Lower Satisfaction Ratings Research Articles

Satisfaction with dental care. A review of the literature.

The satisfaction of the patient is considered important to predict patient compliance, their ability to follow instructions, adherence to treatment and as a determining factor in the future use of health services. In Chile, there are currently not many studies or analyses in the health sector about the quality of care or level of satisfaction of patients. In most cases, these have only been studied through surveys, which are often initiated by the health services themselves, without using validated instruments. This article presents a review of the most relevant aspects described in the literature about satisfaction with dental care. The satisfaction that people experience in the use of a service or consumption of a product is a phenomenon that has been widely studied in recent decades. This concept has mainly been studied in two scientific areas: social psychology and an economistic approach. Multiple studies have demonstrated the multidimensional nature of user satisfaction in dentistry. Davies and Ware developed the Dental Satisfaction Questionnaire (DSQ) to assess access, availability, cost, pain management and quality. Several studies indicate that a positive relationship between the patient and the dentist generates higher satisfaction rates and that a negative relationship between the patient and the dentist leads to lower satisfaction rates on the part of the patients. As a result, a positive relationship with the dentist leads to greater commitment and interest in the dental treatment, generating greater adherence, better outcomes and increased satisfaction.

Patients with head and neck cancer may need more intensive pain management to maintain daily functioning: a multi-center study.

The purpose of this study is to investigate the prevalence of pain, pain management, and impact of recent pain on daily functioning in patients with head and neck cancer (HNC) and patients with other cancers. This multi-center survey was conducted by using Brief Pain Inventory questionnaire to evaluate pain status and its impact on daily functioning. A total of 3289 patients were analyzed including 708 HNC patients and 2581 patients with other cancers. The overall pain prevalence was 69.17%. A higher percentage of HNC patients had recent pain (60.59 vs. 44.01%, P < 0.001), required pain management (86.29 vs. 72.03%, P < 0.001), and used any analgesics (53.81 vs. 34.52%, P < 0.001). HNC patients with pain management had a higher prevalence of recent pain (85.83 vs. 81.14%, P = 0.044) and a slightly lower satisfaction rate (74.00 vs. 79.70%, P = 0.070). Regarding the impact of pain on daily functioning, HNC patients had a lower mean interference score for general activity such as walking, normal work, sleep, and life enjoyment. The HNC patients may need more intensive pain management to achieve optimal pain control and maintain daily functioning.

Thursday, September 27, 2018 1:05 PM–2:05 PM Lumbar Spine Surgery: What You Need to Know: 113. Routine microscope use does not increase operative time or affect short term outcomes in single-level lumbar microdecompression

BACKGROUND CONTEXT Lumbar microdecompression is one of the most common procedures in orthopedic spine surgery with an overall low complication and high satisfaction rate. The procedure is typically performed with visualization aids, either loupes or an operating room microscope. Several studies to date have investigated differences between these two magnification tools, with conflicting results. Some authors argue in favor of the microscope, citing improved visualization, better ergonomics and improved patient outcomes, while others argue that its use makes no clinical difference. These studies consist primarily of small patient cohorts numbering 50-100 subjects. PURPOSE The purpose of this study is to determine how the routine use of an operating room microscope during single level lumbar microdecompression impacts intraoperative and short-term surgical outcomes through an examination of the largest retrospective cohort to date. STUDY DESIGN/SETTING Retrospective review of American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. PATIENT SAMPLE A total of 43,948 patients who underwent single level lumbar microdecompression from 2005 to 2015. OUTCOME MEASURES Assessment of surgical benchmarks of operative time and length of hospital stay as well as differences in early (30 day) complication rates. The specific complications evaluated included the need for blood transfusion, return to the operating room, pulmonary embolism, deep venous thrombosis, sepsis, cerebrovascular accident, cardiac arrest, ventilator time greater than 48 hours, urinary tract infection, pneumonia, myocardial infarction, surgical site infections, and patient mortality. METHODS Using the ACS-NSQIP database, we identified all patients who underwent single level lumbar microdecompression (CPT 63030). They were divided into two cohorts, those cases that involved the use of an operating room microscope (CPT 69990), and those that did not. We compared intraoperative and postoperative procedural data as well as the incidences of local and systemic complications. RESULTS The ACS-NSQIP database identified 43,948 patients who underwent single level lumbar microdecompression from 2005 to 2015. Of that patient cohort 4,654 cases included the use of an operating room microscope. There were no clinically significant demographic differences between patient cohorts. We identified clinically important statistical differences in length of stay (1.37 vs. 1.75 days, p CONCLUSIONS The routine use of an operating room microscope in single level lumbar microdecompression does not affect short-term patient outcomes. Importantly, there is no difference in mean operative time or infection rate with the addition of a microscope. There is a statistically significant trend toward decreased length of stay and fewer blood transfusions in the microscope cohort; however, in the setting of a large database study and small absolute differences, the clinical implications of these findings are difficult to interpret. Based on these results, we conclude that the decision to use an operating room microscope in single level lumbar microdecompression should be left to the treating surgeon and based upon considerations of improvements in visualization, surgeon ergonomics and ability to educate surgical assistants. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

SATISFACTION AT IFES: AN ANALYSIS THROUGH CAREER ANCHORS

ABSTRACT Purpose: The objective of this research is to analyze the job satisfaction of public servants through career anchors. Originality/value: The contribution of this research is to apply a collection instrument in reduced version for the analysis of job satisfaction in the public service in the search of subsidies for proposals of improvements in work processes related to people management. Design/methodology/approach: We conducted the research with 671 public servants from the public education area. As an instrument of collection, we sent questionnaires using the electronic survey method and on paper. We based the questionnaire on the “Career Anchor Inventory” - adapted by Igbaria and Baroudi (1993) and the work by Netemeyer, Boles, and McMurrian (1996), termed as “Global Job Satisfaction”. Findings: The Security/Stability anchor obtained significant explanatory power with job satisfaction, but its representativeness was not the largest in the sample. Our practical contribution will be in the support to the construction of policies of people management, since the results indicated lower rates of satisfaction with regard to the aspects of promotion and with respect to the relationship with senior management.

Dorsal Suspension for Morton’s Neuroma

Category: Midfoot/Forefoot Introduction/Purpose: We performed a dorsal suspension of neuroma using the dorsal transverse ligament for the treatment of Morton’s neuroma. The purpose of this study was to investigate and compare the functional outcomes and complications of dorsal suspension with those of neurectomy. Methods: We conducted a retrospective study of thirty-eight (40 feet, 40 neuromas) and thirty-six (36 feet, 36 neuromas) patients who underwent dorsal suspension and neurectomy, respectively. At twenty-four month follow-up, the visual analog scale was used to evaluate pain, and the Foot and Ankle Ability Measure (FAAM) was used to investigate patient-reported function of activities of daily living and sports. Satisfaction analysis was performed using the Coughlin scale, and postoperative complications were also evaluated. Results: Both groups reported significant pain relief, and there were no significant differences between the groups with respect to postoperative pain (dorsal suspension group, mean, 12.0; neurectomy group, mean, 25.8; p = .99). The postoperative FAAM outcomes showed no significant between-group differences in activities of daily living (dorsal suspension group, mean, 89.5, neurectomy group, mean, 77.2; p = .22) or sports subscales (dorsal suspension group, mean, 85.5; neurectomy group, mean, 69.4; p = .97). Satisfaction analysis showed ‘excellent’ and ‘good’ results in the dorsal suspension and neurectomy groups (95% and 77.7%, respectively). Complications reported in the dorsal suspension and neurectomy groups were numbness (5% vs 61.1%, respectively, p &lt; .05) and paresthesia (5% vs 33.3%, respectively, p &lt; .05). Conclusion: Compared with neurectomy, dorsal suspension provided comparable pain relief and improvement in terms of functional outcomes, as measured by the FAAM. With its lower rate of complication and high satisfaction, dorsal suspension can be another operative option for the treatment of Morton’s neuroma.

601 Clinical outcome/patient and partner satisfaction after penile implant surgery

We conducted a retrospective single centre study to analyse the mechanical reliability, complication rate, quality of life and patient satisfaction of the implantation of a penile prosthesis in patients with erectile dysfunction. Data were collected of 126 patients with erectile dysfunction who underwent primary implantation of an inflatable penile prostheses during a 5-year period. The surgical approach was either penoscrotal or infrapubic. We classified the patients in five aetiological groups: vasculogenic, post-prostatectomie, peyronies disease, diabetes and others. At least one year after implant surgery a structured telephone interview concerning patient and partner satisfaction was conducted. Mechanical failure occurred in 7.14%. The three major complaints were loss of penile length (18.53%), post-operative pain (11.9%) and altered sensation (8.73%). Three patients (2.28%) received prolonged antibiotic therapy for possible signs of infection (no explantation required) and one patient (0.79%) underwent revision surgery for an imminent erosion. The occurrence of floppy glans syndrome was significant higher with the infrapubic approach. In total, 15 patients (11.9%) had revision surgery for various reasons. One year or more after surgery, there were high patient and partner satisfaction rates, respectively 83.2% and 85.4%. We found the highest satisfaction rates in the vasculogenic and post-prostatectomy group. There was a significant lower satisfaction rate for the AMS-Ultrex (25%) comparing to the Coloplast Titan (91%) and AMS-LGX (80%). The average time to activation of the prosthesis after surgery was 6 weeks and more than 50% had sexual intercourse within 4 weeks after activation. 72.41% of the patients had an orgasm during their first sexual intercourse. The average quality of life on a scale from 0 to 5 was 2 before and 3.5 after surgery.

The Impact of Hospital Accreditation on the Patient Satisfaction of In-Patient Department Services

Patient satisfaction is as important as other clinical health measures and is a chief means of assessing the strength of health care delivery. The current competitive environment has driven health care organisations to concentrate on patient satisfaction as a means to acquire and keep market share. If you don’t recognise what your strengths and weaknesses are, you can’t compete effectively. Objectives: To study the impact of National Accreditation Board for Hospitals &amp; Healthcare Providers (NABH) Accreditation, India on the patient satisfaction of In-Patient Department Services. Methods: It is a quantitative, descriptive and inferential research based case study in which sample of a population was studied by structured satisfaction survey questionnaires (before and after the accreditation) in a private tertiary care hospital in Secunderabad, Telangana State, India to determine its characteristics, and it is then inferred that the population has the same or different characteristics. