Excellent Satisfaction Research Articles

Modified McKissock Technique for Secondary Breast Reduction - A Prospective Study on Safety, Surgical and Aesthetic Outcomes.

Numbers of secondary breast reductions are increasing but those are potentially associated with higher complication rates than primary mammaplasty. Necrosis of the Nipple-Areola-Complex (NAC) is a devastating complication that can occur after repeated NAC transposition, particularly when the initially used pedicle is unknown. Thus, the authors established a modification of McKissock's technique for secondary breast reductions including three pedicle components to ensure safe vascular supply of the NAC. The presented technique incorporates a superior and inferior dermoglandular pedicle according to McKissock and an additional central pedicle. The technique was applied for secondary breast reduction in a series of 25 breasts (14 patients: 11 bilateral, 3 unilateral). Complication rates, pre- and postoperative BREAST-Q scores, and aesthetic outcomes were evaluated. Mean resection weight was 299 g (range, 40-646), and the NAC was transposed by 4.2 cm on average (range, 1-10). No case of NAC-necrosis was observed, and comparison of pre- and postoperative BREAST-Q values indicated substantial improvement in all domains. Postoperatively, 84.6% of patients reported excellent satisfaction with breast appearance. According to those results, the modified McKissock-technique is a safe technique for patients requiring secondary breast reduction, even if the primarily used pedicle is unknown. Additionally, the established technique is associated with improved postoperative patient-reported outcomes and yields aesthetically favorable results.

ThP3.6 - Long Term Surgical Outcome of Complete Intrathoracic Stomach (CIS)

Abstract Background & Aims Surgery is required for medically fit symptomatic CIS patients to avoid complications (volvulus, obstruction & strangulation) that have high morbidity & mortality. To assess the long term outcome including QOL (quality of life) for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%). Methods Retrospective analysis of a prospectively collected of 34 CIS of 154 consecutive GPEH(Giant Para-Esophageal Hernia) patients intervened between March 2008- December 2023 in a large DGH. Data collected included demographics, BMI, ASA, Preoperative investigations (OGD & Computerised Tomography), operative details including complications, & standardised GERD-Health Related Quality of Life Questionnaire(GERD-QOL) scores of 0-5, 6-10, 11-15 & more than 15 as excellent, good, fair & poor respectively (pre-operatively, 6-month post-operative & long-term), postoperative diet, SOB (shortness of breath) & patient satisfaction. Results 34 included M:F 11: 23, age 72*(45-83) years, BMI 29 *(20-43), ASA III *(II-III). 20(59%), 20(59%), 18(53%), 14(41%), 14(41%) & 12(35%) had heartburn, dysphagia, retrosternal discomfort, vomiting, weight loss and SOB respectively. 6 (18%) emergencies, 22 (65%) incomplete OGDs, operative time 210* (150-510) mins, 1(3%) conversion, 3*(9%) surgical mortality & PO stay 3*(2-27) days. Pre and 6-month post surgery GERD-QOL poor (≥15) & excellent (<5) in 21(62%) & 32(94%) respectively with 32(94%) excellent satisfaction. Follow up at 102*(16-190) months had 2 more unrelated deaths, 21(72%) contacted with GERD-QOL excellent (<5) in 14(67%), poor 1(5%), 19(90%) solid diet, 2(10%) SOB with 19(90%) excellent satisfaction. Conclusion Favourable long term outcome achieved here supports complex surgery for this debilitating condition in the medically fit symptomatic elderly patients. * Median

Comparison of Outcomes of V-Y Atasoy vs Pentagonal Advancement Flap in the Management of Fingertip Injuries Allen Type II and III in a Tertiary Hospital

Background: Fingertip injuries are the most common traumatic conditions of the hand, affecting productivity and livelihood due to a decrease in manual labor capabilities. The V-Y Atasoy advancement flap is typically effective in managing dorsal or transverse fingertip Allen type II and III injuries but may result in complications like dog ears, flap necrosis, paresthesia, and hook nail deformities. Objective: This paper aimed to describe the assessment, operative technique, and outcomes in patients with fingertip injury Allen type II and type III treated with the V-Y Atasoy advancement flap versus the pentagonal flap. We also aimed to compare the outcomes and complications associated with each technique. Methodology: A randomized controlled trial was done among patients with fingertip injury Allen type II and III who were admitted to a tertiary hospital. Results: There were no significant differences in the rates of immediate complications (flap necrosis, infection, dog ear deformity) or short-term outcomes (two-point discrimination, Semmes-Weinstein monofilament test) between the two groups. Most patients had excellent satisfaction and were able to return to work. Conclusion: Patients of the two groups had good to excellent outcomes and had minimal complications, with no significant differences between the groups. The pentagonal flap can be an alternative to the V-Y Atasoy flap in managing fingertip injuries, especially those with a larger surface area of injury.

