Excellent Patient Satisfaction Research Articles

Patient satisfaction following total knee arthroplasty using restricted kinematic alignment.

Alternative alignment concepts, including kinematic and restricted kinematic, have been introduced to help improve clinical outcomes following total knee arthroplasty (TKA). The purpose of this study was to evaluate the clinical results, along with patient satisfaction, following TKA using the concept of restricted kinematic alignment. A total of 121 consecutive TKAs performed between 11 February 2018 to 11 June 2019 with preoperative varus deformity were reviewed at minimum one-year follow-up. Three knees were excluded due to severe preoperative varus deformity greater than 15°, and a further three due to requiring revision surgery, leaving 109 patients and 115 knees to undergo primary TKA using the concept of restricted kinematic alignment with advanced technology. Patients were stratified into three groups based on the preoperative limb varus deformity: Group A with 1° to 5° varus (43 knees); Group B between 6° and 10° varus (56 knees); and Group C with varus greater than 10° (16 knees). This study group was compared with a matched cohort of 115 TKAs and 115 patients using a neutral mechanical alignment target with manual instruments performed from 24 October 2016 to 14 January 2019. Mean overall patient satisfaction for the entire cohort was 4.7 (SE 0.1) on a 5-point Likert scale, with 93% being either very satisfied or satisfied compared with a Likert of 4.3 and patient satisfaction of 81% in the mechanical alignment group (p < 0.001 and p < 0.006 respectively). At mean follow-up of 17 months (11 to 27), the mean overall Likert, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and Knee Society Knee and Function Scores were significantly better in the kinematic group than in the neutral mechanical alignment group. The most common complication in both groups was contracture requiring manipulation under anaesthesia, involving seven knees (6.1%) in the kinematic group and nine knees (7.8%) in the mechanical alignment group. With the advent of advanced technology, and the ability to obtain accurate bone cuts, the target limb alignment, and soft-tissue balance within millimetres, using a restricted kinematic alignment concept demonstrated excellent patient satisfaction following primary TKA. Longer-term analysis is required as to the durability of this method. Cite this article: Bone Joint J2021;103-B(6 Supple A):59-66.

Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia

Background: Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty. Indications: Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination. Technique Description: The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm–thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur. Results: A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10. Discussion/Conclusion: Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.

THREE-DIMENSIONAL PRINTING AS A POTENTIALLY EFFECTIVE STRATEGY FOR IMPROVING THE OUTCOMES IN MICROTIA RECONSTRUCTION

ABSTRACT:Aim: The reconstruction of microtia cases is a challenging topic and Auricular reconstruction is a unique area of facial plastic surgery where a wide array of reconstructive options often must be considered. The goal is to assess the use of three-dimensional (3D) printing to create a 3D model for use during reconstruction to achieve better aesthetic results.Patients and methods: This study included ten patients with microtia. Two stages of ear reconstruction, the authors used a 3D printed auricular model of the contralateral ear as an intraoperative guide. The Mansoura ear reconstruction scale was conceptualized and used by the authors to assess the final aesthetic outcomes. Results: In total there were 10 patients with 11 affected auricles. Results were 6 patients with an excellent result, 3 patients with a very good result and one patient with a fair result according to Mansoura ear reconstruction scale.Conclusions: To conclude, the use of a 3D printed auricular model specific to each patient for microtia reconstruction led to excellent results and patient satisfaction after reconstruction. The use of 3D printed models for microtia reconstruction resulted in an overall increase in aesthetic outcomes and increased patient satisfaction.Keywords: Auricular model - Costal cartilage - 3D printing - Ear reconstruction- Microtia -Tissue expander.

Management of Allen type III nail bed injuries and distal phalangeal fractures with and without fixation

For combined nail bed injuries and distal phalangeal fractures, fixation may be indicated when there is fracture instability and if a K-wire can be successfully placed in the fracture fragments. We determined the outcomes when these criteria were applied for patients with Allen type III injuries without substantial tissue loss. We retrospectively analyzed 57 patients who had surgery for nail bed injuries with distal phalangeal fractures between October 2017 and January 2020. All patients underwent anatomical nail bed repair, and some had fracture fixation, according to specific surgical criteria. We obtained data about demographic and clinical characteristics, postoperative radiographs, complications, range of motion, and satisfaction. To achieve our primary objective, we evaluated the patient population as a whole. The median follow-up was 12 months (range, 7–21). After 90 days, all 57 patients achieved satisfactory fracture union, 54 (95%) had excellent range of motion, and 54 (95%) were either satisfied or very satisfied with the outcome. Though 6 (10%) patients had residual fracture displacement, none had complications. In patients with Allen type III fingertip injuries without substantial tissue loss, anatomical nail bed repair and triage of patients to fixation or no fixation are likely to result in excellent functional outcomes and high patient satisfaction. However, fixation can neither be recommended nor rejected for these injuries based on this study alone.Level of evidence: IV.

Management of Mild Lower Extremity Deformity and Leg Length Discrepancy

Limb malalignment and length discrepancy are common problems treated by pediatric orthopaedic surgeons. These deformities may increase the rate of degenerative disease of the knee, hip, and spine. Previous teaching suggested that there were no long term consequences of mild deformity, however, newer studies suggest that there may be morbidity associated with as little at 5 mm of leg length discrepancy. There are many etiologies that can contribute to limb deformity, and so a thorough history and physical is key to management. Pediatric patients present the unique opportunity to utilize the growth of the physis to correct these deformities with adequate planning. Alternatively, lengthening techniques have become safer and are associated with excellent patient satisfaction. The mounting evidence of the long term consequences of leg deformity, coupled with more sophisticated correction techniques, brings traditional indications for deformity correction into question.

Crushed Cartilage and Autologous Fat for Dorsal Nasal Refinement.

Dorsal contour irregularities remain a potential undesirable sequela of rhinoplasty. Use of dorsal onlay grafts can camouflage such irregularities. In this article, a novel technique for dorsal onlay grafting utilizing crushed cartilage mixed with autologous fat is described. This study aims to assess long-term graft retention and aesthetic outcomes with this technique. Patients with >18-month follow-up who underwent primary open rhinoplasty with the described technique were reviewed. Three-dimensional photographs taken at multiple timepoints were overlaid with volumetric subtraction used to quantify graft retention. The Rhinoplasty module of the FACE-Q was completed by each patient, and the Rhinoplasty Assessment Scale Photographic (RASP) was completed by surgeon reviewers. Pre- and postoperative changes in dorsal height as well as RASP scores were compared with paired t-tests. Changes in BMI, dorsal volume, and dorsal height were compared with linear regression. P values <0.05 were considered significant. Fourteen patients were included, mean age 32. Mean intermediate and final follow-up was 17.8 months and 28.9 months, respectively. There were no statistically significant dorsal height change (mean = 0.0 mm, p = 0.91) and minimal dorsal volume change (mean = 0.02cm3, range: 0.08 to 0.13). Patients reported a high degree of satisfaction with facial/nasal appearance and psychological/social functioning. There was a statistically significant improvement in RASP scores (p < 0.001) postoperatively. Crushed septal cartilage mixed with autologous fat is an effective option for dorsal nasal onlay in rhinoplasty and is associated with excellent graft retention, patient satisfaction, and nasal aesthetics. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Two Stage Nasolabial Flap for Unilateral Nasal Ala and Soft Triangle Reconstruction

Introduction: Nose is the most noticeable feature in the facial profile. Any deformity of nose causes social embarrassment and ridicule. Isolated nasal alar hypoplasia/cleft or traumatic loss is a rare anomaly which requires reconstruction. Congenital deficiency of soft triangle of nose and part of ala is not paid attention to in early childhood. Hence, most of these individuals present in late childhood, adolescence or adulthood. We report ten such cases and their reconstruction using two stage ipsilateral interpolated nasolabial flap. Material and Methods: Demographic data including age, sex, associated co-morbidities, previous surgeries or history of trauma were documented. Patients were in age group of 10-25 years. The mean size of defect was 1.5 X 1.6 cm. Inferiorly based skin flap raised from ala was turned down and used as inner lining. Conchal cartilage graft was placed for support in the first stage itself. Nasolabial flap was raised by subcutaneous dissection and insetting done to create outer cover. Second stage for pedicle detachement was done after 3 weeks. Results: Post operative period was uneventful in all cases. Minimal cosmetic morbidity was noted. Scar was well concealed in the nasolabial crease and colour match was also acceptable with good patient satisfaction at 6-12 months. Conclusion: Nasal alar hypoplasia/cleft, congenital or traumatic, is a rare entity which needs to be recognised and reconstructed. According to the size of the defect, it can be reconstructed with composite cartilage graft or local flaps. Interpolated nasolabial flap with cartilage graft is a good option with minimal scar and excellent patient satisfaction.

Impact of Effective Communication on the Quality of Excellent Service and Patient Satisfaction in the Outpatient Department

Effective communication is crucial to support nurses in providing excellent service, including a caring attitude towards patients to help facilitate their needs and to realize patient satisfaction. The purpose of this literature review was to describe the impact of effective communication on the improvement of the quality of excellent service and patient satisfaction in outpatient departments. This review was conducted by searching published articles on Google with selected keywords including “effective communication,” “excellent service” and “patient satisfaction.” The search was limited to publications between 2009 and 2019. The result of the study showed that effective communication can significantly impact the improvement of excellent service quality, thereby increasing patient satisfaction with the health care they receive. The study recommends a collaboration between the HR and the Head of Nursing to conduct effective communication training. Nurses are expected to be able to improve their effective communication skills with patients, and further studies are needed to dig deeper into the impact of effective communication on improving the quality of excellent service and patient satisfaction.&#x0D; Keywords: effective communication, excellent service patient satisfaction

An integrated educational and multimodal approach to achieving an opioid-free postoperative course after arthroscopic rotator cuff repair.

BackgroundIn the realm of shoulder surgery, arthroscopic rotator cuff repair (RCR) is one of the most painful procedures and is often associated with higher opioid consumption. The purpose of this study was to evaluate effectiveness of preoperative and postoperative patient education and multimodal pain management to achieve an opioid-free postoperative recovery after RCR.MethodsSixty patients who underwent RCR were divided in 2 groups. All patientsreceived an interscalene nerve block and multimodal pain management. The opioid intervention group (OIG) in addition received preoperative education on expectations of pain, non opioid pain protocols, and alternate therapiesto minimize pain as well as customized postoperative instructions. Patients were compared on pain levels, opioid consumption, and outcomes scores preoperatively and at 48 hours, 2 weeks, and final follow-up. Patient-reported outcomes and opioid usage were compared and analyzed using student’s t-tests and logistic regression.ResultsAt 48 hours, 15% of OIG patients reported use of rescue opioids after surgery compared with 100% of control group patients. Zero percent of OIG patients reported opioid use at 2 weeks compared to 90% of control group patients (P = .0196). Patients in both groups showed significant improvements in all outcome scores (P ≤ .05). At 6 weeks, functional, Constant, and satisfaction outcome scores were all higher in the OIG (P < .05). At last follow-up, there were no significant differences for all patient-reported outcomes between groups.ConclusionsApplication of patient education tools and innovative multimodal pain management protocols successfully eliminates the need for opioids while maintaining excellent patient satisfaction and outcomes.

Addressing financial toxicity in urologic oncology patients.

170 Background: Financial toxicity, or the financial burden related to cancer care, is a source of distress for urologic oncology patients. This study aimed to address financial toxicity among prostate, kidney and bladder cancer patients and test the feasibility of a lay-health worker (LHW) and social work (SW) driven intervention. Methods: LHW assessed financial burden in urologic oncology patients with advanced cancer who presented for return visits at a single academic center. The LHW collected responses to three statements on a Likert scale – “I worry about the financial problems I will have in the future because of my illness or treatment”, “My cancer or treatment has reduced satisfaction with my present financial situation”, and “I feel financially stressed”. Patients who responded, “Very much” (4) or “Quite a bit” (3) to all statements were offered a one-on-one consultation with a trained SW. The SW provided personalized recommendations after review of patients' financial information, insurance status, and out of pocket costs. SW referred patients to appropriate support services including those offered by the hospital, government, nonprofits and private corporations. Pre-specified outcomes included pre/post-intervention financial toxicity and patient satisfaction with the intervention. Results: 145 patients (67%) agreed to be screened for financial toxicity by the LHW. Most participants were White (n = 100, 69%), male (n = 130, 90%), married (n = 104, 72%) and with incomes &gt; $100,000 (n = 111, 77%). The majority had prostate cancer (n = 87, 60%), followed by kidney cancer (n = 36, 25%) and bladder cancer (n = 22, 15%). 12% (n = 26) responded “I worry about the financial problems I will have in the future because of my illness or treatment”, “Very much” or “Quite a bit”. 14% (n = 20) responded “My cancer or treatment has reduced satisfaction with my present financial situation”, “Very much” or “Quite a bit”. 12% (n = 17) reported “I feel financially stressed”, “Very much” or “Quite a bit”. A total of 14 patients were eligible for the intervention and were referred for a one-on-one SW consultation. Post-intervention results indicated excellent patient satisfaction with the intervention and a significant improvement in financial toxicity. 100% of patients reported the SW “provided financial resources that were beneficial to me”, and 78% (n = 11) had a decrease in financial toxicity score post-intervention (average decrease = -1, p = 0.05038). Conclusions: In this single institution study of prostate, kidney and bladder cancer patients with overall low baseline financial burden a LHW and SW driven intervention was feasible and effective in reducing financial toxicity.

