Increased Patient Satisfaction Research Articles

Patient experiences of interprofessional collaboration and intersectoral communication in rare disease healthcare in Germany – a mixed-methods study

BackgroundRare diseases are often complex, chronic and many of them life-shortening. In Germany, healthcare for rare diseases is organized in expert centers for rare diseases. Most patients additionally have regional general practicioners and specialists for basic medical care. Thus, collaboration and information exchange between sectors is highly relevant. Our study focuses on the patient and caregiver perspective on intersectoral and interdisciplinary care between local healthcare professionals (HCPs) and centers for rare diseases in Germany. The aims were (1) to investigate patients’ and caregivers’ general experience of healthcare, (2) to analyse patients’ and caregivers’ perception of collaboration and cooperation between local healthcare professionals and expert centers for rare diseases and (3) to investigate patients’ and caregivers’ satisfaction with healthcare in the expert centers for rare diseases.ResultsIn total 299 individuals of whom 176 were patients and 123 were caregivers to pediatric patients participated in a survey using a questionnaire comprising several instruments and constructs. Fifty participants were additionally interviewed using a semistructured guideline. Most patients reported to receive written information about their care, have a contact person for medical issues and experienced interdisciplinary exchange within the centers for rare diseases. Patients and caregivers in our sample were mainly satisfied with the healthcare in the centers for rare diseases. The qualitative interviews showed a rather mixed picture including experiences of uncoordinated care, low engagement and communication difficulties between professionals of different sectors. Patients reported several factors that influenced the organization and quality of healthcare e.g. engagement and health literacy in patients or engagement of HCPs.ConclusionsOur findings indicate the high relevance of transferring affected patients to specialized care as fast as possible to provide best medical treatment and increase patient satisfaction. Intersectoral collaboration should exceed written information exchange and should unburden patients of being and feeling responsible for communication between sectors and specialists. Results indicate a lack of inclusion of psychosocial aspects in routine care, which suggests opportunities for necessary improvements.

Implementasi Sistem Antrian Pasien Berbasis Website Pada Klinik Sehat Tamba Kelurahan Cilangkap

Clinics are health facilities that provide basic medical services, diagnosis, treatment, and care to patients with minor or non-emergency medical conditions. The development of information technology has triggered the need for information systems in the medical field to improve health services. One important factor in increasing patient satisfaction is minimizing waiting time. Long queues can reduce clinic efficiency and affect patient satisfaction. This study aims to implement a website-based patient queue system at the Tamba Sehat Clinic, with the hope of increasing service efficiency and patient satisfaction. In implementing the website queuing system, researchers used qualitative methods to understand the effectiveness of health services and patient experiences. Data was collected through interviews, observations, and literature studies. The implementation of the Website-Based Patient Queuing System at the Tamba Sehat Clinic has had a significant impact. People can now easily get a queue number online via mobile phone or computer, eliminating the need to queue directly at the clinic location. Tamba Sehat Clinic, which was established in January 2023, has seen increased efficiency with this system. Patients can quickly and efficiently get a queue number, ensuring that their time is spent productively. Additionally, adopting this technology helps clinics improve the quality of service to prospective patients, creating a more comfortable and efficient experience for those in need of healthcare services. Thus, the implementation of a website-based patient queue system has brought real benefits to the community and clinics.

PRACTICE OF USING IMPLANTS IN GYNECOLOGICAL SURGICAL INTERVENTIONS (SCIENTIFIC LITERATURE REVIEW)

Introduction. The use of implants during surgical interventions in gynecology can contribute to the anatomical restoration of the genital organs. The most commonly used implants in gynecology are polypropylene meshes, which promote tissue ingrowth, thus restoring reproductive organs. One of the reasons for using implants in gynecology is pelvic organ prolapse, including uterine prolapse, anterior or posterior vaginal wall prolapse, and vaginal vault prolapse. Synthetic implants are often utilized to reinforce surgical interventions for gynecological disorders, with better indicators of anatomical success in the long term. The aim of the research is to investigate the biomechanical properties of implants in gynecology as effective means for the surgical restoration of female reproductive organs. Materials and methods. Bibliosemantic, comparative, and systematic analysis methods were employed. The proposed recommendations were developed based on the analysis of contemporary literature, results of randomized trials, and meta-analyses dedicated to studying the impact of implants in surgical interventions in gynecological practice. Results. The analyzed results indicate that the optimal supportive framework of implants for gynecological surgery, particularly in the treatment of prolapse, should aim to facilitate the formation of a new matrix for fascial reinforcement, thereby minimizing the development of scar tissue. Conclusions. The primary objective of using implants in gynecological surgical interventions is to search for optimal designs to complement vaginal surgery. This is essential for prolonging treatment outcomes, increasing patient satisfaction, and reducing complications.

Analysis of the Effectiveness of Online-Based Patient Queue Management System Innovation: Study at the Dental and Oral Hospital, Universitas Muhammadiyah Yogyakarta, Indonesia

Long queues and long waiting times at dental and oral health services are frequent complaints from patients. This is caused by the time for dental and oral procedures which generally takes quite a long time compared to other health services. The Dental and Oral Hospital (RSGM) of Universitas Muhammadiyah Yogyakarta (UMY) implemented innovation in the form of an online patient queue management system to overcome this problem. This research aims to evaluate the effectiveness of the online queuing system. This study used a non-experimental observational design with a cross-sectional approach. Data was collected through a survey of 1000 patients who used the RSGM UMY online queue system. Data were analyzed using descriptive statistics and inferential statistical tests. The research results show that the RSGM UMY online queuing system is effective in reducing patient waiting time. The average patient waiting time with the online queuing system was 21.33 (SD 1.45) minutes, shorter than with the manual queuing system which averaged 112.32 (SD 8.23) minutes. Patients were also satisfied with the online queuing system, with 92.32 (SD 4.21) respondents stating they were satisfied. The online patient queue management system at RSGM UMY has proven effective in reducing patient waiting time and increasing patient satisfaction. This system can be a model for other RSGMs to improve the quality of their services.

Robotic assisted Total Knee Arthroplasty (TKA) is not associated with increased patient satisfaction: a systematic review and meta-analysis.

Total knee arthroplasty (TKA) is a common orthopedic surgery, yet postoperative dissatisfaction persists in around 20% of cases. Robotic total knee arthroplasty (rTKA) promises enhanced precision, but its impact on patient satisfaction compared to conventional TKA remains controversial (cTKA). This systematic review aims to evaluate patient satisfaction post-rTKA and compare outcomes with cTKA. Papers from the following databases were identified and reviewed: PubMed, Scopus, Web of Science, and the Cochrane Online Library, using keywords like "Knee replacement," "Total knee arthroplasty," "Robotic," and "Patient satisfaction." Extracted data included patient satisfaction measures, Knee Society Score, Oxford Knee Score, Forgotten Joint Score, SF-36, HSS, and KOOS. Statistical analysis, including odds ratio and 95% CI was performed using R software. Heterogeneity was assessed using Cochrane's Q test. The systematic review included 17 articles, involving 1148 patients (571 in the rTKA group and 577 in the cTKA group) assessing patient satisfaction following rTKA. An analysis of proportions reveals rTKA satisfaction rate was 95%, while for cTKA, it was 91%. A meta-analysis comparing rTKA and cTKA found no statistically significant difference in patient satisfaction. Additionally, various patient-reported outcome measures (PROMs) were examined, showing mixed results across different studies and follow-up periods. The results of this study found no difference in patient satisfaction outcomes in the short to mid-term for rTKA compared to conventional methods. This study does not assert superiority for the robotic approach, highlighting the need for careful consideration of various factors influencing outcomes in knee arthroplasty.

Pipelle Endometrial Sampling With a Full Bladder Compared With Standard Care: A Randomized Controlled Trial.

To compare insertion failure rates for Pipelle endometrial sampling with a full bladder compared with the standard process (not taking into account bladder status) without cervical manipulation. A single-masked randomized trial was conducted in a single tertiary care center from July 2021 to January 2022. Two hundred fourteen participants aged 18 years or older who were scheduled for outpatient Pipelle endometrial sampling were randomized: 107 each to having a full bladder (by oral water intake) or standard process (without delayed sampling and bladder status not taken into account). Women with known cervical stenosis, gynecologic malignancy, uterine anomalies, leiomyoma distorting the uterine cavity, acute cervicitis, urge bladder dysfunction, intense anxiety, need for anesthesia or analgesic before the procedure, positive pregnancy test, or previous failed office endometrial sampling were excluded. The primary outcome was the insertion failure rate of endometrial sampling at first attempt. Secondary outcomes were pain during procedure, satisfaction score, analgesia use, procedure duration, and need for cervical manipulation. Factoring in a baseline insertion failure rate of 30.0%, relative risk of 0.45, α of 0.05, 80.0% power, and a dropout rate of 10.0%, we needed 107 participants in each arm. The insertion failure rate was significantly lower in the full bladder group compared with standard process: 25 of 107 (23.4%) compared with 45 of 107 (42.1%) (relative risk 0.56, 95% CI, 0.37-0.84; number needed to treat to benefit 6.0, 95% CI, 3.20-15.70). Pain score (median) during the procedure (interquartile range) was 4 (3-6) compared with 5 (3-8) (P=.004); patient satisfaction score was 8 (7-9) compared with 7 (4-8) (P<.001); and mean±SD procedure duration was 3.0±2.4 compared with 4.7±2.9 minutes (P<.001) for the full bladder and standard process arm, respectively. Other secondary outcomes of cervical laceration, analgesia use, and adequacy of endometrial tissue for histopathologic assessment were not significantly different between groups. Pipelle endometrial sampling with a full bladder reduces the initial insertion failure rate, procedure-related pain, and duration of sampling and increases patient satisfaction compared with the standard process. ISRCTN, ISRCTN33938192.

EFFICACY OF PERICAPSULAR NERVE GROUP BLOCK AS A MODALITY FOR POSTOPERATIVE PAIN MANAGEMENT IN PATIENTS UNDERGOING ARTHROSCOPIC TREATMENT OF FEMOROACETABULAR IMPINGEMENT

The postoperative pain after hip arthroscopy remains a major challenge in the immediate postoperative period. Adequate postoperative analgesia has been associated with increased patient satisfaction and decreased consumption of opioids. We evaluated the efficacy of pericapsular nerve group block (PENG) versus fascia iliaca block (FIB) in reducing post-operative pain and analgesic consumption within the first 24 hours following arthroscopic management of femoroacetabular impingement (FAI).Thirty-nine patients (17 females and 25 males, ages 18–42 years, mean ± SD (27.9 ± 6.2), and mean BMI of 25.13±5.08 kg/m2 were scheduled for primary arthroscopic management of FAI. Included patients were randomized into two groups according to the block used in each. Group (A) 19 patients were included and had FIB and group (B) 20 patients were included and received PENG block. The efficacy of both techniques was clinically and statistically valuated using VAS score and quadriceps muscle power.There was a statically significance difference in the mean at rest between the two groups at all measured time points following surgery (6, 12, 18 and 24 h). Also, in dynamic pain scores (with hip flexion) scores were statistically significant at 24 hours post-operative (P = .001). Total opioid consumption in the first 24 hours postoperative was lower in the PENG group with significant difference of mean 16.5 ±9.9 mg for PENG group versus 27.5±9.6 mg for FIB group (P &lt; .005). Five patients (26.31%) in FIB group had weaker quadriceps muscle power while none in PENG group patients had quadriceps weakness.PENG block might be considered as an ideal regional anesthesia modality for hip arthroscopy. As an alternative to more conventional regional nerve blocks such as a fascia iliaca block. PENG block is easily performed in the preoperative setting, and appears to spare motor function while providing a prolonged sensory pain relief.

Selection of parenteral iron supplement for iron deficiency anemia: A review

The article reviews medicinal products for the treatment of iron deficiency conditions and iron deficiency anemia, the prevalence of which is about 30% among the world population. Iron deficiency is a significant cause of anemia, which can lead to hospitalization and even death. In case of intolerance or ineffectiveness of oral formulations of iron supplements, if it is necessary to replenish the iron level quickly, trivalent iron formulations for intravenous administration are used. These supplements are iron complexes with an iron hydroxide core surrounded by a carbohydrate shell. Iron formulations for intravenous administration can be divided into drugs of the "old" and "new" generation. One of the most studied and popular representatives of the "new" generation is iron carboxymaltose (ICM). The results of clinical studies showed that ICM better and faster increases hemoglobin concentration and replenishes iron stores in patients compared to the "old" generation formulations and also has a more favorable safety profile. Large doses of ICM can be administered in a short time, saving resources and increasing patient satisfaction. The injection of large doses of iron with a small number of infusions in the case of ICM is more economically beneficial for all departments of medical institutions, as it significantly reduces the total cost of medical care. Intravenous iron plays an essential role in the perioperative treatment of iron deficiency anemia, especially in elective surgery. Currently, there is a reliable evidence base confirming the efficacy and safety of intravenous iron formulations in chronic kidney disease, inflammatory bowel disease, heart failure, gynecological and obstetric diseases, and cancer.

Analysis of Marketing Strategies in Increasing Patient Satisfaction Using SWOT Analysis at Voluntary Healthy Clinic in Pondok Aren, South Tangerang

This research aims to find out what kind of marketing strategy should be used to increase patient satisfaction and also to identify the strengths, weaknesses, opportunities and threats that exist at the Voluntary Healthy Clinic. This research uses qualitative research with a case study approach. Primary data was collected through interviews with several clinic stakeholders. Apart from using the interview method, the author also uses observation and documentation methods to deepen the data obtained. The data that has been collected is then analyzed using the SWOT method. The results of this research show that an effective marketing strategy used to increase patient satisfaction is at quadrant 1 point, namely supporting aggressive strategies (SO/Strengths and Opportunities) by implementing several strategies, namely (1) By utilizing a strategic location, the clinic can take advantage of various opportunities such as develop services or programs, namely laboratories, midwifery, inpatient services, etc. and carry out promotions via internet media, distribute brochures and put up banners, (2) With strengths such as ambulance facilities, various kinds of patent medicines, home services care/home visits, long-distance consultations provide opportunities to increase patient satisfaction and also increase patient confidence in seeking treatment at the Voluntary Healthy Clinic.

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

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

Endoscopic Primary Breast Augmentation With Loco-Regional Anesthesia: Preliminary Experience of 200 Consecutive Patients

Abstract Background breast augmentation with implants recorded over 1.6 billion procedures globally in 2022. To reduce surgical trauma and complications and facilitate a fast recovery, we employ an ultrasound-guided local-regional anesthesia technique, the creation of a partial sub-muscular implant pocket by a direct endoscopic visualization and a minimal skin access on the mammary fold. Objectives The aim of the study is to evaluate whether the breast augmentation performed in endoscopy under local-regional anesthesia reduces post-operative recovery time, reduces complications and increases patient satisfaction. Methods Patients provided their consent through a signed form. We set strict inclusion and exclusion criteria. We prospectively evaluate postoperative pain and recovery times, rate of complications and patient satisfaction at 12 months post-surgery. Results Between January 2021 and September 2022, 200 patients met the inclusion criteria. The average operation time was 54.2 minutes. Patients were discharged from the hospital within 2 to 3 h.  Eighty-nine % of patients expressed great satisfaction with the result. None of the patients experienced post-surgical complications. Conclusions our initial study showed that endoscopic breast augmentation conducted under localized anesthesia is safe. It allows for quick recovery post-surgery and swift resumption of everyday activities. The overall complication risk is less than what has been reported in scientific studies for the classic dual-plane technique. Moreover, this approach yields excellent patient satisfaction. Additional prospective and randomized studies will be required to enhance the scientific validity of this technique. Moreover, a larger patient cohort will be essential to stratify the risks associated with varying prosthetic volumes.

A SYSTEMATIC REVIEW OF PREOPERATIVE LOCALIZATION TECHNIQUES FOR PRIMARY HYPERPARATHYROIDISM SURGERY

Background: Hyperactivity of the parathyroid gland is a major abnormality that can lead to bone loss and other serious disorders. For effective treatment, some preoperative approaches such as computed tomography, positron emission tomography, and nuclear medicine imaging tests exist. Methodology: The methodology followed PRISMA guidelines, encompassing a thorough search of key databases (2008-2020) using specific keywords. Inclusion criteria emphasized diagnostic test design, primary hyperparathyroidism population, noninvasive imaging methods, comparative analyses, and histopathologic validation. Quality assessment utilized the QUADAS-2 tool, and data extraction was comprehensive, covering the study, participant characteristics, imaging techniques, and diagnostic metrics. Results: Of the 14 selected papers, CT Scan, ultrasound, MRI, and nuclear medicine imaging test/ sestamibi scanning are highly cited and better preoperative localization techniques than others. The success rate of CT scans in preoperative localization in surgery for primary hyperparathyroidism had a wide range of 58 – 93%. Conclusion: All the localization techniques have different success rates when used for preoperative localization in surgery for primary hyperparathyroidism. CT scan and MRI showed the highest success rate among all. Education in terms of effectiveness causes the least to no harm to the human body, must keep the cost affordable for the patients, how this therapeutic approach increases patient satisfaction, and how this approach assists in surgical planning should be considered.

Exploring patients' perspectives: a mixed methods study on Outpatient Parenteral Antimicrobial Therapy (OPAT) experiences.

Outpatient Parenteral Antimicrobial Therapy (OPAT), an alternative to inpatient intravenous antibiotic therapy, has shown benefits in international studies such as increased patient satisfaction. Because OPAT has been used only sporadically in Germany so far, no structured results on patients' experiences and concerns regarding OPAT have yet been available. This study therefore aims to explore the experiences of OPAT patients in a pilot region in Germany. This is an observational study in a German pilot region, including a survey of 58 patients on their experiences with OPAT, and in-depth interviews with 12 patients (explanatory-sequential mixed-methods design). Patients reported that they were satisfied with OPAT. That a hospital discharge was possible and anti-infective therapy could be continued in the home environment was rated as being particularly positive. In the beginning, many patients in the interviews were unsure about being able to administer the antibiotic therapy at home on their own. However, healthcare providers (doctors and pharmacy service provider staff) were able to allay these concerns. Patients appreciated regular contact with care providers. There were suggestions for improvement, particularly concerning the organization of the weekly check-up appointments and the provision of information about OPAT. Patients were generally satisfied with OPAT. However, the treatment structures in Germany still need to be expanded to ensure comprehensive and high-quality OPAT care. NCT04002453, https://www. gov/ , (registration date: 2019-06-21).

Brave new world: expanding home care in stem cell transplantation and advanced therapies with new technologies.

Hematopoietic stem cell transplantation and cell therapies like CAR-T are costly, complex therapeutic procedures. Outpatient models, including at-home transplantation, have been developed, resulting in similar survival results, reduced costs, and increased patient satisfaction. The complexity and safety of the process can be addressed with various emerging technologies (artificial intelligence, wearable sensors, point-of-care analytical devices, drones, virtual assistants) that allow continuous patient monitoring and improved decision-making processes. Patients, caregivers, and staff can also benefit from improved training with simulation or virtual reality. However, many technical, operational, and above all, ethical concerns need to be addressed. Finally, outpatient or at-home hematopoietic transplantation or CAR-T therapy creates a different, integrated operative system that must be planned, designed, and carefully adapted to the patient's characteristics and distance from the hospital. Patients, clinicians, and their clinical environments can benefit from technically improved at-home transplantation.

Croatian Translation and Validation of the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ).

Patient satisfaction is a crucial measure of the quality of healthcare, especially with regard to nursing services in hospital settings. Understanding and increasing patient satisfaction with nursing care is critical to improving overall healthcare and ensuring positive patient experiences during their hospital stay. The aim of this research was to evaluate the psychometric properties of the Croatian version of the Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), test the reliability and validity of the tool after translation, and investigate differences in patient satisfaction based on demographic variables, as well as their contribution to satisfaction with the quality of nursing care. After translation and adaptation, the Croatian version of the PSNCQQ was applied to 350 hospitalized patients (average age 51.19 years (range: 18-87)), of whom 194 (55.4%) were men and 156 (44.6%) were women. The results showed high internal consistency (Cronbach's α = 0.977) and confirmed the one-factor structure of the questionnaire, explaining 70.64% of the total variance. Confirmatory factor analysis supported the unidimensional model, showing strong fit indices (χ2 = 583.047, df = 149, p < 0.001, GFI = 0.861, AGFI = 0.818, NFI = 0.936, TLI = 0.946, CFI = 0.955, RMSEA = 0.080, PCLOSE < 0.001). In conclusion, the validation of the PSNCQQ in the Croatian language increases resources for evaluating and improving the quality of nursing care. This research lays the foundation for future studies and practical applications aimed at improving patient satisfaction and nursing care outcomes in Croatia, but there are also limitations to this study, including its one-institution scope, the possible influence of factors outside the current treatment on satisfaction, and the lack of comparison with objective clinical indicators.