THE LIST: TRANSFORMING THE ORTHOPAEDIC TRAUMA MANAGEMENT AND HANDOVER IN A SUSTAINABLE AND COST-NEUTRAL WAY

Trauma, across the United Kingdom, is managed using several software, paper based lists on Microsoft Word/Excel or Teams. There is usually poor handover or no handover in a standard format- during the on call, in the trauma meetings or in the wards. The software in the market for trauma management are not cost friendly or adaptable to local demands. The alternatives like Microsoft WORD based lists are fraught with their own problems. We endeavoured to make our trauma management effective.A Quality Improvement Project was done. The goals to achieve at end of a year were:Daily Trauma Handover in standardised format >90%Ward Handover in standardised format >90%Availability of outcomes of patients in clinic >80%Reduction of paper usage >90% at the end of six monthsAvailability of updated “outliers” information >90% at the weekend ward roundDocumentation from the Trauma Meeting > 90%On-Call documentation in standardised format >90%Doctor Satisfaction >75% in terms of: ease of us;, searchability of patient; ward round experience; morning trauma meeting experience; handover experience; inter-specialty communication; reliability; daily time saving; on-call time saving; patient care/safety; overall satisfaction.We used Microsoft Sharepoint List to manage our trauma workload and have named the tool as “The List”. The List has achieved all objectives as above in one year's time, except Outlier information which was at 67% in a recent PDSA (Plan-Do-Study-Act) cycle. The survey showed excellent doctor satisfaction and 90% respondents felt that The List saved an hour or more during the on-call and also during the ward rounds.We conclude that The List is a very powerful tool making trauma meetings efficient and handover effective. It is indigenous, adaptable, safe, sustainable, cost neutral and easy to use.

The Relationship of Culture-Based Primary Service with Patient Satisfaction in the Inpatition Room of Hospital X in Pontianak

The aim of this research is to analyze the relationship between culture-based excellent service and patient satisfaction in the inpatient room at Hospital X in Pontianak.The research uses quantitative descriptive methods with a cross-sectional study approach. The total sample is 86 respondents, the measuring instrument is a questionnaire of excellent service and customer satisfaction which was created by the author himself with validation results of calculated r values ranging from 0.40 to 0.887 and reliability of 0.944 and 0.956. The research results showed that almost all of the respondents said it was very good, 68 people or (79.07%), the level of patient satisfaction, the majority of respondents said it was very satisfied, 63 people or (73.26%), the results of the analysis of excellent service relationships based on Culture and patient satisfaction with the Spearman Rank obtained a SIG value = 0.000 (Sig < 0.05), so it can be concluded that there is a very significant relationship between excellent service and patient satisfaction in the Inpatient Room at Hospital X in Pontianak. It is hoped that the results of this research can be used to improve excellent nursing service because of the importance of excellent nursing service in increasing the satisfaction of inpatients at Hospital X in Pontianak.

U-Turn Design Metatarsal Artery Flap: Reliable Solution in Distal Forefoot Defect.

In distal forefoot defect, finding wound closure is challenging because of the distal site and small blood vessels involved. One possible resolution is the utilization of a metatarsal artery flap in a 'U-turn' design. This method offers several advantages, including its long length and a viable option for distal forefoot defect. Thirty-six patients with forefoot injuries from metatarsophalangeal (MTP) joint to distal interphalangeal (DIP) joint due to trauma were consecutively recruited and completed the study. Outcomes were analyzed descriptively, and risk prediction modeling for edge necrosis was performed. The mean ± SD follow-up time was 27.3 months ±1.9. The median (IQR) MTP-to-DIP joint wound width and length were 1.8 (1.4, 3.0) and 3.2 cm (2.9, 6.2), respectively. The median (IQR) width, length, and width-to-length ratio flap dimensions were 3.6 (2.8, 6.0), 4.7 cm (4.3, 9.3), and 1.5 (1.2, 1.7), respectively. The mean ± SD operative time was 32.9 min ± 5.7. The median (IQR) intraoperative blood loss was 5.0 mL (4.0, 5.0). The mean ± SD hospital length of stay postoperatively was 4.0 days ±1.0. The mean ± SD Foot and Ankle Outcome Score and Foot Function Index were 64.1 ± 2.5 and 7.8% ± 3.3, respectively. All patients had good or excellent aesthetic satisfaction. Spontaneously resolving edge necrosis occurred in 13.9%. The mean ± SD time-to-start-ambulation was 1.7 weeks ±0.5. At the 2-year follow-up visit, all patients had reduced U-turn flap pivot point redundancy without shoe size impact, needing reoperation, or donor site morbidity. Edge necrosis was significantly associated with length-to-width ratio ( P = 0.014) but not with Foot and Ankle Outcome Score or Foot Function Index. Metatarsal artery flap of U-turn design was reliable and was associated with a short recovery time, alternative resolution for forefoot area due to short operation time, minimal blood loss, short hospital length of stay, and excellent availability.

Assessing Customer Satisfaction in Mahindra’s Automotive Division: The Role of Service Quality and Technological Integration

This study examines customer satisfaction in Mahindra's automotive division, highlighting the impact of technological integration and service excellence. Using a mixed-methods approach, the study examines qualitative insights from in-depth interviews with consumers and service staff in addition to quantitative data from customer surveys. The results show that excellent customer satisfaction is greatly increased by high service quality, with personnel competency, promptness, and reliability being important contributing variables. To further enhance the client experience, cutting-edge technology integration is essential. Examples of these are linked car features and digital service platforms. The report emphasizes how crucial it is for Mahindra to keep coming up with new ideas and tweaking its service plans in order to stay ahead of the competition and satisfy changing customer demands. The management implications emphasize how crucial it is to allocate resources to both human resources and The findings show that timeliness, dependability, and professionalism—the three qualities that make up service quality—are crucial in influencing consumer satisfaction. Additionally, by offering convenience and customized services, the integration of cutting-edge technologies—like digital service interfaces and linked car features—significantly improves the client experience. The results indicate that in order to exceed customer expectations and maintain competitive advantage, Mahindra should give equal weight to ongoing improvements in service quality and technology advances. In order to promote long-term customer loyalty and happiness, the study offers management practical insights by highlighting the necessity of strategic investments in personnel training and state-of-the-art technologies. Keywords: Customer satisfaction, Technology integration, Strategic investments, Competitive advantage, Personalized services, Management insights, Digital service interfaces, Connected car features.

Pilot study evaluating the usability of MonŒil, a ChatGPT-based education tool in ophthalmology

ImportanceThere is an increasing use of artificial intelligence (AI) in ophthalmology to respond to the needs of patients to access reliable, easy-to-understand medical information. ObjectiveTo assess patient satisfaction with the usability of MonŒil, an AI-based platform designed for patient education in ophthalmology. DesignThis was a pilot cross-sectional study of the usability of MonŒil by patients followed for advanced age-related macular degeneration (AMD). MonŒil is based on ChatGPT-4 technology with specific ophthalmology-focused customizations and accessibility enhancements, and is freely available at monoeil.help. Patients were given 20 min of unsupervised interaction with no prior training or guidance, after which their feedback was collected. SettingThe study was performed in the ophthalmology department at the Creteil University Hospital. ParticipantsParticipants included 54 patients diagnosed with advanced AMD defined presenting for follow-up. Patients had to be older than 50 years of age, capable of giving informed consent, and able to understand and interact with MonŒil. Exclusion criteria were severe visual and cognitive impairment that prevented interaction with MonŒil. Main Outcome(s) and Measure(s)The primary outcome was the usability of MonŒil as measured by the System Usability Scale (SUS) questionnaire. ResultsOf the 54 participants, 34 were female (62.96 %). The mean age of the cohort was 77.76±8.14 years (range 58 to 97 years). The mean SUS score was 90.23±12.04 with a median of 92.50 (range 42.50 to 100.00), indicating excellent usability. There was a positive relationship between visual acuity and SUS score (regression coefficient 0.30 (95 % CI 0.08 to 0.51), r2=0.19, p = 0.0077). Conclusions and RelevanceMonŒil demonstrated excellent usability and satisfaction in a sample population of elderly patients with advanced AMD. These results suggest that AI-based tools like MonŒil can enhance patient education with minimal oversight in a complex field like ophthalmology, supporting its use as an adjunct to the physician-patient discussion. Further studies may be necessary to establish the applicability of MonŒil to a broader user base, and to assess its usefulness and clinical impact on patient outcomes such as patient knowledge and vision-related quality of life.

Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review.

To investigate long-term and patient-reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes. We conducted a retrospective analysis at a tertiary referral centre (2010-2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient-reported outcome measures in UGF repair was also performed. The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7) for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR) ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross-study comparisons. Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula.

Evaluation of the effectiveness of caudal epidural steroid injection as an adjuvant to ganglion impar pulsed radiofrequency therapy in chronic coccygodynia

BackgroundThis study aimed to evaluate the effectiveness of adding caudal epidural steroid injection (CESI) to ganglion impar pulsed radiofrequency (GI-PRF) therapy in patients with refractory chronic coccygodynia, and to determine the effect of pain duration and trauma on treatment success. Materials and methodsForty patients who underwent GI-PRF (n = 20) or GI-PRF + CESI (n = 20) were retrospectively assessed for age, gender, pain duration, history of trauma to the coccyx, Numerical Rating Scale (NRS) pain scores pre-procedure and 1, 3, and 6 months post-procedure and satisfaction rates at 6 months post-procedure. Satisfaction was categorized as excellent, high, moderate, and low. ResultsIn both groups, NRS scores were significantly decreased at 6 months (pre-vs. 6 mo. post-procedure: GI-PRF [8 vs. 5], GI-PRF + CESI [8.5 vs. 3.5]; p < 0.001). The proportion of patients reporting excellent satisfaction was significantly higher in the GI PRF + CESI group (50 % vs. 15 %; p < 0.05). Patients with trauma history in the GI-PRF + CESI group had significantly lower median NRS values at 6 months compared to patients in both groups with negative trauma history (p < 0.02). Within the GI-PRF only group, patients with trauma history had significantly lower NRS scores at 6 months than those without a history of trauma (p = 0.012). Pain duration did not significantly impact satisfaction levels (p = 0.055). ConclusionGI-PRF therapy was effective in coccygodynia, especially in patients with positive trauma history, and adjuvant CESI increased patient satisfaction by providing better pain control.

Usefulness of a Cementless Highly-Porous Acetabular Cup in Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty.

Total hip arthroplasty in patients with rheumatoid arthritis is difficult and leads to worse implant survival and higher risk for complications compared to osteoarthritis. Poor periacetabular bone quality might challenge the stability of the acetabular cup. Contemporary 3D-printed highly-porous titanium cup designs have become the benchmark for cementless implants; however, their usefulness in rheumatoid arthritis is still unclear. The purpose of this study was to assess the short-term results of the use of a highly-porous 3D-printed acetabular titanium cup in patients with rheumatoid arthritis. We studied a consecutive series of RA patients who underwent cementless THA between 2019 and 2020 in our center with the same 3D-printed highly-porous titanium acetabular cup. All patients were evaluated prospectively for a minimum 3-year follow-up with the Harris hip score, VAS and Roles and Maudsley score. Radiographic assessment focused on evidence of cup osseointegration. 37 RA patients, mean age at surgery of 51.3 years, were included. Mean follow-up was 3.2 years (3 to 4 years). By the last follow-up visit, the Harris hip score had increased significantly from 37.8 to 88.5, VAS had decreased from 6.1 to 1.0 and excellent satisfaction for 31 patients. All 5 Moore's radiographic signs were present in 35 hips, with only 4 signs present in the remaining 2 hips, thus indicating complete osseointegration of all cups. There were no complications on the acetabular side but one intraoperative proximal calcar fracture. 3D-printed highly porous implants used in primary THA worked well in patients with rheumatoid arthritis, showing excellent osseointegration and good clinical results in the short term.

Robotic Neck Dissection in Head and Neck Cancer via Modified BABA Technique.

