Global Satisfaction Scale Research Articles

Assessment of spine surgery outcomes: inconsistency of change amongst outcome measurements

Background Context Outcomes of spinal treatments are evaluated by clinical relevance: the proportion of patients who reach a minimum clinically important outcome change. Outcomes are evaluated through multiple measurements, and the inconsistency of outcome change across measurements is not known. Purpose The primary purpose of this study was to illustrate outcome inconsistencies after spinal surgery. Secondary goals of this study were to develop an index of overall change that incorporates outcome inconsistencies, to relate the index of overall change to patients' global assessment and satisfaction with treatment, to relate the index of global change to an intuitively understandable outcome: the level of tolerable pain. Study Design This study is a review of prospectively collected patient-reported outcomes data. Patient Sample Four hundred sixty patients from a large multicenter database were chosen. Those patients were included in the sample because they had undergone lumbar surgery and had baseline and 1-year follow-up scores. Baseline and 1-year follow-up scores for Oswestry Disability Index (ODI), physical component summary (PCS) of the Medical Outcome Study Short Form-36 (SF-36), numerical back and leg pain scales, and 1-year scores for satisfaction with results were included in the study. Outcome Measures The outcome measures of the study were preoperative and 1-year postoperative scores for ODI, PCS, back pain scale, leg pain scale, health transition item of the SF-36, and satisfaction with results scales. Methods Oswestry Disability Index, SF-36, and pain scales were administered before and 1 year after spinal surgery. Satisfaction with results questionnaires were administered 1 year after surgery. The following threshold values were previously established and were used to evaluate outcome changes: minimum clinically important difference (MCID), substantial clinical benefit (SCB), and standard error of the mean. The following proportions of patients were determined according to outcome changes: “deteriorated,” “no change,” “below MCID,” “above MCID,” and “above SCB.” The consistency of outcome change was determined amongst the four outcome measures. An index of overall change was developed and related to patients' answers to the health transition item of the SF-36 and to the satisfaction with results scale. The overall change index was also compared with the tolerable pain level. Results Only 40.5% of patients report consistent outcome changes on all four measures. The overall change index was significantly correlated to the global change and satisfaction scale (ρ=.67, p less than .001). The overall change index was clearly associated with the tolerable pain level. Conclusions Efforts should be made to take into account the inconsistency of outcomes and to make clinical relevance more readily understandable by patients and clinicians.

Transobturator tape for female stress incontinence: follow up after 24 months

The objective of this paper is to evaluate the effectiveness of transobturator vaginal tape (TOT) in the treatment of female stress urinary incontinence (SUI) and to analyze functional results and quality of life after 24 months follow-up. The study included all women with SUI who underwent a TOT procedure in which the sling passes from the obturator foramen from the outside to the inside, under general or regional anesthesia from December 2004 to January 2006. All study patients must have had a minimal follow-up of 24 months. The patients were prospectively evaluated, and the following factors were assessed: number of pads used per day, physical examination including pelvic examination, urinalysis, urogenital distress inventory (UDI-6), analog global satisfaction scale (GSS), pad weight test, and urodynamic studies including filling cystometry and Valsalva leak point pressure (VLPP) test. Fifty-two consecutive patients who fulfilled the inclusion criteria underwent TOT procedure by 1 surgeon. The mean age was 50 +/-9 (range 37-72) and minimal follow-up was 24 months (range 24-30 months). Two patients were lost to follow-up after 12 months and 3 patients did not come for the 24-month evaluation. The mean operative time was 18 minutes +/-4 (range 15-31), with an average amount of bleeding 57 cc +/-22cc. Our results demonstrate a 92% cure or improvement rate after 12 months, and an 85% after 24 months. The transobturator approach from outside to inside is a very effective treatment of SUI with low morbidity. However, longer follow-up in larger populations should assess the long-term reliability of this procedure.

