Higher Patient Satisfaction Scores Research Articles

Build your own all-virtual multidisciplinary kidney stone clinic.

With the dramatic rise of telemedicine in the post coronavirus disease 2019 (COVID-19) pandemic, our objective was to develop a totally virtual multidisciplinary kidney stone clinic and assess patient satisfaction of this format. The virtual multidisciplinary stone clinic began July 2021 and continued monthly. Prior to the beginning of each clinic, providers from the urology, nephrology, and dietitian teams meet virtually to discuss the patients. Patients would then log into WebEx virtual platform and providers would subsequently log into the patient's virtual room, to review radiology, laboratory results, and dietary logs then provide counseling. Patients were then sent a survey via electronic mail regarding their experience. A 5-point Likert scale was used for responses ranging from strongly disagree to strongly agree. Scores were averaged to rank results. A total of 122 patients were sent surveys, and a total of 31 surveys were completed. Sixty-one percent of patients strongly agree and 13% agree that they felt comfortable using the virtual platform. When asked if they prefer using the virtual platform for their visit, 70% of patients agreed or strongly agreed and only 16% of patients disagreed or strongly disagreed. In regards to potential advantages of a virtual visit, the Likert scores were averaged and ranked from most to least important with improved timeliness (3.7) and ease of scheduling into day (3.6) the highest rated advantages. Most patients did not find any concerns using the virtual platform, however the ability to see the provider in-person and connecting personally was of highest concern with an average Likert score of 2.3. Overall, 83% of patients agreed or strongly agreed that the multidisciplinary stone clinic satisfied their kidney stone related questions regarding treatment and prevention. A virtual multidisciplinary kidney stone clinic can be implemented with high patient satisfaction scores and help overcome the limitations of physical clinic space and provider schedule coordination. There are few disadvantages to using the platform.

Treatment efficacy and patient satisfaction of ustekinumab compared with tumor necrosis factor-alpha inhibitors in Chinese patients with moderate-to-severe psoriasis: a real-world study

Background Ustekinumab is an interleukin (IL)-12/IL-23 inhibitor for the treatment of moderate-to-severe psoriasis. Objective This real-world study compared ustekinumab and tumor necrosis factor-alpha inhibitors (TNFis) in Chinese moderate-to-severe psoriasis patients. Methods Patient health records of 110 moderate-to-severe psoriasis patients initiating or switching biologics were reviewed, with 31 patients receiving ustekinumab (ustekinumab group) and 79 patients receiving TNFis (TNFi group). Results Compared with TNFi group, psoriasis area and severity index (PASI)-75 response rate at month 6 (M6) were elevated (87.1% versus 65.8%, p = 0.026) in the ustekinumab group, whereas the rates at month 1 (M1) and month 3 (M3) and PASI-90 response rates at M1, M3, and M6 only showed an increasing trend (all p > 0.050) in the ustekinumab group than the TNFi group. By subgroup analyses, ustekinumab (versus TNFi) was more effective in patients with biologics therapy history than those without. Compared with the TNFi group, the ustekinumab group had lower dermatology life quality index scores and higher patient satisfaction scores at M3 and M6 (all p < 0.050). Conclusion Chinese moderate-to-severe psoriasis patients treated with ustekinumab have a better treatment response at 6 months with improved quality of life and patient satisfaction after 3–6 months of treatment when compared to TNFi.

A retrospective cohort study on enhanced recovery after surgery (ERAS) in patients with diabetic foot ulcer