ANALYSIS OF THE DIMENSIONS OF HEALTH SERVICE QUALITY ON PATIENT SATISFACTION AT ROYAL PRIMA MARELAN HOSPITAL IN 2024

One indicator of quality in health services is patient satisfaction, where high-quality health services will generally create a high level of patient satisfaction, leading to loyalty to health services. The study aimed to analyze the dimensions of Health Service Quality toward Patient Satisfaction at Royal Prima Marelan Hospital in 2024. The method used in this research is quantitative non-experimental with a descriptive approach (cross-sectional survey) and associative analysis. The population was 318 people, and the sample determination used Slovin so that the sample size was 197, rounded up to 200 samples, with incidental sampling technique-data analysis using univariate, bivariate (Chi-Square), multivariate (multiple logistic regression Enter method). The results of the Chi-Square analysis obtained the variables of Physical Evidence (p-value 0.004), reliability (p-value 0.006), Responsiveness (p-value 0.008), assurance (p-value 0.004), empathy (p-value 0.002) have a p-value ≤ 0.05 with a significant level of 0.05. It is concluded that the most influential variable is the empathy variable, with a p-value of 0.000 &lt;0.05. The OR value obtained is 10.224, meaning that ease of relationship, good communication, and understanding of the needs of patients have an opportunity of 10.224 times to increase patient satisfaction at Royal Prima Marelan Hospital in 2024. KEYWORDS: quality, satisfaction, patient, empathy

The Impact of Involving a Senior Emergency Physician in the Triage Process

BACKGROUND: Emergency Department (ED) overcrowding has been demonstrated in several studies to be associated with undesirable effects such as longer waiting times, reduced patient satisfaction, and, most importantly, poor patient outcomes. Furthermore, long waiting times for walk-ins result in more complaints and patient dissatisfaction than illness management itself, with the majority of issues arising as a result of real and perceived waiting periods before being seen by the doctor. AIM: We set out to investigate whether introducing a senior emergency physician into the triage system would reduce waiting time, door-to-decision time, and door-to-doctor time, as well as increase patient satisfaction across the ED. METHOD: This was an interventional pre-post study that utilised retrospective data to evaluate the effect on ED throughput of triage by senior emergency physicians. We aimed to measure its impact on waiting time, door-to-decision time, and door-to-doctor time, along with ED patient satisfaction. RESULTS: Patient satisfaction, the overall assessment of treatment received during the visit, increased, from 74.975 to 77.425, and the likelihood of patients recommending the ED increased from 71.36 to 75.21. Operational metrics revealed a considerable drop in door-to-decision time (admit or discharge) of 46 minutes and 3 seconds, as well as a 1 minute and 21 second reduction in time from door to doctor (arrival to first provider). CONCLUSION: The mixed results hint at an effective but iterative process of enhancing patient flow and experience in the ED through senior physician triage.

Outcomes of ECAP-controlled closed-loop spinal cord stimulation therapy in JAPAN: how to increase patient satisfaction with spinal cord stimulation

Objective: Orthopedic surgeons commonly encounter patients with low back pain and leg pain. Despite conservative treatment, which may involve the use of weak opioids or NSAIDs, some patients do not experience improvement and may require increased dosages, contributing to concerns about opioid overuse overseas. Spinal cord stimulation (SCS) therapy, which can be trialed without surgical intervention, offers a potential treatment option. We evaluated Inceptiv (Medtronic), a generator that allows new stimulation settings using evoked compound action potentials (ECAPs)-controlled Closed-Loop technology. Methods: We evaluated six patients (four females, two males) who underwent implantation of the Inceptiv generator for SCS therapy. The average walking time (seconds) during a 2.1-meter walk and pain assessment using the Numerical Rating Scale (NRS) were conducted. Patient satisfaction was assessed using a 5-point scale: very satisfied (5), somewhat satisfied (4), neutral (3), somewhat dissatisfied (2), very dissatisfied. (1). Results: The average walking time improved from 11.8 seconds to 6.6 seconds, and the NRS score decreased from 7.6 to 4.2. Patient satisfaction was high, with four patients being very satisfied (5), one somewhat satisfied (4), and one neutral (3). Discussion: SCS therapy with Closed-Loop technology using the Inceptiv generator offers the potential to adjust electrical stimulation to minimize discomfort in daily activities and provide pain relief. It is considered a new treatment option for patients with common orthopedic conditions such as thoracolumbar compression fractures and lumbar spinal stenosis who suffer from chronic refractory pain in routine clinical practice.

Application of Neural Rehabilitation Manipulator Training in Upper Limb Rehabilitation of Stroke Patients with Hemiplegia

Objective: To analyze the application of neural rehabilitation manipulator training in upper limb rehabilitation of stroke patients with hemiplegia. Methods: 94 patients with hemiplegia after stroke were selected from January 2021 to January 2023. The patients were randomly divided into a control group and an observation group, with 47 cases in each group. The control group received routine rehabilitation training while the observation group received neural rehabilitation manipulator training. The upper limb and nerve function, daily task performance ability, quality of life, and rehabilitation training satisfaction were compared between the two groups. Results: There was no significant difference in upper limb and nerve function between the two groups before training, P &gt; 0.05. After training, the observation group had 51.45 ± 8.75 points in ARAT and 52.59 ± 8.48 points in FMA-UE, which were higher than those in the control group with 43.81 ± 6.67 points and 45.51 ± 7.31 points respectively, P &lt; 0.05. The observation group had 5.71 ± 1.53 points in NIHSS, which was lower than those in the control group with 8.04 ± 2.39 points, P &lt; 0.05. In terms of daily task performance ability and quality of life, there was no significant difference between the two groups before training, P &gt; 0.05. After training, the observation group had 78.54 ± 10.63 scores in MBI and 171.93 ± 19.12 scores in SS-QOL, which were higher than those in the control group with 70.51 ± 9.25 scores and 160.13 ± 18.42 scores respectively, P &lt; 0.05. In terms of satisfaction, the total satisfaction rate of the observation group was 93.62%, which was higher than that of the control group with 74.47%, P &lt; 0.05. Conclusion: The application of neural rehabilitation manipulator training in the upper limb rehabilitation of stroke patients with hemiplegia can significantly improve the upper limb function of patients, relieve nerve defects, improve daily task performance ability and quality of life, and increase patient satisfaction with rehabilitation training.

Implementasi Metode Kano dan Importance Performance Analysis pada Pengembangan Sistem Pelayanan Puskesmas

&lt;p&gt;&lt;em&gt;Puskesmas is a community health service. Improving public health services can be achieved through providing excellent and quality health services. In terms of the performance of the puskesmas administrative services, there is no information system for processing patient data, which has an impact on the quality of services in the puskesmas. The aim of this research is to create a web-based knowledge management system that assesses the quality of health services provided by health centers. This will measure the gap between the actual performance of the Puskesmas, patient expectations, and the level of satisfaction experienced by patients. The system will also propose alternative solutions to increase patient satisfaction. in improving the quality of services provided by Community Health Centers. The methods used in the research are Importance and Performance Analysis (IPA) and the Kano method. The reason for choosing the IPA method is because IPA can be used to measure respondents' mastery of research attributes and can also measure the importance of an attribute based on respondents' perceptions. This research uses the Kano technique to categorize the features of a product or service based on their ability to fulfill customer desires effectively. The result of this research is a Knowledge Management System designed for Community Health Center services, which has the potential to reduce knowledge gaps.&lt;/em&gt;&lt;/p&gt;