Scar satisfaction assessment after conventional thyroidectomy: follow-up results.

SUMMARYObjectiveWith the introduction of remote access thyroidectomy questions regarding patient satisfaction after trans-cervical thyroidectomy has been raised in several publications. As far as neck scars are concerned, patient satisfaction in the early post-operative period and long term are different. This study assessed patient satisfaction regarding their neck scar in the early post-operative period and at long term follow-up.MethodsRetrospective study. Patients underwent total thyroidectomy by single surgeon. Scar satisfaction scores assessed at different time intervals (< 6 weeks, 6 months, 2 years and 5 years after procedure). Scores of patients aged < 35 years and > 35 years were compared. Patient and observer scar assessment scales (PSAS, OSAS) and patient satisfaction score (PSS) were used.Results595 patients were included (443 females and 152 males, age 19-77 years). Improvement was observed in the PSAS (13.5 ± 2.3 at 6 weeks; to 4.32 ± 1.37 at 5 years; p < 0.05) and OSAS (7.32 ± 1.35 to 4.18 ± 1.51; p < 0.05). PSS improved over time from 1.8 ± 0.8 to 0.92 ± 0.66 (p < 0.05). The satisfaction scores were higher in patients < 35 years (p = 0.003). The scores indicated excellent patient satisfaction and are similar to those published in the literature regarding minimally invasive surgery (MIS).ConclusionsProper incision placement and suturing resulted in excellent patient satisfaction regarding scars after conventional thyroidectomy.

98 Smartphone-based counseling and support platform and the effect on postpartum lactation-a randomized controlled trial

We aimed to study the impact of introducing a smartphone-based daily feedback and counseling platform among post-partum women and a multidisciplinary lactation-support team - on lactation rates and additional maternal and neonatal outcomes. Counseling was provided via a specifically developed App from a multi-disciplinary team (obstetricians, neonatologists, nurses, lactation counselors, psychologist) in attempt to assist and counsel in maintaining lactation. This is a prospective, single center, randomized controlled trial. Women planning to breast-feed were recruited at postpartum day 1 and were randomized to: (1) routine lactation counseling and support (control group) or (2) additional daily detailed counseling and feedback on lactation from the team via the App (App group). The primary outcome was partial or full lactation at three months. Secondary outcomes included lactation at additional time-points up to six months postpartum and various maternal and neonatal outcomes including psychological aspects (postpartum depression, anxiety). The study was adequately powered to detect a 15% difference in the primary outcome. A total of 197 women were recruited , 97 in the App group and 100 in the control group. The two groups did not differ in any maternal background or delivery characteristics. The App group demonstrated higher rates of the primary outcome of lactation 3 months postpartum (81.4% vs. 69.0%, p=0.04) as well as lactation 6 weeks postpartum (96.9% vs. 82.0%, p<0.001), compared to the control group. Neonatal and maternal outcomes including psychological outcomes were comparable between the groups. Patients in the App group reported excellent satisfaction from the use of the App and from their postnatal care. The current study adds to the growing utility of technology platforms in obstetric care. Introduction of a smartphone-based daily feedback and counseling platform between postpartum women and a multidisciplinary lactation-supporting team increased lactation rates 3 months postpartum with excellent patient satisfaction.