Enhanced recovery after surgery (ERAS) has been successfully integrated into a diverse array of surgical fields to improve the quality and efficacy of treatment intervention. Nonetheless, the application of the ERAS protocol for patients with diabetic foot ulcer (DFU) subsequent to undergoing surgical procedures has not been previously explored. Therefore, this study aimed to investigate the effect of an enhanced recovery protocol on perioperative outcomes in patients with DFU following surgical procedures. A retrospective analysis was conducted on 112 patients with DFU who underwent surgery between January 2020 and December 2021 at a tertiary referral care center. In total, 57 patients received standard perioperative care (the non-ERAS group), and 55 patients received ERAS care (the ERAS group). The primary outcomes included the length of stay (LOS), wound healing time, patient satisfaction, and costs, serving as the basis for assessing the effectiveness of the two approaches. Secondary outcomes included preoperative anxiety (APAIS score), nutritional status (PG-SGA), pain (NRS score), the incidence of lower-extremity deep vein thrombosis (DVT), the reduction in lower-limb circumference, and the activity of daily living scale (Barthel Index). The ERAS group exhibited significantly shorter LOS (11.36 vs. 26.74 days; P < 0.001) and lower hospital costs (CNY 62,165.27 vs. CNY 118,326.84; P < 0.001), as well as a higher patient satisfaction score and Barthel Index score (P < 0.05). Additionally, we found a lower APAIS score, incidence of DVT, and circumference reduction in lower limbs in the ERAS group compared to the non-ERAS group (P < 0.05). In comparison, the wound healing time, nutritional status, and pain levels of participants in both groups showed no significant difference (P > 0.05). By reducing the LOS and hospital costs, and by minimizing perioperative complications, the ERAS protocol improves the quality and efficacy of treatment intervention in patients with DFU who underwent surgical procedures.Trial registration number: ChiCTR 2200064223 (Registration Date: 30/09/2022).

Refractive Surgery Patient Characteristics Associated With Satisfaction Scores.

To determine factors influencing patient satisfaction scores in recipients of refractive surgery. In this prospective survey-based study, patients who had refractive surgery at an outpatient refractive clinic completed a survey of selected questions from the Press Ganey survey and the National Eye Institute Visual Function Questionnaire-25. Correlation between patient-specific variables and survey questions were assessed using Student's t-tests. Fifty-three patients were recruited over a 3-year period. Most were male (55%) and middle aged (mean age: 34 years). Eleven percent underwent photorefractive keratectomy surgery and the rest had laser in situ keratomileusis, with no complications. Twenty-four percent of surveyed patients reported mild to moderate eye pain postoperatively, with the rest reporting no pain. All patients reported a full score for overall satisfaction. This study found persistent high patient satisfaction score across a variation of characteristics, suggesting that optimal scores are mainstay after refractive surgery procedures with excellent visual outcomes, independent of patient clinical and sociodemographic characteristics. [J Refract Surg. 2024;40(8):e539-e543.].

0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period

Background3% chloroprocaine (CP) has been reported as the common local anesthetic used in pregnant women undergoing urgent cesarean delivery during labor analgesia period. However, 0.75% ropivacaine is considered a promising and effective alternative. Therefore, we conducted a randomized controlled trial to compare the effectiveness and safety of 0.75% ropivacaine with 3% chloroprocaine for extended epidural anesthesia in pregnant women.MethodsWe conducted a double-blind, randomized, controlled, single-center study from November 1, 2022, to April 30, 2023. We selected forty-five pregnant women undergoing urgent cesarean delivery during labor analgesia period and randomized them to receive either 0.75% ropivacaine or 3% chloroprocaine in a 1:1 ratio. The primary outcome was the time to loss of cold sensation at the T4 level.ResultsThere was a significant difference between the two groups in the time to achieve loss of cold sensation (303, 95%CI 255 to 402 S vs. 372, 95%CI 297 to 630 S, p = 0.024). There was no significant difference the degree of motor block (p = 0.185) at the Th4 level. Fewer pregnant women required additional local anesthetics in the ropivacaine group compared to the chloroprocaine group (4.5% VS. 34.8%, p = 0.011). The ropivacaine group had lower intraoperative VAS scores (p = 0.023) and higher patient satisfaction scores (p = 0.040) than the chloroprocaine group. The incidence of intraoperative complications was similar between the two groups, and no serious complications were observed.ConclusionsOur study found that 0.75% ropivacaine was associated with less intraoperative pain treatment, higher patient satisfaction and reduced the onset time compared to 3% chloroprocaine in pregnant women undergoing urgent cesarean delivery during labor analgesia period. Therefore, 0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period.Clinical trial number and registry URLThe registration number: ChiCTR2200065201; http://www.chictr.org.cn, Principal investigator: MEN, Date of registration: 31/10/2022.

Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial

Background Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. Methods This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Results Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. Conclusions In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. Registration CTRI (CTRI/2020/09/027946; 22/09/2020).