TOUCH™ Study Patient Outcomes: The Impact of Natalizumab on Utilization of Healthcare Resources by the Patients and Their Associated Treatment Satisfaction

Purpose: Natalizumab (NAT) is approved for the treatment of moderate to severe Crohn's disease (CD) in patients who have had an inadequate response to or are unable to tolerate conventional and anti-TNF therapies. In this naturalistic treatment experience study, the impact of NAT on a variety of outcomes is evaluated. Methods: The study sample was comprised of patients enrolled in the Tysabri Outreach: Unified Commitment to Health (TOUCH™) prescribing program that were appraised of the project and agreed to study participation. Subjects completed online or phone surveys regarding their prior biologic history, steroid use, complications over the past 3 months and healthcare utilization. Patients also completed the Treatment Satisfaction Questionnaire for Medicines (TSQM) which measures their satisfaction with treatment effectiveness, side-effects and convenience, and global treatment satisfaction. Data were collected prior to the initiation of NAT therapy and at month 3 of treatment. Results: To date, forty-nine patients have provided baseline data. Females comprised 59% of the sample, and they had a mean age of 41 years and mean time from diagnosis of 13 years. Ninety-four percent of the patients reported prior biologic use, 88% had used infliximab; 65% had used adalimumab and 20% had used certolizumab. Overall, 24% of patients had used one anti-TNF, while 59% had used 2 anti-TNFs and 10% had used all 3 anti-TNFs. Sixty-nine percent of patients reported steroid use in the past 3 months, while the mean number of hospital admissions, days in hospital, and emergency room (ER) visits due to CD and days of total parenteral nutrition during the same time period were 0.8, 6.6, 1.4 and 5.8, respectively. Among the 16 patients providing month 3 data, there was a significant decrease in the number of CD-related ER visits (1.4 vs. 0.6 p=0.032) and the percent of patients with CD-related complications (abscess, fistula, ostomy, obstruction (56.2% vs. 31.2% p=0.041). Significant improvements were observed in each of the four scales of the TSQM at follow-up (Effectiveness Scale 26.0 vs. 65.6 p<0.001; Side-effects Scale 56.8 vs. 87.5 p=0.002, Convenience Scale 61.8 vs. 71.9 p=0.032; Global Satisfaction Scale 35.9 vs. 69.8 p<0.001). Conclusion: NAT therapy was found to be associated with significant improvements in treatment satisfaction compared to previous therapy. Healthcare utilization during the 3 months prior to study start was high. Patients reported significantly lower complications and ER visits while they were on NAT therapy. Disclosure: Dr Kane reports having received Grant/Research Support and serving as an Advisory Committee/Board Member to Elan and Biogen Idec; Dr Panaccione reports serving as a consultant and an Advisory Committee/Board Member to Elan and Biogen Idec; Dr Colombel reports serving as a consultant and an Advisory Committee/Board Member to Elan and Biogen Idec; Dr Sands reports serving as a consultant and an Advisory Committee /Board Member to Elan and Biogen Idec; Dr Rubin reports serving as a consultant and an Advisory Committee/Board Member to Elan and Biogen Idec; Dr Lewis reports serving as a consultant and an Advisory Committee/Board Member to Elan and Biogen Idec; Dr Hass, Ms. Nag and Mr. Panjabi are employees of Elan. These studies are supported by Elan Pharmaceuticals, Inc. and Biogen Idec, Inc.

Job satisfaction of nurses with multicultural backgrounds: a questionnaire survey in Kuwait

