Good Satisfaction Rates Research Articles

P1008 Subcutaneous infliximab in IBD patients previously treated with an optimized intravenous infliximab dosing schedule: preliminary results on expectations and satisfaction of switching from intravenous to subcutaneous infliximab

Abstract Background The anti-TNF agent infliximab (IFX) CT-P13 is now available as a subcutaneous (SC) formulation. Unanswered questions persist regarding the use of SC IFX in patients previously on optimized intravenous (IV) regimens. The AMARETTO study investigates if switching to weekly SC IFX 120 mg is associated with better outcomes than bi-weekly dosing in patients with prior optimized IV therapy. Methods This multicentre, randomized, open-label superiority trial includes adult IBD patients treated with optimized IV IFX in steroid-free clinical (PRO-2) and biological remission (CRP <10 mg/L, and faecal calprotectin <250 μg/g) on optimized IV IFX (ClinicalTrials.gov ID: NCT06113913). Eligible patients may continue their IV treatment (IV comparison group) or switch to SC IFX. Those switching to SC are randomized 1:1 to open-label weekly (SC intervention) or bi-weekly 120 mg SC IFX (SC comparison). Primary endpoint is the proportion maintaining steroid-free clinical and biological remission at week 52 without treatment optimization. Here we focus on the secondary endpoints of patient expectations, experience and satisfaction using a 11-point Likert scale (0 = lowest and 10 = highest). Results From May to October 2024, 163 patients were screened, with 120 included (66 SC, 54 IV; Table 1). Among the 66 SC patients willing to switch, 57 (37 CD, 20 UC/IBDU) already had their baseline visit with first SC IFX and completed the treatment expectations questionnaire, and 29 have already been treated with SC IFX for at least 8 weeks and completed a satisfaction questionnaire (Figure 1). The pen was preferred by 42 (74%), the syringe by 4 (7%), and 11 patients (19%) had no preference. Key reasons for pen preference were needle visibility (38%) and injection control (48%). Training for SC injection was mainly provided by IBD nurses (N=45, 79%). Median (interquartile range, IQR) satisfaction with training, confidence, and ease of use were 10 (9–10), 9 (8–10), and 9 (8–10), respectively. By week 8, median (IQR) scores for confidence remained stable at 9 (9–10) and increased for ease of use 10 (8–10). Median (IQR) scores for injection pain and fear at week 8 were 2 (0–4) and 0 (0–1). Satisfaction and likelihood of recommending SC treatment were both 9 (8–10). No significant differences at week 8 were observed between both SC groups. Conclusion Preliminary data suggest a highly positive patient experience with SC IFX among those previously treated with optimized IV IFX, highlighting strong preferences for the pen and good satisfaction rates regarding training, ease of use, confidence and injection pain. The AMARETTO trial will further clarify if weekly SC dosing offers superior outcomes compared to bi-weekly SC IFX.

Medial Breast Reconstruction after Breast Conserving Surgery with Local Flap: A Single Center Experience.

Breast-conserving surgery (BCS) and post-surgical radiotherapy are the treatment of choice in early-stage breast cancers. Surgeons use different techniques for the reconstruction of the breast after BCS. We aimed to present our novel reconstruction technique for medial breast defects and report the follow-up results of patients who underwent breast reconstruction using this method in the short and long term. Forty patients with medially located breast tumors under BCS referred to Shahid Modares Hospital in Tehran, Iran from 2018 to 2022 were enrolled in the study. The patients underwent breast reconstruction post-lumpectomy using the local transposition flap technique. We followed the patients for one year, and the satisfaction and complication results were assessed and reported post-operation, after radio-chemotherapy, and after one year. The patients' mean age was 48.4 (±12.3) years, and the mean BMI was 30.9 (±3.1). There were no cases of complication, including infection, seroma formation, hematoma, flap ischemia, or necrosis post-operation, one week and one month after discharge. The surgeon and patient satisfaction surveys conducted post-op, after the radio-chemotherapy course, and one year after BCS using the Breast-Q satisfaction domain showed that the excellent and good satisfaction rates are 88%, 92%, and 92%, respectively. Local transposition flap has remarkable cosmetic results with the least complication rate in the reconstruction of medial breast defects after breast-conserving surgery and is an excellent choice for surgeons.