Influence of multidisciplinary teams (MDT) on breast satisfaction and sexual well-being in the immediate postoperative phase following breast-conserving surgery (BCS).

e13788 Background: Despite the recognized significance of multidisciplinary team (MDT) on patient satisfaction post-operatively, limited data exists on its overall impact. This study assessed the impact of MDT, including the surgeon, medical oncologist, and office staff, on patient breast satisfaction and sexual well-being among early-stage breast cancer patients. We examine three early time points after breast-conserving surgery (BCS): 2 weeks, 4 weeks, and 3 months. In addition, demographic and socioeconomic factors affecting patient satisfaction were also analyzed. Methods: A survey using BREAST-Q modules was conducted via telephone interviews among early-stage breast cancer patients who had BCS at a university-affiliated community hospital from October 2022 to September 2023. BREAST-Q responses were translated to Rasch scores (0=lowest, 100=highest). Patient-reported concerns were collected with open-ended questions. The correlation between variables was measured using Pearson’s correlation. A comparison of Rasch scores over time was done with repeated measures of ANOVA. SPSS 28.0 was used for statistical analysis, with a p-value&lt;0.05 considered statistically significant. Results: Of 200 patients assessed, 61 met the study criteria, and 30 participated (mean age 66.3 years±9.9). Most were White (90%), married (55%), with stage 1 cancer (63%) and comorbidities (60%). At 2 weeks, the mean breast satisfaction score was 66.8, which increased to 71.0 at 4 weeks and 88.1 at 3 months (p&lt;0.05), while sexual well-being remained stable (69.0 at 2 weeks, 73.1 at 4 weeks, and 68.3 at 3 months, p&gt;0.05). Pain at the surgical site was the most cited concern at 2 and 4 weeks (30% and 41%, respectively), while dry skin (25%) was the top concern at 3 months. High patient satisfaction scores with the surgeon (mean 95.5), medical team (mean 98.3), and office staff (mean 99.3) were noted throughout the three time periods (p&gt;0.05). Satisfaction with the surgeon was associated with better breast satisfaction and higher sexual well-being scores at two weeks after BCS (p&lt;0.05). No other significant correlations were found between the influence of MDT on patient satisfaction at 4 weeks and 3 months. In a univariate analysis, widows reported the highest breast satisfaction at 2 weeks (94.0, p&lt;0.05). White patients had a higher sexual well-being score than Black patients (72.4 vs. 51.5, p&lt;0.05), while alcohol use had lower sexual well-being scores at 2 weeks (62.5 vs. 89.8, p&lt;0.05). In a multivariable analysis, only marital status and alcohol use remained significant at 2 weeks post-BCS (p&lt;0.05). Conclusions: The study highlights the surgeon’s critical role in achieving high level of patient satisfaction with their breasts and sexual well-being after BCS. Additionally, it reveals the significant influence of sociodemographic factors on patient outcomes.

Excellent Clinical Outcomes and Rapid Return to Activity Following In-Office Needle Tendoscopy for Chronic Achilles Tendinopathy

To assess outcomes following Achilles in-office needle tendoscopy (IONT) for the treatment of chronic Achilles tendinopathy (cAT) at a minimum 12-month follow-up. A retrospective case series was conducted to evaluate patients who underwent Achilles IONT for cAT between January 2019 and December 2022. Inclusion criteria were patients ≥18 years of age and clinical history, physical history, and magnetic resonance imaging findings consistent with cAT who did not respond to a minimum of 3 months of conservative management for which each patient underwent Achilles IONT and had a minimum 12-month follow-up. Clinical outcomes were evaluated using the Victorian Institute of Sport Assessment-Achilles and visual analog scale scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. Twelve patients (13 Achilles) with a mean age of 50.9 ± 14.6 years were included in the study. The mean follow-up time was 26.3 ± 6.3 months. The mean Victorian Institute of Sport Assessment-Achilles scores improved from a preoperative score of 35.6 ± 5.9 to a postoperative score of 83.6 ± 14.1 (P < .001). The mean visual analog scale score improved from a preoperative score of 6.6 ± 1.0 to a postoperative score of 1.3 ± 1.7 (P < .001). There were 10 patients (83.3%) who participated in sports activities before the IONT procedure. Within this group, 9 patients (90.0%) returned to play at a mean time of 5.9 ± 2.6 weeks. The mean time to return to work was 4.2 ± 1.2 days. Patients reported an overall positive IONT experience with a mean rating scale of 4.5 ± 0.9. This retrospective review demonstrated that Achilles IONT for the treatment of cAT results in significant improvements in subjective clinical outcomes and a low complication rate together with high patient satisfaction scores at short-term follow-up. Level IV, therapeutic case series.

