variations and the orthodontic treatment changes is crucial for an accurate diagnosis and treatment plan to achieve a successful outcome and excellent patient satisfaction.

Comparative Evaluation of Intraarticular Facet Joint Injection Versus Medial Branch Block in Patients With Low Back Pain: A Randomised Controlled Study.

Lumbar facet joint pain may refer to the back, buttocks, and proximal parts of the lower extremities. Intraarticular facet joint injections, facet joint nerve blocks, or facet joint neurolytic procedures are popular for the management of facet joint pain. In this prospective, randomised study, 60 patients with a medical evaluation and pain pattern consistent with lumbar facet joint pain were randomly allocated to two groups. Group Ⅰ (n=30) patients were administered fluoroscope-guided lumbar facet joint injection, and group Ⅱ (n=30) patients were administered fluoroscope-guided lumbar facet joint nerve block. The primary objective is to compare the efficacy of both in managing facet joint pain in terms of pain and disability improvement. Secondary objectives were to compare the requirement for repeat injections and parameters related to the block, such as ease of administering the block, and to note the side effects pertaining to either of the blocks. There was a statistically significant improvement in pain score after injection in both groups (p>0.05). The mean pain score in both groups remained less than two at all time intervals throughout the study period (p>0.05) Excellent patient satisfaction was reported by the majority of the patients at different time intervals in both groups. Both lumbar facet joint injection and lumbar facet joint nerve block are safe and effective techniques for managing lower back pain patients. Both techniques provide adequate pain relief and disability improvement.

Endoprosthetic Reconstruction of the Proximal Humerus with an Inverse Tumor Prosthesis.

Reconstructing the proximal humerus after tumor removal is challenging due to muscle and bone loss. The current methods often result in poor shoulder function. This study assessed the long-term functional and oncological outcomes of using an inverse proximal humerus prosthesis in 46 patients with bone tumors. The results showed a mean range of motion of 62° in anteversion, 28° in retroversion, and 55° in abduction. Notably, 23 patients achieved over 90° of shoulder abduction, with an average of 140°. The median Musculoskeletal Tumor Society Score was 25. Complications included infection in two radiotherapy patients and single dislocations in seven patients. One patient with recurrent dislocations needed revision surgery. In conclusion, the use of the inverse proximal humerus prosthesis in bone tumor treatment yields excellent shoulder function and high patient satisfaction. This approach is especially beneficial for those with metastatic disease.

Proximal Interphalangeal Joint Arthroplasty for Fracture.

Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis. These surgeries provide excellent pain relief and patient satisfaction but patients should be cautioned not to expect an improvement in motion postoperatively. Despite high rates of minor complications and radiographic loosening, these implants have good rates of long-term survival with most revisions occurring in the early postoperative period. They provide viable alternatives to arthrodesis, osteotomy and amputation in the appropriate patient.

Patient satisfaction, safety and efficacy of nurse-led compared to physician-led implantation of cardiac monitors.

Implantation of an implantable cardiac monitor (ICM) is a simple procedure, but adds significant and increasing workload to the arrhythmia service. In 2020, we established a nurse-led ICM implantation service. We aimed to analyze patient satisfaction, adverse events during implant and ICM re-interventions with nurse-led ICM implantation (N-Implant) compared to physician-led ICM implantation (P-Implant). From January 2020 to December 2021 we included all consecutive patients implanted with an ICM in a prospective registry. We collected data on patient characteristics, implant procedure and follow-up. Patients were interviewed by phone four weeks after ICM implantation.Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-Implants. More N-Implants were performed in the outpatient clinic compared to P-Implants (95% vs. 8%; p<0.001). Two N-Implant patients experienced vaso-vagal reaction during implantation (1%), whereas no adverse events occurred during P-Implant (p=0.51). 297 patients (93%) completed the questionnaire. Duration of pain was shorter and wound closure after 2 weeks better following N-Implant (p=0.019 and p=0.018). A minor bruise or swelling at the implant site was reported more frequently after N-Implant (p=0.003 and p=0.041). Patient satisfaction was excellent with both N-Implant and P-Implant (99% and 97%; p=0.16). After a median follow-up of 242 days (range 7-725 days), five ICMs (2%) were explanted prematurely, without differences among groups. Reasons for premature explants were local discomfort (n=2), infection, MRI and ICM malfunction. Nurse-led ICM implantation has excellent patient satisfaction without compromising safety. N-Implant both expands nursing competencies and reduces physician workload.

The transverse upper gracilis flap for autologous breast reconstruction: patient satisfaction outcomes from a single centre experience.

The transverse upper gracilis (TUG) flap procedure is an alternative procedure for autologous breast reconstruction, that is indicated in patients with a low body mass index (BMI) and small to moderate sized breasts. We investigated patient satisfaction of all TUG flap breast reconstructions at Royal Free Hospital. A retrospective review of all patients who had undergone a TUG flap procedure was performed using Electronic Patient Records between October 2010 and October 2021 in Royal Free Hospital. We collected patient demographic data and surveyed our cohort by telephone, investigating patient satisfaction with a 31-item questionnaire. From 2010 to 2021, 57 TUG procedures for autologous breast reconstruction were carried out on 36 patients. One patient died 6 years postoperatively. Patient age ranged from 29-74 with an average of 49.5 years. Also, 3/57 flaps failed, and 1 patient died 6 years postoperatively. Twenty one out of 35 patients responded to the telephone call survey. Out of the survey respondents 11/21 underwent unilateral breast reconstruction and 10/21 underwent bilateral breast reconstruction. The BODY-Q scale in appraisal of thighs reported an overall patient satisfaction mean score of 75.6±27.4 points. The BREAST-Q scale in breast satisfaction reported an overall patient satisfaction mean score of 61.5±24.1 points. Overall, 19/21 of patients were satisfied with the outcome of the TUG procedure. Royal Free Hospital reported excellent patient satisfaction scores. The TUG procedure is a suitable method for patient's undergoing autologous breast reconstruction. However, patient expectations regarding breast satisfaction should be managed.