Neck dissection forms an important component in the surgical management of head and neck cancers. By using the conventional techniques of neck dissection, a conspicuous scar is inevitable for the patients. The development of robotic assisted neck dissection provides for a scar-free neck along with good oncological and functional outcomes. A prospective observational study was conducted in our institute from 2020 March to 2022 March, where robotic-assisted neck dissections performed via the modified bilateral axillo-breast insufflation technique. Eighty-two patients underwent robotic neck dissections in our institute. Notably, 79 patients were treatment-naïve. The average docking time was 12 min and console time was 160 ± 15 min. The mean lymph node yield was 28.2. The average post-operative stay was 5.6 days. The average follow-up was noted to be 6.4 months. The mean cosmetic satisfaction score in our patients was 4.45. Only one patient presented with nodal recurrence, who was identified as a defaulter for adjuvant treatment. Robotic neck dissection gives similar functional and oncological outcomes as compared with conventional neck dissection. Patients had excellent cosmetic satisfaction following the procedure. The limitations of these techniques include high cost of procedure and longer operating time. This is a level IV evidence study. Although good oncological, functional, and cosmetic outcomes have been attained in robotic assisted neck dissection, further randomized controlled studies need to be conducted to justify the added costs, cosmetic advantage, and the time taken. IV Laryngoscope, 134:4045-4051, 2024.

Long-term outcomes after terminalization for acute fingertip injuries.

The primary aim of this study was to report outcomes after fingertip terminalization in 90 patients over a 19-year period. We report excellent functional outcomes and satisfaction, but a 33% incidence of neuropathic pain.

The value and advanced features of pre- and metabiotics in the treatment of symptomatic uncomplicated diverticular colon disease

Background. Symptomatic uncomplicated diverticular colon disease (SNDCD) is a common condition that significantly affects the quality of life of patients. One of the main therapeutic targets in SNDCD is the microbiota.&#x0D; Aim. To evaluate the efficacy and safety of microbiocenosis-based therapy (prebiotic Mucofalk + metabiotic Zakofalk) in relieving symptoms of SNDCD and maintaining asymptomatic remission.&#x0D; Materials and methods. The study included 60 patients with clinically apparent SNDCD. For 3 months, they were treated with Mukofalk and Zakofalk and then followed up for another 3 months. Parameters such as treatment efficacy, satisfaction and compliance were evaluated, as well as change of short-chain fatty acids in feces using gas-liquid chromatography was measured.&#x0D; Results. A statistically significant improvement of all assessed symptoms (abdominal pain, constipation, diarrhea, flatulence, tenesmus) was observed after 3 months of therapy. Relapse of abdominal pain and bowel movement disorders (constipation) after completion of therapy were observed in 7 (11.6%) subjects. The compliance study showed that more than 80% of the required number of sachets/tablets was taken by more than 80% of patients. At the end of follow-up, 49 (81.7%) patients rated their outcomes as "excellent" and 11 (18.3%) as "good". During treatment, there was a significant tendency to increase the absolute content of butyric acid in feces.&#x0D; Conclusion. Microbiocenosis-based therapy with the prebiotic Mukofalk and the metabiotic Zakofalk is effective and safe for treating SNDCD and preventing the recurrence of symptoms and disease complications. The therapy is associated with excellent and good satisfaction and a high compliance to treatment. Therapy with Mukofalk and Zakofalk resulted in the normalization of the intestinal microbiota.

Safety, Efficacy and Attributes of 2.5% Selenium Sulfide Shampoo in the Treatment of Dandruff: A Single-Center Study.