All-Inside Endoscopic Classic Bröstrom-Gould Technique: Medium-term Results

Background: Short-term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability have been satisfactory, although medium- to longer-term results are lacking. Purpose/Hypothesis: The purpose of this study was to report the medium-term results of an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly, interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. It was hypothesized that the all-inside endoscopic classic Bröstrom-Gould procedure would produce sustainable good outcomes at a medium term of 5 years. Study Design: Case series; Level of evidence, 4 Methods: A prospective database for 43 patients who underwent an all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament and calcaneofibular ligament with inferior extensor retinaculum augmentation was reviewed. Patient details, American Orthopaedic Foot & Ankle Society score, Karlsson score, ankle activity score (AAS), and patient satisfaction were collected and analyzed. Results: The study cohort of 43 patients with a mean age of 29.4 years (SD, 11.9 years) were reviewed at a mean follow-up of 63.1 months (SD, 8.5 months). The American Orthopaedic Foot & Ankle Society scores showed significant improvement from a mean of 69.6 (SD, 13.9) to 93.7 (SD, 10.7), while the Karlsson score improved from 59.7 (SD, 14.5) to 91.5 (SD, 14.5) at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS, from a mean of 5.38 (SD, 2.8) to 5.41 (SD, 2.8), with a mean satisfaction rate of 9.1 (SD, 1.3). Although the remaining 11 patients had a reduced AAS, at a mean of 4.6 (SD, 2.6), they reported a mean satisfaction rate of 7.4 (SD, 2.9). There were no surgical complications or reoperations reported in this cohort, although there were 3 patients with recurrent instability at their last follow-up, resulting in a failure rate of 7%. Conclusion: The current study is the first to report the medium-term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. Overall, 93% of the patients had good functional outcomes, but approximately 25% of patients had decreased ankle activity levels at a mean of 5 years postoperatively, albeit with good satisfaction rates.

Long-term outcomes of the Universal 2 total wrist arthroplasty

AimsThe Universal 2 total wrist arthroplasty (TWA) aims to alleviate wrist pain and restore function. This study investigates the survival time, revision rate, complication rate, and performs radiological analysis on Universal 2 TWAs in the long term. MethodsForty-seven Universal 2 TWA in 45 patients were performed between 2006 and 2014. Patient satisfaction, DASH score, complications, revision rate and radiological analysis of the TWA were recorded. ResultsMean follow-up was 11.7 years (range 2.5–17.6 years). There was significant improvement in post-operative DASH score (mean 58.3, SD 13) compared to preoperative DASH scores (mean 33, SD 20, p < 0.001). At latest follow-up, 65 % of patients would undergo the procedure, a reduction from 87 % at mid-term follow-up. On radiological analysis, 26 wrists had lucencies of at least one component. Complications occurred in 18 wrists (38 %). Eleven TWA (23 %) were revised at a mean 7.3 years post-operation (range 2.0–13.7 years). Mean survival of the implant was 13.6 years (12.2–15.0 years 95 % CI). Kaplan-Meier analysis identified no significant differences in survivorship between inflammatory arthritis (13.2 years, 11.5–14.9 years 95 % CI) and osteoarthritis (12.9 years, 11.0–14.8 years 95 % CI, p = 0.39). ConclusionAt long-term follow-up, the Universal 2 TWA can produce significant improvements in DASH scores and good satisfaction rates. However, a significant number of implants showed radiological loosening, with a high associated complication and revision rate. Patients should be adequately counselled on these risks pre-operatively.

Study of Patients’ Satisfaction with different types of Telemedicine Services provided by the Ministry of Health in Saudi Arabia

One way to gauge the quality of healthcare is to look at how satisfied patients are with the system overall. Finding out how happy patients are with various telemedicine services offered by Saudi Arabia's Ministry of Health is the main goal of this research. The satisfaction of Saudi Arabian customers using telemedicine services was assessed in a cross-sectional survey. Customers of the 940 medical contact centre and the Sehha app, two telemedicine services, were surveyed using a rigorous random selection technique. Two hundred and fifty users of the 940 medical contact centre and the Sehha app were selected at random to fill out a pre-designed survey about their level of satisfaction with various aspects of the two health services. Out of 250 people who used telemedicine services, 83.14 percent were happy with the care they received overall, while 8.03 percent were unhappy. These days, telemedicine apps are employed by a lot of wealthy nations and even some underdeveloped ones to help provide healthcare to people faster for all sorts of medical issues. In Saudi Arabia, telemedicine services generally had good satisfaction ratings, with no discernible variation in ratings between the 940 medical contact centre and the Sehha app. Customers who used telemedicine services were generally pleased and were even willing to recommend them to others.