Cosmetic Breast Augmentation with Autologous Ex Vivo-Expanded Adipose-Derived Mesenchymal Stem/Stromal Cell (Stemform®)-Enriched Fat Grafts: A Study of the First Twenty-Two Real-World Patients

BackgroundFat grafting is commonly utilized in breast surgery, and since it was first described, clinicians and researchers have stridden towards improvement of graft retention. Current advancements include adding adipose-derived mesenchymal stem/stromal cells (MSC(AT)s), which have demonstrated promise for improved graft retention.ObjectivesThis study reports outcomes for the first twenty-two patients undergoing breast augmentation (Stemform BA) or artificial implant replacement (Stemform AIR) with MSC(AT)-enriched fat in a real-world setting.MethodsAutologous MSC(AT)s were isolated and expanded ex vivo, then mixed with lipoaspirate and injected as enriched fat for Stemform BA and AIR. The breast volume was measured preoperatively and at 3 and 12 months postoperative using a 3D Infinity Dual-Lens Camera and LifeVizApp software. Additionally, independent plastic surgeons evaluated clinical images, and patient satisfaction was obtained at equal time points.ResultsTwenty-two patients were included. All completed 3 and 12 months clinical follow-up and 3 months volume measurements. Nineteen patients completed 12 months volume measurements. The median fat graft retention at 12 months was 95.7% (IQR = 82.44–103.12%) for Stemform BA patients and 113.0% (IQR = 94.8–131.2%) for Stemform AIR patients. The Stemform BA patients had a median breast enlargement of 172.0% (IQR = 156.7–241.0%). The implant replacement volume of Stemform AIR patients was 102% (IQR = 85.1–130.3%). The patient reported 92.8% and 100% would elect to repeat treatment if they had the opportunity for Stemform BA and Stemform AIR, respectively.ConclusionBreast augmentation and breast implant replacement patients receiving ex vivo-expanded MSC(AT)-enriched fat grafts had high graft retention and patient satisfaction scores. The paper confirms the clinical efficacy of using ex vivo-expanded MSC(AT)s.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Interim Analysis of Treatment Satisfaction from a Prospective Phase 4 Study in Adult Immune Thrombocytopenia (ITP) Subjects after Switching from Eltrombopag or Romiplostim to Avatrombopag

Background: Recently, the Thrombopoietin-Receptor Agonist (TPO-RA) Patient experience survey (TRAPeze) determined that the characteristics which influence preference towards TPO-RA treatments the most were the method of administration and drug-food interactions. Specifically, participants were more likely to select an oral tablet over a subcutaneous injection and a treatment without food restrictions rather than one with food restrictions (McDonald V, et al, 2021). A majority of patients in a real-world analysis who switched from eltrombopag (ELT) or romiplostim (ROMI) to avatrombopag (AVA) did so due to perceived convenience benefits (Al-Samkari H, et al, 2022). The ongoing AVA-ITP-401 prospective interventional study is evaluating treatment satisfaction and on-therapy convenience in patients immediately switching to AVA from either ELT or ROMI and aims to provide valuable patient-reported outcomes. Safety and platelet count (PC) response to AVA following a switch from the other two TPO-RAs are also being evaluated. In a separate abstract submission, the mean/median PCs are reported to either be improved or maintained with AVA treatment over 90 days. Methods: This is an interim analysis of a prospective, multi-center, open-label Phase 4 study being conducted in the US (NCT04638829) since March 2021. Subjects who have been receiving ELT or ROMI for ≥90 days prior to study entry are enrolled and immediately switched to AVA at a starting dose of 20 mg daily. Key inclusion criteria: age ≥18 years; subjects have been undergoing treatment for primary ITP with ELT or ROMI for ≥90 days prior to the screening visit; subjects have had a previous response to either ELT or ROMI. The primary endpoint is occurrence of adverse events and serious adverse events. A key secondary endpoint is the change from baseline in each of the 4 domains of the self-administered Treatment Satisfaction Medication Questionnaire (TSQM) Version 1.4 (convenience, global satisfaction, effectiveness, and side effects) to Day 90 (D90) or End of Study (EOS). An increase in domain mean score indicates an increased patient preference to a given therapy in that domain. Clinic Visits were mandated per protocol at Days 15 (D15), 30 (D30), 60 (D60), and 90/End of Study (D90/EOS) with PCs obtained at each timepoint. The TSQM was assessed at baseline (BL), D30, and D90/EOS. Results: As of April 1, 2023, 51 patients were screened with 47 enrolled. 35 completed the study, 3 dropped out, and 6 are on-going. The mean age at enrollment was 58 years, the median (min,max) time since ITP diagnosis was 2.88 years (0.2,31.0), 60% were female, 72% were Caucasian, and 11% had a previous history of splenectomy. 62% of patients were switched to AVA from ELT (median prior treatment duration 42 weeks (range 12 - 442); median daily dose 50 mg) and 38% from ROMI (median prior treatment duration 81 weeks (range 12 - 468); median weekly dose ≤3 µg). Safety results will be reported when the study is complete. TSQM individual domain BL, D30, and D90/EOS mean values and mean percent change from BL following the switch from either ELT or ROMI to AVA are summarized in Table 1. In the Total Population, scores at BL in all four domains were generally high reflecting patient satisfaction to their prior therapy. Following the switch to AVA, however, there was measurable improvement in satisfaction across all domains-most pronounced in the effectiveness, convenience, and global satisfaction domains. This improvement began at D30 and was maintained through D90/EOS. The increase in patient-reported satisfaction was greater in ELT-switchers than with ROMI-switchers; however, improvement in satisfaction was observed by EOS across all four domains in the ROMI-switching population as well. Summary/Conclusion: Despite high patient satisfaction scores at BL from prior therapy (ELT or ROMI), patients reported higher satisfaction following a switch to AVA across all domains of the TSQM (effectiveness, side effects, convenience, and global satisfaction) over 90 days. In a population of patients who were generally responding to TPO-RAs prior to a switch to AVA, mean/median PCs were also either improved or maintained with AVA treatment for the duration of the study (reported in a separate abstract submission), suggesting that some patients may experience sustained effectiveness paired with enhanced overall treatment satisfaction when switching from ELT or ROMI.