Developing a Breast Reconstruction Program in a Resource-Constrained Ghanaian Teaching Hospital: Needs Assessment and Implementation.

As the detection of breast cancer in Ghana improves, the incidence of mastectomy has increased and the outcomes have improved. As a secondary result, the need for breast reconstruction is increasing. The cultural hesitation to undergo a mastectomy and live without a breast can be decreased by making breast reconstruction available, cost-effective, and acceptable. Cultural, economic, and technical factors were considered in choosing the best method of breast reconstruction. Discussions, lectures, and cadaver dissections investigated the various reconstructive options. Operative cases were performed using a latissimus musculocutaneous flap, a lower abdominal transverse rectus abdominis myocutaneous (TRAM) flap, and a midabdominal TRAM flap. The midabdominal TRAM was found to be the best choice at Komfo Anokye Teaching Hospital. It is a reliable, robust, well-perfused, single-stage flap that produced excellent patient satisfaction.

Factors Associated with Failure following Hip Arthroscopy for FAI in Patients over 40

Hip arthroscopy is considered one option in preserving the hip. Previous studies have shown age may be a predictor of failure; however, it is unclear what factors lead to failure in older patient. The purpose of this study was to determine factors associated with conversion to total hip arthroplasty in patient over 40 undergoing hip arthroscopy. 268 patients were identified who were over 40 years of age, had primary hip arthroscopy for FAI with labral repair. All had minimum joint space of >2mm. There were 144 females and124 males, with an average age of 49±6. Hips were evaluated using the modified Harris hip score(mHHS), Hip Outcome Score (HOS), WOMAC and patient satisfaction (1 to 10; 10=very satisfied). Conversion to THA was confirmed by patients. 87 patients underwent THA. Patients who converted to THA were significantly older (50 vs 48;p=0.001), higher Tonnis angle (10.7 vs 6.8;p=0.016), lower lateral center edge (34 vs 37;p=0.044), larger alpha angle (77 vs 70;p=0.028). The following preoperative subjective complaints were associated with THA: stiffness interfering with activity were 3.7 [95%CI, 2-7] time more likely to convert to THA(p<0.001); weakness were 2.7[95%CI,1.5-5] times more likely to convert to THA(p=0.001) and loss of motion were 1.9{95%CI,1.1 to 3.2] times more likely to convert to THA. At arthroscopy, the presence of femoral cyst was not associated with THR, but patients with an acetabular cyst were 3.0 [95%CI,1.6-5.4] times more likely to convert to THA. Patients with microfracture were 10 [95%CI, 6-18] times more likely to convert to THR. Using regression analysis, preoperative weakness, microfracture, and acetabular cyst were independent predictors of THA (p<0.001, R2=0.408). Of the patients who did not have THA, at an average 7-year follow-up (5 to 11 years), the mean SF-12 PCS was 51.7±9, and mHHS was 85±17, HOS ADL was 89±15. The median WOMAC was 5 [95%CI 8.7-12.9] and median patient satisfaction with outcome was 10 [95%CI 8-9]. HOS-ADL PASS was achieved in 75% of patients. Factors associated with THR following arthroscopy in patients over 40 include age, symptoms of weakness, stiffness, and loss of motion, and microfracture and acetabular cysts at arthroscopy. Those patients who do not require THR, have excellent outcomes and high patient satisfaction.

A novel indigenous technique for corneal tattooing using self-prepared do-it-yourself carbon soot pigment.

Purpose:To evaluate the cosmetic efficacy and safety of an indigenous novel corneal tattooing technique using a self-prepared candle soot pigment.Methods:This pilot observational study involved 22 eyes of patients at a Bengaluru-based ophthalmology setting. The study considered only eyes with nil or low visual potential. Eyes with active ocular inflammation, nasolacrimal obstruction, severe hypotony, and shrunken globe due to phthisis bulbi were excluded. The surgery was carried out under aseptic conditions using a self-prepared carbon soot pigment. Different methods such as lamellar, surface needle micropuncture, machine-assisted surface tattooing, or a combination were used for pigment application.Results:Ten eyes underwent combined lamellar and surface tattooing; lamellar tattooing was performed for 11 eyes, and surface tattooing for one eye. Nineteen patients underwent limbus-to-limbus corneal tattooing and three patients had undergone focal tattooing to cover nasal pterygium scar, inferior iridectomy, and leukocoria due to calcific cataract. Nearly 91% were subjectively satisfied with the tattooing technique and 82% had excellent cosmetic coverage along with subjective satisfaction. None of the subjects required a repeat surgery or augmentation of tattooing. There was no reported case of corneal inflammation, epithelial erosions, infiltrations, infections, nonhealing areas, stromal melting, or any other complications.Conclusion:This novel procedure, involving self-prepared carbon soot pigment tattooing, provides excellent cosmetic results and high patient satisfaction. It is relatively safe, easy to perform, and the conventional steps of tattooing such as pigment procurement, storage, and sterilization can be avoided, as the carbon pigment is freshly prepared under aseptic conditions.