A randomized feasibility trial evaluating the "My Changed Body" writing activity for people with endometriosis.

Body image disturbance is prevalent in people with endometriosis. This study aimed to explore the feasibility, acceptability and preliminary efficacy of the My Changed Body (MyCB) writing activity for body image in people with endometriosis. Two-arm randomized controlled pilot and feasibility study. Australian adults living with endometriosis who identified as having had a negative endometriosis-related body image experience were recruited online through Endometriosis Australia. Participants completed a baseline survey capturing demographic and health data before being randomized into the MyCB or control writing conditions. Additional assessment was administered post-activity and at 1-week follow-up. A total of 82 participants were recruited and randomized (Mage = 32 years, SD = 7.8). MyCB participants were less likely to complete the writing tasks compared to the control group (51% vs. 83%); MyCB completers had lower self-compassion and quality of life, and higher psychological distress, compared to those who dropped out. The MyCB activity received good satisfaction rates (47%-87%). However, there was significant drop-out in the MyCB group (n = 4 vs. 13 at 1-week follow-up). Limited-efficacy testing showed an increase in the self-compassion self-identification for the MyCB group. The MyCB writing activity may be feasible for people with endometriosis. A future larger trial will benefit from several methodology changes to enhance recruitment and retention. Australian and New Zealand Clinical Trial Registry ACTRN12622000496718; Date: 29/3/2022; retrospectively registered.

Conservative versus surgical treatment for displaced olecranon fractures in the elderly: a retrospective study and a review of the literature.

Surgery is the gold standard treatment of displaced olecranon fracture, but it presents a high rate of complications, especially in the elderly, including wound breakdown and fixation failure. Conservative treatment of these fractures has recently been proposed with good functional outcomes. The aim of this retrospective study was to compare the functional results and level of satisfaction of displaced olecranon fractures which were managed surgically or conservatively in geriatric patients. The rate of implant removal and reoperation in the surgical group were also calculated. Sixteen and eleven patients aged ≥ 75years (mean 83 and 86.2, respectively) with isolated Mayo IIA or IIB olecranon fracture were surgically and conservatively treated, respectively. All but 1 were females. Due to coronavirus pandemic, they were contacted by phone to validated clinical scores (QuickDASH, PREE and VAS), which were used to assess the outcome. At an average follow-up of 26.5months in the conservative group and 53.1 in the surgical group (range 4-82), the mean Quick DASH was 11.67 and 11.2, respectively, while the mean PREE was 11.36 and 12.67, respectively. There was no significant difference in functional outcomes between the two groups, and all patients were satisfied. Seven complications occurred in the surgical cohort (33.3%), requiring reoperation in 4 cases (19%). Displaced olecranon fractures can successfully be treated conservatively in low-demand geriatric patients with good functional results and high satisfaction rate.

IDEAL-D Phase 0 Evaluation of the Avatera System in Robot-Assisted Prostate, Bladder and Renal Surgery.

Purpose: To evaluate the utilization of novel Avatera system in urological operations according to the IDEAL-D framework recommendations for high-risk invasive surgical devices. Materials and Methods: Three surgeons attempted to perform 23 upper and lower urinary tract operations on human cadavers and in live porcine models using the Avatera system. Total operative time and the duration of the substeps were evaluated. Surgical performance was assessed with the Global Evaluative Assessment of Robotic Skills (GEARS) score. Suturing was rated using the technical checklist for the assessment of suturing in robotic surgery. Attending surgeons rated their satisfaction with the Avatera system on a scale of 1-5. Results and Limitation: Seventeen out of 18 operations performed on cadavers were completed, while one pyeloplasty was discontinued. All five operations performed in porcine models were completed. Although 1 pig was euthanized on the fifth postoperative day, its symptoms were unrelated to surgery. Mean GEARS and Suturing scores in the upper urinary tract were 29 ± 0.7 and 29.5 ± 0.95, respectively, and in the lower urinary 28.5 ± 1.2 and 29.5 ± 0.5, respectively. Surgeons' satisfaction was high or very high for all procedures. Conclusions: The Avatera system was associated with good surgical performance and high surgeons' satisfaction rates. All urological procedures performed were shown to be feasible, with comparable risks to other robot-assisted surgery systems.