Comparison of the Postoperative Analgesia Effects of Patient-Controlled Analgesia and Epidural Catheter After Posterior Instrumentation Surgery

Objective: To prospectively assess the effects of intravenous patient-controlled analgesia (IV PCA) and epidural patient-controlled analgesia (epidural PCA) on postoperative pain management following posterior instrumentation surgery.&#x0D; Materials and Methods: The study involved the ASA 1-2 group, 60 patients who underwent elective thoracic or lumbar posterior instrumentation surgery at our tertiary centre for spinal stenosis. Two groups of patients were created: Group 1 (n = 30), IV PCA group, and Group 2 (n=30), epidural PCA group. IV PCA was applied by fentanyl. Epidural PCA was maintained by lading to epidural space by the neurosurgeon. Bupivacaine was administered to Group 2 patients in the recovery room. Following surgery, patients in both groups were assessed for pain using the visual analogue scale (VAS) and for motor block using the Bromage scale. Additionally, hemodynamic parameters, side effects, and patient satisfaction were noted. Following 48 hours, patients' overall rescue analgesia, opioid, and local anaesthetic requirements were recorded. &#x0D; Results: Postoperative VAS scores of Group 2 at the 1st, 2nd, 4th, 8th and 16th hours were lower than Group 1 and these differences was statistically significant. Postoperative patient satisfaction scores at 1st, 2nd, 4th, 8th, 12th, 16th, 20th, 24th, 30th, 36th, 42nd and 48th hours were significantly different between the groups and the patient satisfaction scores of Group 2 were higher than the Group 1. Side effects were similar in both groups. Group 1 required statistically significantly higher number of rescue analgesia. &#x0D; Conclusion: This study shows that epidural PCA is more comfortable than IV PCA with low VAS and high patient satisfaction scores. As a conclusion, epidural PCA is a safe, highly efficient method for patients with posterior instrumentation surgery.

Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial.

Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. CTRI ( CTRI/2020/09/027946; 22/09/2020).