Functional and MRI Outcomes of Superior Capsule Reconstruction with Acellular Dermal Matrix

Superior capsular reconstruction (SCR) is an emerging treatment option for irreparable massive rotator cuff tears (MRCT). The initial description utilized fascia lata autograft, but acellular dermal matrix (ADM) has become the graft of choice in the USA. Several reports have demonstrated excellent short-term functional improvement and patient satisfaction, but there is limited data correlating imaging studies of graft integrity to functional outcome. The purpose of this study was to determine if functional outcome after SCR is dependent on dermal allograft integrity on post-operative MRI.

Management of Postcaesarean Delivery Analgesia-Diclofenac Suppository, Paracetamol Infusion and a Combination

Introduction: One of the most important aspect of postoperative care is pain management which plays an important role in early recovery and improves patient’s general condition. Paracetamol and diclofenac have an excellent safety profile when compared to opioids. Aim: To assess and compare the analgesic efficacy and safety of individual use of Intravenous (IV) paracetamol, diclofenac suppository and in combination. Materials and Methods: This hospital-based cross-sectional study was conducted from October 2018 to June 2020 at Department of Obstetrics and Gynaecology. A total of 90 women who underwent caesarean section were recruited for the study and were randomly allocated (lottery method) into three groups with 30 participants in each group. The patients underwent Lower Segment Caesarean Section (LSCS) under spinal anaesthesia with the same technique and medicine, (Bupivacaine 0.5%) without receiving any sedation. Group A patients received diclofenac suppository 50 mg every eight hourly, Group B received paracetamol infusion 1000 mg every eight hourly and Group C received 50 mg diclofenac suppository and 500 mg IV paracetamol every eight hourly. Pain severity (Visual Analogue Scale (VAS) score), Heart Rate (HR), Blood Pressure (BP) and side-effects were evaluated at 2,4,6,8,12 and 24 hours postoperatively. Patient satisfaction score was evaluated 24 hours after caesarean section. Results: Age range of participants was 19 to 28 years. Mean duration of surgery (minutes) in each group were- Group A-56.5±7.49, Group B-58.27±8.06 and Group C-56.97±6.78, respectively. There was a significant reduction of pain in patients receiving paracetamol and diclofenac suppository combination group. The satisfaction score was categorised as excellent by 80% patients in Group C. In Group A 30% and in Group B 16.6% categorised as excellent patient satisfaction score. The adverse effects such as nausea and epigastric discomfort was higher (7.7%) with diclofenac suppository group followed by Paracetamol (2.2% side-effects) and minimal with combination (1%). Conclusion: Paracetamol infusion is as effective as diclofenac suppository in reducing postoperative pain following caesarean section. Diclofenac suppository and IV paracetamol combination provides more effective postoperative analgesia compared with individual usage of IV paracetamol or diclofenac suppository in patients following caesarean section. The combined use of paracetamol and diclofenac suppository has fewer side-effects compared with individual use of either IV paracetamol or diclofenac suppository.