Qualidade da atenção primária à saúde da pessoa idosa durante a pandemia da covid-19: uma revisão sistemática

Abstract Objective To evaluate the quality of primary healthcare services for older adults during the COVID-19 pandemic through studies evaluating health services. Method A systematic literature review was conducted. The search for articles covered the databases Web of Science, Embase, Scopus, and Medline/Pubmed. Original scientific articles with a case-control or cross-sectional design, involving populations that included older adults, focusing on primary healthcare, and assessing the quality of health services were included. Exclusion criteria were studies without specific analysis for older adults, studies evaluating health access or economic evaluation of health. The risk of bias analysis was conducted according to JBI protocols, and data synthesis was performed using SWiM guidelines. Results Seven studies were included in the review. The primary care services evaluated were mostly outpatient, with diverse quality assessment parameters related to individual care. The evaluation of quality identified a decrease in in-person consultations and visits, and an increase in the use of telehealth, with good satisfaction ratings among older adults. Conclusion The studies highlighted the difficulties maintaining and accessing in-person services during the COVID-19 pandemic, which directly contributed to a reduction in consultations and exams, usage of and access to health services, and the quality of primary healthcare.

Clinical evaluation of subcutaneous immunotherapy with a polymerized molecular allergoid of Alt a 1 in patients with allergic rhinoconjunctivitis and/or allergic asthma caused by the mould Alternaria alternata.

This is a retrospective analysis of the clinical evolution of 14 patients diagnosed with allergic rhinoconjunctivitis (AR) and/or allergic asthma (AA) caused by Alternaria alternata, who were attended by the allergology service of Vega Baja Hospital of Orihuela (Alicante, Spain). The purpose was to assess the clinical impact and safety of 1-year of subcutaneous immunotherapy with a polymerized molecular allergoid of Alt a 1. Impact of the treatment on allergic diseases (mean number AR/AA episodes and ARIA/GINA classifications), changes in symptoms and prescribed medication, change in the global subjective clinical status of patients and satisfaction with the treatment were also evaluated. Adverse reactions were also recorded and analyzed. After 1-year of treatment, fewer AR and AA episodes (p less than 0.05) and improvements in ARIA/GINA classifications were observed. Significant improvements of symptoms (p less than 0.05) and a resulting general reduction of the medication prescribed was also detected. Improvements in the global subjective clinical status and good satisfaction rates were observed. Only 1 patient presented a local and not clinically relevant adverse reaction. The treatment showed promising effects with a significant improvement in the clinical status of all patients with a good safety profile.

Usability Evaluation of a Community Pharmacy Health Information Exchange Interface Prototype.

Few community pharmacies have access to health information exchange (HIE) data. We conducted a first-of-its-kind usability evaluation of an HIE interface prototype (referred to throughout as the "HIE-Pioneer mock-up") developed with pharmacists and pharmacy technicians to aid future implementation in community pharmacies. Community pharmacists and pharmacy technicians were recruited to complete usability evaluations with the HIE-Pioneer mock-up. Each usability evaluation lasted up to 60 minutes. System usability scale (SUS) scores were collected from each participant following each usability evaluation session and summarized with descriptive statistics. Usability evaluation videos were reviewed for common usability attributes, such as the impact of identified usability problems, learnability, and efficiency. Time on task, task success rates, and prototype utilization were also recorded. Sixteen total participants completed usability testing across three community pharmacies. The average SUS score was 69.7 (scale 0-100, where 100 is the best), with pharmacists on average reporting higher satisfaction than technicians (74.1 vs. 65.3, respectively). Altogether, we identified 23 distinct usability problems. Key problems identified included needed clarification in tool label names and accessibility of HIE links within the existing workflow. Overall, the usability of the HIE-Pioneer mock-up generally fostered pharmacy professionals' ease of learning and efficiency. Our study identified key areas, and potential solutions, to improve the usability of the HIE-Pioneer mock-up. Overall, pharmacy professionals viewed the HIE-Pioneer mock-up positively, with good satisfaction ratings. The HIE-Pioneer mock-up provides a blueprint for future HIE implementation in community pharmacy settings, which would increase community pharmacy teams' access to HIE data nationwide. Community pharmacy access to bi-directional HIE is expected to improve communication among more health care professionals involved in patient care and equip pharmacy professionals with needed information for improved clinical decision-making.