Background Nurses working in Ministry of Health hospitals in Kuwait come from 35 countries, and only 12% of them are Kuwaitis. This study explores factors that influence the job satisfaction of nurses of multicultural background working in five general hospitals in Kuwait. Objectives This study aims to identify factors related to the job satisfaction of nurses and the effect of selected background characteristics (e.g., age, gender, nationality, educational qualification, marital status, monthly salary, experience in other countries, and years of experience) on the global satisfaction scale by using the McCloskey–Mueller Satisfaction Scale. Methods A stratified random sample size of 500 subjects was selected, and a questionnaire was distributed among them. Four hundred thirty-six completed questionnaires were returned, resulting in a response rate of 87.2%. Results Factor analysis identified five factors: satisfaction with (a) professional opportunities; (b) praise and recognition; (c) scheduling of duty; (d) control and responsibility, and (e) extrinsic rewards. These together explained 59.5% of the total variance. Nurses were found to be dissatisfied with two of five factors: professional opportunities and extrinsic rewards. Nurses were satisfied with the remaining three factors, although levels of satisfaction were not very high. The relationship of job satisfaction with nationality and marital status was positive and significant. However, a higher level of educational qualification showed an inverse relationship with job satisfaction. Conclusions Two issues identified here concerned aspects of nurses' professional development and extrinsic rewards, which have to be addressed as prerequisites to any improvement in the quality of nursing care in Kuwait. Based on our findings, we recommend a concerted action in developing a strategy to improve various aspects of nurses' professional development and extrinsic rewards. This will have a positive impact on the quality of health care of the Kuwaiti population.

Development and Validation of the Work Effort Scale

In the current article, the development and validation of the Work Effort Scale (WESC), a self-report 10-item scale, is described. Data from several samples are used. The three-factor structure (persistence, direction, and intensity) of the WESC is confirmed by confirmatory factor analysis and reliability is well documented. In accordance with our expectations, we found positive correlations between self-rated performance and global job satisfaction scales and work effort.

Transobturator tape for female stress incontinence: A day surgery case

Aim: To evaluate the effectiveness of transobturator vaginal tape (TOT) in the treatment of female stress urinary incontinence (SUI) and to analyze functional results and quality of life after12 months follow up. Materials and Methods : All women with SUI who underwent TOT procedure from outside to inside under general or regional anesthesia from December 2004 to January 2007 were included in the study. All must have had a minimal follow up of one year. The patients were prospectively evaluated with history including pads use/day, physical examination - pelvic examination, urinalysis, urogenital distress inventory (UDI-6), and analog global satisfaction scale - and urodynamic studies - filling cystometry, pressure-flow studies, and Valsalva leak point pressure. Results: Sixty two consecutive patients who fulfilled the inclusion criteria underwent TOT procedure by one surgeon. The mean age was 52 ± 9 years (range, 34-70 years) and minimal follow up was one year (12-24 months). The mean operative time was 17 ± 4 minutes (15-31) with average amount of bleeding 62 ± 22 cc. We found objectively 89% cure or improvement rate after one year. Conclusion: The out-in transobturator approach is a very effective treatment of SUI with low morbidity and high success rate. However, longer follow up in larger populations should assess the long-term reliability of this attractive procedure.

Transobturator tape (TOT): Two years follow‐up

The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress incontinence (SUI). One hundred and thirty patients were prospectively evaluated with history, physical examination, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ), urogenital distress inventory (UDI), and analog global satisfaction scale (GSS), and urodynamic studies. One hundred and seventeen patients (90%) had history of SUI, and 78 (60%) had urge incontinence. Pads/day (PPD) used was 2.48 +/- 2.42, and the score of IIQ 16.13 +/- 7.86, UDI 10.95 +/- 3.4, and GSS 1.41 +/- 1.67. All patients underwent TOT using the ObTape. Hospital stay was 0.84 +/- 0.76 days and catheter duration was 1.42 +/- 2.08 days. At a follow-up of 16.85 +/- 4.68 months, 13 patients (10%) have recurrent SUI, 21 (16.15%) persistent urge incontinence, and 1 (1.92%) de novo urge incontinence. The mean PPD is 0.15 +/- 0.56, IIQ 1.47 +/- 5.14, UDI 3.28 +/- 3.09, and GSS 8.29 +/- 1.64. Two patients (1.52%) developed urethral obstruction, five (3.84%) had vaginal extrusion of the tape, and two (1.52%) had intra-operative bladder perforation. These results demonstrate the safety and efficacy of the TOT. The short hospitalization and catheterization, low incidence of de novo urge incontinence and obstructive voiding offers a distinct advantage over existing techniques. No significant difference in outcome between patients with VLPP < or =60 cm H2O, and patients with VLPP >60 cm H2O was observed.