Patient experience with electronic health record–integrated postoperative telemedicine visits in an academic endocrine surgery program

BackgroundIn response to the coronavirus 2019 pandemic, telemedicine use has increased throughout the United States. We aimed to measure patient experience with electronic health record-integrated postoperative telemedicine encounters following thyroid and parathyroid surgery. MethodsIn this preliminary study, adult patients receiving postoperative electronic health record–integrated telemedicine video encounters or standard in-person visits after thyroid or parathyroid surgery at a single institution were prospectively enrolled from November 2019 through May 2020. Patients with home zip codes 10 to 75 miles from the medical center were included. Patient experience was assessed using the Consumer Assessment of Health Care Providers and Systems Clinician & Group Visit Survey 2.0 and the Communication Assessment Tool. Top box analysis was performed, defined as the percentage of respondents who chose the most positive response score. ResultsThe cohort consisted of 45 telemedicine and 32 in-person encounters. Both groups reported similar and excellent patient experience and satisfaction (9.7 of 10 for telemedicine vs 9.8 of 10 for in-person encounters, mean difference 0.02, 95% confidence interval, [–0.25 to 0.29]). Similar surgeon communication performance was observed (mean Communication Assessment Tool top box score 83% telemedicine vs 86% in-person, mean difference 3%, 95% confidence interval [–10% to 17%]). Nonlinear increases in monthly telemedicine encounter volume were observed within the section of endocrine surgery (3-fold increase) and the health system (125-fold increase) from November 2019 to May 2020. ConclusionPatients who underwent cervical endocrine surgery reported similarly high rates of satisfaction and excellent surgeon communication following either telemedicine or in-person postoperative encounters. Electronic health record–integrated telemedicine for a subset of low-risk procedures can act as a suitable replacement for in-person encounters. A surge in telemedicine use, stimulated by the coronavirus 2019 pandemic, was experienced at our institution.

Integrating behavioral health services at employer-sponsored health clinics: A descriptive analysis.

Approximately, 20% of adults in the United States have a behavioral health concern, resulting in $732M in direct medical spending and over 5 million lost workdays annually. Employers bear a substantial share of these costs. The objective of this study was to describe the integration of behavioral health services at employer-sponsored health clinics. Retrospective cohort analysis of patients seen for individual behavioral health services from 1/1/2018 to 12/31/2018 in employer-sponsored clinics. Among the 2,954 patients cared for by a behavioral health provider, 49% met criteria for moderate or severe depression and/or anxiety. The median duration between appointment scheduling and a behavioral health triage visit was 2 days (SD = 7.2 days), and median interval to an initial psychotherapy visit was 10 days (SD = 14 days). The mean number of visits with a behavioral health provider within the initial 3 months after presenting for care was 5.3 visits (SD = 2.8 visits). During the course of treatment, anxiety (Generalized Anxiety Disorder-7 [GAD-7] scores) decreased by 31% and depression (Patient Health Questionnaire-9 [PHQ-9] scores) decreased by 24%. Patient satisfaction with their behavioral health care was excellent. Integrating behavioral health services into employer-sponsored clinics can result in timely access to psychotherapy, improvements in clinical symptoms, and excellent patient satisfaction. Employers interested in providing greater access to behavioral health care should evaluate integrating such services into onsite or near-site health clinics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Early Osia® 2 bone conduction hearing implant experience: Nationwide controlled-market release data and single-center outcomes

PurposeBone conduction hearing devices are a well-established treatment option for conductive or mixed hearing losses as well as single-sided deafness. The Osia® 2 System is an active osseointegrated device where a surgically implanted titanium fixture supports a newly developed piezoelectric actuator that is placed under the skin. MethodsNationwide data collected during a controlled-market release (CMR) of the Cochlear™ Osia® 2 System as well as outcomes at single, tertiary-level private practice Otology/Neurotology center were retrospectively reviewed. Key learnings from surgeons and audiologists are discussed. ResultsDuring the CMR period, 23 surgeons performed 44 operations on 43 recipients. The mean age of recipients was 44 years and mean surgery duration was 52 min. The most commonly used incision was postauricular but anterior to the device (78%). Five complications were observed during the CMR, none of which were device related. Twenty-one audiologists performed 33 Osia® 2 activations during the CMR. The mean age of this group was 47 years, and the mean duration of each activation appointment was 55 min. Single-center data at the authors' institution demonstrated an average additional PTA4 gain with the Osia® 2 patients of 9.6 dB compared to Baha Attract and 10.2 dB compared to Baha Connect. ConclusionThe Cochlear™ Osia® 2 System represents a significant advance in auditory osseointegrated implant technology. Digital piezoelectric stimulation delivers high power outputs, improves high frequency gain for optimal speech perception, and maintains safety while providing excellent patient satisfaction.