TELE-ANC model in public sector in India: a feasible option to sustain quality antenatal care

Introduction: Prenatal care is one of the most widely used preventive strategies in healthcare. Despite rapid advances in medical practice over a century, obstetric care remains ‘traditional’. It is resource intensive with heavy footfall in public sector antenatal OPD leading to compromise in quality of care. Therefore, hybrid ‘TELE-ANC model’ is a feasible option to sustain quality care in limited resource setting. We assessed feasibility of this model in reducing ‘in-person visits’ in terms of provider, process and recipient and determined barriers and facilitators to implementation and robustness of process in delivering the model. Methods: Single center prospective feasibility study, composed of 50 low-risk women within 20 weeks of pregnancy; recruited from outpatient obstetric department. Model had 5 in-person and 4 virtual visits. During in-person visits; history, general and systemic examination, ANC investigations and ultrasounds were done and clubbed; counseling and treatment were advised. During virtual visit, patients monitored blood pressure, pulse, weight and fetal movements at home. Pictures of prescription were sent on patients’ phones with records maintained by provider. Patients and provider filled detailed Satisfaction Performa after each virtual visit and last antenatal visit which were measured through Likert scale. Results: Each pregnant woman on an average made 5 physical and 5 virtual visits (one extra than proposed 4 in the model). Each patient saved approximately 10 productive hours and 700 Rupees during their antenatal period. Doctor was able to implement services readily. Adequacy to conduct virtual visits, successful decision making, technical issues faced, ease and safety of process and overall improvement in access to healthcare and positive change, demonstrates high levels of Provider satisfaction score of &gt;80% overall. There was high patient satisfaction score of 80 to 90% in areas assessed i.e., satisfaction with the care received, doctor-patient rapport, knowledge about pregnancy, convenience of self-monitoring and ability to contact provider during emergencies. Nearing term, patients had satisfaction score of 85-90% overall in ability to express, continuation of visits post COVID, reduction in overall cost and time, desire for such a model in future and positive change. Minimal technological barriers were identified which did not adversely impact the quality of care. It is ‘Good’ in terms of its robustness. 96% of patients desired hybrid model as mode of future antenatal care. Discussion: Due to rapid increase in use of telehealth during COVID-19 pandemic, we were encouraged to test feasibility of a reduced in-person visit hybrid model; ‘The TELE-ANC model’ in a tertiary care public hospital. It is feasible in delivering an efficient antenatal care with additional advantages of lower cost, greater doctor-patient rapport, increased patient’s productivity, increased patient satisfaction, better continuity of care, better time management and increased provider engagement and satisfaction. It has potential to be standard care model for antenatal services in future leading to a more flexible and patient centered care

Sulcus-Deepening Trochleoplasty for High-Grade Trochlear Dysplasia: Demystifying the Procedure-a Review of the Current Literature.

The most common and biomechanically influential pathoanatomic risk factor for recurrent patellofemoral instability is trochlear dysplasia. Sulcus-deepening trochleoplasty is a procedure developed to address high-grade trochlear dysplasia in the setting of patellofemoral instability. The purpose of this paper is to outline the current classification and surgical management of trochlear dysplasia as well as to review the current literature on the clinical outcomes and complications of sulcus-deepening trochleoplasty. This review outlines the most recent literature reporting evidence behind the decision-making to perform a trochleoplasty in the setting of patellofemoral instability and high-grade trochlear dysplasia. Critical parameters include grade of trochlear dysplasia, severity of symptoms, pertinent physical examination findings, surgical techniques, modifications for skeletally immature patients, and considerations for the revision setting. Historic studies have elicited concerns regarding high reported complication rates for trochleoplasty; however, recent studies consistently report good clinical outcomes and acceptable complication rates, similar to those of other patellar stabilizing procedures. The addition of a trochleoplasty in patients with high-grade dysplasia results in a lower re-dislocation rate, significant improvements in patient-reported outcome measures (PROMs) as well as high levels of patient satisfaction and return to sport. The use of sulcus-deepening trochleoplasty for the treatment of high-grade dysplasia and recurrent patellofemoral instability is a well-established technique with good outcomes and an acceptable complication profile. In patients with high-grade dysplasia, trochleoplasty results in lower re-dislocation rates, high patient satisfaction scores, and good clinical and functional outcomes. An understanding of trochleoplasty and its indications should be in the armamentarium of surgeons treating patellofemoral instability.

Operation Diversify Plastic Surgery: An Innovative Strategy to Increase Diversity in Plastic and Reconstructive Surgery.

Healthcare disparities remain a significant problem facing the US healthcare system with recent evidence of persistent racial and ethnic disparities especially among patients from minority backgrounds. Recent studies have documented advantages to a racially and ethnically diverse surgical workforce such as higher patient satisfaction scores, superior patient compliance with physician recommendations, and increased participation in clinical research studies by minority patients. In plastic and reconstructive surgery (PRS), there is a noted deficit among residents and faculty that come from ethnically underrepresented in medicine (URiM) backgrounds despite recent efforts to increase diversity in PRS surgeons. URiM medical students from three of the four historically Black medical universities organized to discuss pathways to PRS. Operation Diversify Plastic Surgery is a student-led organization that was developed to address the lack of diversity in PRS, challenges faced by students from institutions that lack PRS residency training programs, and unique factors that affect URiM students interested in PRS. Available studies note that mentoring relationships and research opportunities were instrumental in recruiting URiM students into PRS residency programs. Operation Diversify Plastic Surgery is an innovative solution to the insufficient URiM PRS residency candidate pool by increasing medical student exposure to PRS via educational lectures, virtual mentoring opportunities, and insights into research fellowships.

Hospital Development of a Hybrid Emergency Department—Inpatient Care Observation Unit

IntroductionThis project aimed to design and implement an emergency department-managed observation unit that improves inpatient bed and emergency department stretcher capacity, decreases observation patient length of stay, earns high patient satisfaction scores, and generates a positive fiscal impact on the organization. MethodsThis quality improvement project followed a 1-group, pre- and postprogram implementation design. ResultsIn the first year of operations, 40% of the total observation patients treated in this hospital were managed in the new observation unit. Emergency department observation unit length of stay across all patient complaints was half of the average length of stay for observation patients located on hospital inpatient units. In most cases, the emergency department observation unit was in the top 25 percentile of hospital Press Ganey inpatient satisfaction categories. The hospital estimates a contribution margin of three-quarters of a million dollars in the first year. DiscussionThis effective and efficient hybrid observation unit possessed specific aspects of inpatient and emergency department patient care models. Placing providers and nurses at the workstation for faster communication expedited care. Prioritizing all observation patient testing, transportation, phlebotomy, and intravenous (IV) services shortened disposition times. Emergency nurses transitioning to the observation unit were challenged to acquire inpatient care knowledge. Observation unit management struggled to maintain staffing while under an inpatient productivity model managed by the inpatient house supervisor. Reducing patient disposition time required clear communication between observation unit and inpatient staffing managers, between physician consultants and advanced practice nursing providers, and among nurses, patients, and providers. Observation units are 1 solution to decrease observation patient length of stay and improve emergency department capacity.

Application of double-tube negative pressure drainage in repair of refractory wounds.

To observe the application effect of double-tube negative pressure drainage in the repair of refractory wounds. From January 2020 to April 2023, 50 patients undergoing refractory wound repair in the Department of Burn and Plastic Surgery of Jingjiang People's Hospital, Jiangsu were selected. According to different treatment methods, they were divided into an observation group and a control group, with 25 patients in each group. The observation group was treated with double-tube negative pressure drainage inside and outside the wound, while the control group was treated with negative pressure drainage inside the wound. By two-week observation, the wound healing status and complication rate after treatment, as well as the wound bacterial clearance rate, wound pain score and patient satisfaction 3, 7 and 14 d after treatment were compared between the two groups. Statistical analysis was carried out to determine the efficacy. After treatment for two weeks, the observation group showed a higher grade A healing rate (92%vs. 60%, X2 =7.018, P=0.008), a higher wound bacterial clearance rate (100%vs. 76%, X2 =6.818, P=0.03), a lower pain score (1.44±0.51vs. 2.36±0.49, t=-6.53, P<0.01), a higher patient satisfaction score (8.48±0.96vs. 6.64±0.95, t=6.80, P<0.01), and a lower complication rate (8%vs. 40%, X2 =7.018, P=0.008) compared with the control group. Double-tube negative pressure drainage has a significant application effect in the repair of refractory wounds. It can accelerate wound healing, shorten treatment time, effectively eliminate bacteria, relieve wound infection, reduce complications, alleviate pain and improve patient satisfaction. Therefore, the application, promotion and research of double-tube negative pressure drainage should be strengthened in clinical practice.

Maxillary sinus membrane elevation and coagulum compared with maxillary sinus floor augmentation and a composite graft: A 1-year single-blinded randomized controlled trial.