Selenium sulfide, available as a shampoo or topical lotion at 1%, or 2.5% concentrations in India, is used as a topical antiseborrheic and antifungal for the treatment of dandruff, seborrheic dermatitis, psoriasis, and tinea versicolor. In the present study, the safety, efficacy, and attributes of 2.5% selenium sulfide shampoo were evaluated in Indian participants with dandruff. A single-center, single-arm, prospective, investigator-initiated, open-label, post-marketing interventional study was conducted on Indian subjects aged 18-70 years diagnosed with moderate dandruffwho were prescribed 2.5% selenium sulfide shampoo every three days for four weeks. The primary endpoints were 1) reduction in total dandruff score assessed using a clinical grading scale for adherent and loose dandruff from baselineto weeks 1, 2, and 4, and 2) incidence of adverse events up to the end of the study. The key secondary endpoints were 1) participants' perception of shampoo attributes (dandruff reduction, scalp itch, scalp oiliness/greasiness, or fragrance) as assessed by a subjective self-assessment questionnaire post-first wash and at weeks 1, 2, and/or 4; 2) satisfaction with treatment as assessed by investigators and participants using a subjective self-assessment questionnaire at week 4; and 3) reduction in scalp sebum as assessed with a meibometer at weeks 2 and 4.Statistical analysis was performed using the Wilcoxon signed-rank test for continuous variables and the Chi-square test for categorical variables. A p-value of 0.05 was considered to be statistically significant. Of 34 enrolled subjects, 30 completed the four-week study. The mean (standard deviation, SD) age of the study participants was 29.8 (7.87) years, with the majority being females (n=18; 60.0%). Mean (SD) total dandruff score significantly (p=0.001) reduced from a baseline score of 11.5 (2.15) to 7.17 (2.12) at week 1, 4.93 (1.72) at week 2, and 2.5 (1.17) at week 4. All the participants reported dandruff reduction and acceptable fragrance of the shampoo at four weeks. Absence of itching and reduction in oiliness was reported by 73.3% (n=22) of participants at week 4 and by 50.0% (n=15) of participants at week 2, respectively. All participants reported good, very good, or excellent satisfaction with the test shampoo at week 4, whereas the investigators rated the shampoo as very good or excellent in managing dandruff in all participants. At week 4, erythema was reported to be absent in all participants. No adverse events were reported during the study. The 2.5% selenium sulfide shampoo was found to be effective in the management of dandruff and related symptoms like itching, oiliness, and greasiness and had a good safety profile in Indian participants with dandruff.

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 Oncological and Surgical Outcomes of Immediate Oncoplastic Breast Reconstruction With Contralateral Breast Adjustment.

Oncoplastic surgery is an expanding approach for managing breast conservation because it offers improved cosmetic outcomes while maintaining oncological safety. This study aimed to assess the oncological and surgical outcomes of patients who underwent oncoplastic procedures at a single institution. The study population includes all consecutive breast cancer patients who underwent lumpectomy followed by immediate oncoplastic breast reconstruction with contralateral breast adjustment between 2010 and 2021. Following IRB approval, patient demographics, tumor characteristics, surgical details, complications, and follow-up were evaluated for this group. Quality of life (QOL) and patient-reported outcome measures were assessed through questionnaires. Following multidisciplinary tumor board discussion, 77 patients (82 breasts) underwent oncoplastic surgery. Of these, 92.2% underwent breast MRI prior to surgery with mean mass enhancement of 2.35 cm (range, 0-8.5 cm) and non-mass enhancement of 5.77 cm (range, 0-14 cm), and 44% presented with multifocal disease. The final positive surgical margin rate was 2.4%, and all conserved breasts received adjuvant radiation therapy. The 5-year local recurrence rate for invasive tumors was 4.1%. QOL scores were generally high, with most patients reporting good to excellent cosmetic outcomes and high personal satisfaction with breast appearance and softness. Physicians reported breast symmetry in 89.5%. The findings suggest that oncoplastic surgery with contralateral breast adjustment is safe, effective, and an excellent option for breast cancer patients wishing for breast conservation even for large or multifocal masses, with favorable oncologic and cosmetic outcomes. The QOL analysis indicates high patient satisfaction. These results support the use of oncoplastic surgery in the management of breast cancer.

Effects of the powerball® system on muscle strength, coordination, fatigue, functionality and quality of life in people with multiple sclerosis. A randomized clinical trial

IntroductionAlthough clinical and functional impairments in the lower limbs have been extensively studied in patients with MS, the upper limb (UL) are also frequently affected. Clinical impairment of the UL in patients with MS is very common with muscle strength and hand dexterity as critical factors in maintaining functional activities that are the basis for independence and quality of life in people with MS.ObjectiveTo investigate the effects of a training protocol using the Powerball® system in combination with conventional physiotherapy on muscle strength, coordination, fatigue, functionality, and quality of life in persons with MS over an 8-week period.Materials and methodsA double-blind randomized controlled trial was conducted. The control group received conventional treatment, while the experimental group received additional UL training using the Powerball® system. Both groups received the same number of sessions and weeks of intervention. The following outcome measures were used: isometric grip and pinch strength, Box and Block Test (BBT), Nine Hole Peg Test (NHPT), Abilhand scale, Fatigue Severity Scale (FSS), Multiple Sclerosis Impact Scale (MSIS-29), and Likert satisfaction questionnaire for the experimental group. All measures were administered at baseline, after the treatment, and during a 3-week follow-up period.Results25 patients completed the study (12 in the experimental and 13 in the control group). The experimental group showed significant improvements in coordination and manual dexterity of the more affected UL as measured by the BBT comparing pre- to post-treatment (p = 0.048) and pre-treatment to follow-up (p = 0.001), and on the less affected UP comparing pre-treatment to follow-up (p < 0.001) and post-treatment to follow-up (p = 0.034). The Likert-type satisfaction questionnaire obtained a mean score of 89.10 (± 8.54) out of 100 points.ConclusionsUpper limb treatment protocol using the Powerball® system, in combination with conventional physiotherapy for 8 weeks resulted in significant improvements in the intra-group analysis for UL coordination and manual dexterity in favor of the experimental group. The experimental group showed excellent satisfaction to the treatment.

Incision techniques for trigger thumb release: a comparison of outcomes of four types of skin incision.

Although trigger thumb release is commonly performed, there is no consensus on the optimal skin incision. This study aimed to compare outcomes of four incision techniques, including V-shaped, oblique, transverse and longitudinal incisions. Outcomes included the Michigan Hand Outcomes Questionnaire, satisfaction with the treatment and postoperative complications. The results of 875 patients who underwent trigger thumb release were assessed. All groups demonstrated improvement in self-reported hand function (range of 10-14 points), pain (25-27 points) and aesthetics (4-7 points) from baseline to 3 months postoperatively with no differences between incision techniques. Of the patients, 76% reported good or excellent satisfaction with the outcome of treatment. Satisfaction and complication rates of the different incision techniques were similar. These findings imply that there is no clear benefit of one type of incision over another for trigger thumb release, suggesting that surgeons may use the technique of their preference.Level of evidence: III.

N44 Implementing Electronic Documentation of a Nurse-Led IBD Advice Line

Abstract Background Beaumont Hospital is a tertiary referral centre providing care to over 4500 patients with inflammatory bowel disease (IBD). This service offers an IBD nurse telephone advice line per international IBD standards. This was established to allow patients on-demand access to our service, improving the overall quality of care. Aims/Background • Time-to-response is recorded for all calls • Calls and emails are audited every month to ensure • Local KPIs are met • Identify potential weakness in service (i.e. access to emergency clinic spots) • Ensure continued improvement and service evolution • Track appropriate use of service by patients Methods Data was collected by establishing an Excel spreadsheet due to a lack of infrastructure to support a database. The spreadsheet will document the date of the call, date of the return call, patient name, hospital identification number, consultant name, reason for calling, and intervention time spent with each patient. Based on the initial audit of findings, the Patient Satisfaction Survey was distributed (n=110) and recorded. Patient feedback to identify areas for education and service development Results Two thousand six hundred and thirty-three (2,633) calls were received from January 2022 to September 2022. Auditing is performed monthly, identifying areas requiring improvement. Patients are frequently re-educated on how to best engage with our service. Pathways have been established to divert the calls to the appropriate alternative services such as administrators, endoscopy department, infusion services, and GP services, freeing our service for the appropriate calls only—30% of calls related to IBD flares. IBD nurses directly managed 82% of patients with flares. Overall, 75% of calls were managed virtually by an IBD nurse. An online patient satisfaction survey showed that 98% of patients expressed excellent satisfaction with the advice line service. Conclusion The precise documentation guided the established lean pathways for prescription renewal and pathways to redirect patients to endoscopy and non-IBD queries. The study results in aids to establishing protocols to limit prescriptions for patients who are non-compliant with blood/visits. It developed written and verbal information for patients on parameters for appropriate service use—education of patients: Modified written and oral patient education. The results of an online patient satisfaction survey showed 98% of patients report satisfaction with “excellent. The precise documentation and measurement of all the calls received facilitates service improvements and locally appropriate patient care. Patient involvement in improvement projects allows improvements to develop with patients at the centre.