Virtual OSCE examinations during COVID-19: A 360 satisfaction assessment from examiners and candidates.

We sought to determine the satisfaction rates of examiners and candidates in a Virtual Objective Structured Clinical Exam (OSCE) of graduating Canadian urology residents. An annual mock exam, aimed at simulating the licencing urology exam for Canadian graduates, was moved to an online format for the 2020 cohort. This exam consists of an Objective Structured Clinical Exam (OSCE), and a written multiple-choice exam. The Telemedicine Satisfaction Questionnaire (TSQ), a previously validated tool for clinical encounters with three sub-domains (quality of care provided, similarity to face-to-face encounter, and perception of the interaction) was modified for the purposes of evaluating the OSCE encounter. The TSQ was sent electronically to all examiners and candidates after the exam. There were 14/16 responses from examiners (87.5%) and 24/39 responses from candidates (61.5%). Overall, the format was judged to be a good experience by 13/14 (92.9%) of examiners and 21/24 (87.5%) of candidates; however, when asked specifically if the virtual OSCE was an acceptable way to determine a candidate's competency to practice urology independently, only 8/14 (57.1%) of examiners and 15/24 (62.5%) of candidates agreed. This study demonstrates an overall good satisfaction rate among both examiners and candidates when using a teleconference format for a mock OSCE.

Blending an internet-based emotion regulation intervention with face-to-face psychotherapy: Findings from a pilot randomized controlled trial

BackgroundTransdiagnostic interventions targeting shared mechanisms may improve treatment of mental health disorders. One way of providing such interventions is through blended treatment. This study examined the addition of an internet-based emotion regulation intervention to face-to-face psychotherapy in an outpatient setting. MethodsIn a pilot randomized controlled trial, 70 patients with a range of diagnoses were assigned to an internet-based program targeting emotion regulation + treatment as usual (face-to-face psychotherapy; TAU) (n = 35) or TAU (n = 35). Assessments occurred at baseline, after six, and after 12 weeks and included measures of symptom severity, emotion regulation, and various intervention feasibility parameters. ResultsITT-analyses revealed no significant group-by-time interaction for the primary and almost all secondary outcomes. Descriptively, between-group effect sizes were in favor of the intervention group for almost all outcomes. Sensitivity analysis with patients who completed a minimum of three modules of the internet-based program showed a significant group-by-time interaction for the Difficulties in Emotion Regulation Scale in favor of the intervention group. The internet-based intervention showed good satisfaction ratings, user experience and usability. Findings from therapist measures complemented patient measures. ConclusionPreliminary results show that an internet-based emotion regulation intervention added to psychotherapy may not reduce symptom severity compared to psychotherapy alone. The intervention was rated positively by patients and therapists regarding several parameters, but certain features still need to be improved. An RCT powered to detect small between-group effect-sizes is necessary to consolidate findings.

Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders

Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents’ risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 208 adolescents (48.5% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Data from 153 adolescents who completed all assessments in the different phases of the study were analyzed. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6 month follow-up was carried out, together with a 1 month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE + in the short and long term. Interventions were acceptable in terms of acceptability, with good satisfaction rates. Tailored targeted selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.

V11-06 ABDOMINOPLASTY AND PENILE PROTHESIS IMPLANT (PPI): A NEW STANDARD APPROACH FOR OBESE PATIENTS?