A pilot study of valdecoxib for reduction of postoperative opioid use after cesarean delivery

AFTER CESAREAN DELIVERY DARLENE ESPER, KIM BOGGESS, CLARENCE POTTER, RHONDA ARNETTE, DAVID MAYER, University of North Carolina at Chapel Hill, Obstetrics/Gynecology, Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, GCRC, Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Anesthesiology, Chapel Hill, North Carolina OBJECTIVE: To evaluate whether postcesarean section administration of valdecoxib (VAL) reduces narcotic usage and pain. STUDY DESIGN: A double-blinded RCT of VAL 40 mg after c-section was performed. 20 subjectswould result inO80%power to detect a 50%difference in total morphine use in 24 hours. After IRB approval, 21 consenting women at R37 weeks gestation, undergoing elective c-section with a standardized spinal anesthetic technique were enrolled. Subjects were randomized to either VAL 40mg or placebo, given 30-60 minutes after c-section. Morphine PCA was used for pain control. The total morphine usage in 24 hours postop and use of rescue analgesics was recorded. Visual analog scales (VAS), global pain assessment and satisfaction scales were administered postoperatively at 2, 4, 8, 12, 18, and 24 hours. Data was analyzed using Fisher exact, Chi-square and ANOVA. RESULTS: Twelve women had complete data for analysis. Total morphine use was 25% lower among women who received VAL vs placebo (67.9 mg vs 46.4, p = 0.2). Pain intensity scores were lower at all time points in VAL group, and no one in VAL reported pain at 12 hrs:

Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease

BackgroundThe objective of this study was to develop and psychometrically evaluate a general measure of patients' satisfaction with medication, the Treatment Satisfaction Questionnaire for Medication (TSQM).MethodsThe content and format of 55 initial questions were based on a formal conceptual framework, an extensive literature review, and the input from three patient focus groups. Patient interviews were used to select the most relevant questions for further evaluation (n = 31). The psychometric performance of items and resulting TSQM scales were examined using eight diverse patient groups (arthritis, asthma, major depression, type I diabetes, high cholesterol, hypertension, migraine, and psoriasis) recruited from a national longitudinal panel study of chronic illness (n = 567). Participants were then randomized to complete the test items using one of two alternate scaling methods (Visual Analogue vs. Likert-type).ResultsA factor analysis (principal component extraction with varimax rotation) of specific items revealed three factors (Eigenvalues > 1.7) explaining 75.6% of the total variance; namely Side effects (4 items, 28.4%, Cronbach's Alpha = .87), Effectiveness (3 items, 24.1%, Cronbach's Alpha = .85), and Convenience (3 items, 23.1%, Cronbach's Alpha = .87). A second factor analysis of more generally worded items yielded a Global Satisfaction scale (3 items, Eigenvalue = 2.3, 79.1%, Cronbach's Alpha = .85). The final four scales possessed good psychometric properties, with the Likert-type scaling method performing better than the VAS approach. Significant differences were found on the TSQM by the route of medication administration (oral, injectable, topical, inhalable), level of illness severity, and length of time on medication. Regression analyses using the TSQM scales accounted for 40–60% of variation in patients' ratings of their likelihood to persist with their current medication.ConclusionThe TSQM is a psychometrically sound and valid measure of the major dimensions of patients' satisfaction with medication. Preliminary evidence suggests that the TSQM may also be a good predictor of patients' medication adherence across different types of medication and patient populations.

Testing Karasek's Demands-Control Model in restructured healthcare settings: effects of job strain on staff nurses' quality of work life.

Job strain among staff nurses has become an increasingly important concern in relationship to employee performance and commitment to the organization in current restructured healthcare settings. The purpose of this study was to test Karasek's Demands-Control Model of job strain by examining the extent to which the degree of job strain in nursing work environments affects staff nurses' perceptions of structural and psychological empowerment, work satisfaction, and organizational commitment. A predictive, nonexperimental design was used to test these relationships in a random sample of 404 Canadian staff nurses. Karasek's Job Content Questionnaire, the Conditions of Work Effectiveness Questionnaire-II, Spreitzer's Psychological Empowerment Questionnaire, Meyer and Allen's Organizational Commitment Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables. Nurses with higher level of job strain were found to be significantly more empowered, more committed to the organization, and more satisfied with their work. Support for Karasek's Demands/Control theory was established in this study.

Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model.

In this study, we tested an expanded model of Kanter's structural empowerment, which specified the relationships among structural and psychological empowerment, job strain, and work satisfaction. Strategies proposed in Kanter's empowerment theory have the potential to reduce job strain and improve employee work satisfaction and performance in current restructured healthcare settings. The addition to the model of psychological empowerment as an outcome of structural empowerment provides an understanding of the intervening mechanisms between structural work conditions and important organizational outcomes. A predictive, nonexperimental design was used to test the model in a random sample of 404 Canadian staff nurses. The Conditions of Work Effectiveness Questionnaire, the Psychological Empowerment Questionnaire, the Job Content Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables. Structural equation modelling analyses revealed a good fit of the hypothesized model to the data based on various fit indices (chi 2 = 1140, df = 545, chi 2/df ratio = 2.09, CFI = 0.986, RMSEA = 0.050). The amount of variance accounted for in the model was 58%. Staff nurses felt that structural empowerment in their workplace resulted in higher levels of psychological empowerment. These heightened feelings of psychological empowerment in turn strongly influenced job strain and work satisfaction. However, job strain did not have a direct effect on work satisfaction. These results provide initial support for an expanded model of organizational empowerment and offer a broader understanding of the empowerment process.

Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine.

Changes in the demographic, specialty, and employment sector composition of medicine have altered physicians' jobs, limiting autonomy and reducing morale. Because physician job satisfaction has been linked to clinical variables, better measurement might help to ameliorate conditions linked to medical disaffection, possibly improving health care. To document conceptual development, item construction, and use of content experts in designing multidimensional measures of physician job satisfaction and global satisfaction scales for assessing physicians' job perceptions across settings and specialties. Using previous research, physician focus groups, secondary analysis of survey data, interviews with physician informants, and a multispecialty physician expert panel, distinct job facets and statements representing those facets were developed. Facets from previously validated instruments included autonomy, relationships with colleagues, relationships with patients, relationships with staff, pay, resources, and status. New facets included intrinsic satisfaction, free time away from work, administrative support, and community involvement. Physician status items were reconfigured into relationships with peers, patients, staff, and community, yielding 10 hypothetical facets. Global scales and items were developed representing satisfaction with job, career, and specialty. A comprehensive approach to assessing physician job satisfaction yielded 10 facets, some of which had not been previously identified, and generated a matching pool of items for subsequent use in field tests.

Handicap one year after a stroke: validity of a new scale.

The aim was to determine the handicap experienced by subjects one year after a stroke, and assess the acceptability, validity, and reliability of a new handicap measurement scale. A cross sectional survey of 141 survivors of a cohort of consecutive hospital admissions with acute stroke was undertaken. The London handicap scale (a new health outcome measurement scale), Barthel index, Nottingham extended activities of daily living scale, Nottingham health profile, Geriatric depression score, and a global life satisfaction scale were used. 94 subjects (67%) responded to a single mailing; 89 (95%) responses were usable. Mean handicap was 0.40 (range 0.06-1.0, SD 0.20) on a scale of 0 (maximum handicap) to 1 (no handicap). All handicap dimensions showed a wide range of problems, with physical independence and occupation particularly affected. Correlations between handicap score and other outcome measures were all in the expected direction and of about the strength expected (0.36 < r < 0.69). The reliability coefficient was 0.91, limits of agreement +/- 0.19. The measurements demonstrated substantial handicap one year after a stroke, reflecting considerable unmet rehabilitation needs. The scale proved acceptable to subjects, and the results were consistent with good validity.