The aim was to evaluate the 1-year implant outcome and patient-related outcome measures (PROMs) after maxillary sinus membrane elevation and coagulum (test) compared with maxillary sinus floor augmentation and a 1:1 ratio of autogenous bone graft from the buccal antrostomy and deproteinised porcine bone mineral (DPBM) (control). Forty patients (30 female, 10 male) with a mean age of 50 years (range 25-71 years) and an alveolar ridge height between 4 and 7 mm were randomly allocated to test or control. Outcome measures included survival of suprastructures and implants, implant stability quotient, health status of the peri-implant tissue, peri-implant marginal bone loss, frequency of complications and PROMs using Oral Health Impact Profile-14 combined with questionnaires assessing patient's perception of the peri-implant soft tissue, implant crown, function of the implant, and total implant treatment outcome using visual analogue scale. Mean differences were expressed with standard deviation and 95% confidence interval. Level of significance was 0.05. All suprastructures and implants were well-functioning after 1-year of functional implant loading. No significant difference in any of the applied outcome measures was observed between test and control. Both treatments revealed high patient satisfaction scores and significant improvement in oral health-related quality of life. There were no significant differences in implant outcome and PROMs between test and control, after 1-year of functional implant loading. Neither of the treatments can therefore be considered better than the other. Thus, long-term randomized controlled trials are needed before definitive conclusions can be provided about the two treatment modalities.

Comparison of the efficacy of ultrasound guided pectoralis-II block and intercostal approach to paravertebral block (proximal intercostal block) among patients undergoing conservative breast surgery: A randomised control study.

Regional anesthesia techniques have attributed a multimodal dimension to pain management after breast surgery. The intercostal approach to paravertebral block has been gaining interest, becoming an alternative to conventional paravertebral block, devoid of complexities in its approach, being recognized as the proximal intercostal block. Parallel to the widespread acceptance of fascial plane blocks in breast surgery, pectoralis II block has emerged as being non-inferior to paravertebral block. The aim of this study was to evaluate the efficacy of two independent fascial plane blocks, proximal intercostal block and pectoralis II block, in breast conservation surgery. This prospective, randomized control, pilot study included 40 patients, randomly allocated among two groups: proximal intercostal block and pectoralis II block. The pectoralis II block group had significantly lower pain scores at rest in the immediate postoperative period but became comparable with the proximal intercostal block group in the late postoperative period. Pain scores on movement though were lower at 0 h postoperatively and became comparable with the proximal intercostal block group subsequently. Although the pectoralis II group had earlier recovery in the post-anesthesia care unit, the overall time to discharge from the hospital was comparable and not influential. Both groups had high patient satisfaction scores and similar perioperative opioid consumption. Sedation, time to first rescue analgesia, and postoperative nausea vomiting scores were comparable. Fascial plane blocks in the form of pectoralis II and proximal intercostal block facilitate pain alleviation, early return to shoulder arm exercise, and enhanced recovery, which should render them to be incorporated into multimodal interdisciplinary pain management in breast conservation surgery.

Comparing definitive unilateral cleft rhinoplasty with and without diced-cartilage alar-base augmentation: A retrospective cohort study

This retrospective cohort study aimed to compare the long-term aesthetic outcomes and satisfaction of patients who underwent two techniques of definitive unilateral cleft rhinoplasty. The two cohorts, comprising patients with mature unilateral cleft deformity, were managed with definitive rhinoplasty, either with or without diced-cartilage alar-base and peri-alar augmentation (ABPA). Thirty patients were included in each cohort. Anthropometric measurements, complications, patient satisfaction scores, and third-party surgeon assessment scores were reviewed. In both cohorts, anthropometric parameters improved. Rhinoplasty with ABPA was the superior cohort in terms of columellar length (10.3 ± 1.0 in the cohort with ABPA, compared with 7.9 ± 0.6 in the cohort without ABPA; p < 0.001), alar-base angle (0.2 ± 0.2, compared with 4.3 ± 0.3; p < 0.001), and columellar deviation (2.5 ± 1.4, compared with 10.3 ± 2.1; p < 0.001). This cohort also had more symmetry in nostril height and nostril width (p < 0.001), a lower recurrence rate (one case compared with 22 cases; p < 0.001), a higher patient satisfaction score (p = 0.002), and a higher surgeon assessment score (p < 0.001, Cronbach’s alpha = 0.706, Kendall’s coefficient of concordance = 0.787). Within the limitations of this study, it appears that the described technique for augmenting the alar-base and peri-alar maxillary area is manageable, and yields consistent long-term results.