You have accessJournal of UrologyCME1 Apr 2023V11-06 ABDOMINOPLASTY AND PENILE PROTHESIS IMPLANT (PPI): A NEW STANDARD APPROACH FOR OBESE PATIENTS? Manuel Alonso-Isa, Esther García-Rojo, Borja García-Gómez, José Medina-Polo, Elena Peña-Vallejo, and Javier Romero-Otero Manuel Alonso-IsaManuel Alonso-Isa More articles by this author , Esther García-RojoEsther García-Rojo More articles by this author , Borja García-GómezBorja García-Gómez More articles by this author , José Medina-PoloJosé Medina-Polo More articles by this author , Elena Peña-VallejoElena Peña-Vallejo More articles by this author , and Javier Romero-OteroJavier Romero-Otero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One-third of adult men are obese and profound sexual dysfunction is quite common in them. PPI has been proven to be an effective option for patients that do not respond to non-surgical treatments. Together with an abdominoplasty, it could be an alternative treatment in obese patients to improve satisfaction and facilitate sexual intercourse. For us, this is the new gold standard. METHODS: We retrospectively review a total of 15 patients from 2016 to 2022 who underwent a abdominoplasty and PPI. Demographic, comorbidities, type of PPI and, the perform of other additional techniques, surgery time, complications and other relevant variables were recorded for analysis. RESULTS: All patients were obese with erectile dysfunction. 8 were diabetic. 10 inflatable penile prostheses and 5 malleable ones were implanted. Only one device had to be removed due to prosthesis infection. Mean surgery time was 97 minutes. Mean hospital stay was 3.6 days after surgery. A significant increase in postoperative penile length of 2.8 cm (1.3-4.2 cm) and good satisfaction rates (85% in Erectile Dysfunction Inventory of Treatment Satisfaction, EDITS) were achieved. CONCLUSIONS: Abdominoplasty is a safe and reproducible technique that can be performed simultaneously with the placement of a penile prothesis in selected patients. Allows also to combine with different other surgical techniques. Patients always must be counseled on the expectations and the risk of postoperative complications. However, for us, due the excellent postoperative results and patient satisfaction, it is the new gold standard for this kind of patients. Source of Funding: Authors have no potential conflict of interest to report © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1000 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuel Alonso-Isa More articles by this author Esther García-Rojo More articles by this author Borja García-Gómez More articles by this author José Medina-Polo More articles by this author Elena Peña-Vallejo More articles by this author Javier Romero-Otero More articles by this author Expand All Advertisement PDF downloadLoading ...

Symptom Outcome of Walant Technique for Carpal Tunnel Release – A Prospective Study in the Tertiary Care Hospital, Nowshera

OBJECTIVES The study aims to determine the outcome of the WALANT technique for Carpal Tunnel Release CTR.METHODOLOGY A descriptive study was done in the Neurosurgery department at Qazi Hussain Ahmad Medical Complex, Nowshera, from 15th September 2020 to 15th March 2021. A total of 29 consecutive patients of carpal tunnel syndrome (CTS) were undergoing carpal tunnel release (CTR) under wide awake local anaesthesia no tourniquet (WALANT) technique, using a mixture of lidocaine and epinephrine for local anaesthesia, and the outcome was assessed for patient satisfaction by Boston Carpal Tunnel Questionnaire (BCTQ) (symptom severity scales (SSS)) at pre-operatively and six weeks postoperatively.RESULTSWide awake CTR was done in 29 patients; 86.2% were female and 13.8% male. The mean age was 47.3 years. The average time of return to daily activity was three weeks. No complications were noted, like wound infection and dehiscence. BCTQ symptom (BCTQ-S) score significantly improved at six weeks postoperatively. 86% significantly reduced the symptom severity score (SSS). Mean SSS improved from preoperative 3.2 points to 1.7 points postoperatively. There was a significant decrease in distal latencies (p &lt;0.01). CONCLUSIONWide awake surgery is an excellent technique with favourable outcomes and good satisfaction rates for CTR. The study shows that clinical symptoms resolve rapidly after CTR. Without the need for monitored anaesthesia, the cost could decrease dramatically.

Improving Quality of Life with Brachytherapy for Urological Malignancies

Brachytherapy for localised prostate, muscle-invasive bladder and penile cancer is well established, providing high tumour dose delivery and minimising normal tissue doses compared with external beam techniques. In prostate cancer, the main impact on quality of life relates to diminished sexual function and irritative or obstructive urinary symptoms, which are seen up to 15 years after treatment. Significant changes in bowel function are rare. Compared with radical prostatectomy or external beam radiotherapy, irritative or obstructive urinary symptoms are more prominent, whereas incontinence is less than after radical prostatectomy and bowel changes are less than after external beam radiotherapy. For muscle-invasive bladder cancer, when compared with radical cystectomy, although no difference is seen for urinary symptoms or fatigue, role and social functioning scores are higher and there is better post-treatment sexual function in both men and women. Compared with surgical treatment for penile cancer, brachytherapy results in better erectile function scores than after glansectomy and partial penectomy and high quality of life scores, with good satisfaction ratings for cosmetic appearance.

RETRACTED ARTICLE: Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders

Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, online-delivered, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session, to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents’ risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 286 adolescents (53.3% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6-month follow-up was carried out, together with a 1-month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE +. Interventions were excellent in terms of acceptability, with good satisfaction rates. Tailored selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.

Benign Ovarian Cystectomies in Children and Adolescents: A Comparison of Transumbilical Single-Port and Multi-Port Laparoscopic Surgery

<h3>Study Objective</h3> To investigate the safety and clinical value of transumbilical single-port laparoscopic surgery (TSPLS) in the treatment of benign ovarian cysts in children and adolescents. <h3>Design</h3> A retrospective analysis was performed on 85 children and adolescents who underwent benign ovarian cystectomies in Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University from January 2019 to January 2022, including 55 cases of mature cystic teratoma, 16 cases of myxoid cystadenoma, 9 cases of serous cystadenoma, 2 cases of parovarium cyst, 2 cases of follicular cyst, and 1 cases of ovarian thecoma-fibroma. Among them, 33 cases with transumbilical single-port laparoscopic oophorocystectomy (TSPLO group), median age was 14 years (7-18 years), mean diameter of ovarian cysts was (13.06 ± 7.80 cm). 52 cases with transumbilical multi-port laparoscopic oophorocystectomy (TMPLO group), median age was 15 years (6-18 years) and mean diameter of ovarian cysts was (7.69 ± 2.80 cm). Operative time, intraoperative blood loss, intraoperative cyst rupture rate, time to anal exhaust and hospital stay, Cosmetic Score (CS) and Visual Analogue Scale (VAS) were compared between the two groups. <h3>Setting</h3> N/A <h3>Patients or Participants</h3> N/A <h3>Interventions</h3> N/A <h3>Measurements and Main Results</h3> No conversion to laparotomy or surgical complications occurred in the two groups, and no statistical significance in operative time, intraoperative blood loss and intraoperative cyst rupture rate (all P > 0.05). The time to anal exhaust (18.82 ± 4.58 h vs. 21.29 ± 5.11 h, P = 0.027) and hospital stay (3.39 ± 0.83 day vs.3.92 ± 1.13-day, P = 0.023) in TSPLO group were shorter than those in TMPLO group. Lower postoperative VAS scores and higher CS scores were seen in the TSPLO group (all P < 0.05). <h3>Conclusion</h3> TSPLS is safe and feasible for benign ovarian cysts in children and adolescents, and has obvious advantages of fast postoperative recovery, good cosmetic effect and high satisfaction rate of patients.

ATFL All Inside Arthroscopic Repair: Clinical and Functional Outcomes

Category: Arthroscopy Introduction/Purpose: The arthroscopic techniques used to treat chronic lateral ankle instability have developed greatly in recent years. The purpose of this work is to present clinical and functional results of patients with chronic ankle instability submitted to surgical treatment by all-inside arthroscopic repair of the anterior talofibular ligament (ATFL). Methods: This is a series of cases of 18 consecutive patients who underwent the all-inside arthroscopic ATFL repair technique, a surgical treatment for chronic lateral ligament instability of the ankle, after the failure of conservative treatment performed for 6 months. The evaluation was made using the American Orthopaedic Foot and Ankle Score (AOFAS), visual analog pain scale (VAS), anterior drawer and talar tilt tests. Surgical complications and patient satisfaction indices were also evaluated. Results: All 18 patients were evaluated for a mean follow-up period of 12 months. There was an improvement in the AOFAS (p&lt; 0.001), with the mean improving from 69.6 points to 98.1, and in the mean VAS score, from 5.0 to 0.5 points (p &lt; 0.001). All ankles were stable, as assessed by the anterior drawer test and talar tilt test. The only complication found was neurapraxia of the superficial fibular nerve in one patient (5%). All of the patients classified the treatment as good or excellent and returned to daily and sports activities without limitations. Conclusion: Treatment of chronic ankle ligament instability by the all inside arthroscopic ATFL repair technique was able to restore ankle stability and showed good clinical results and high satisfaction rates.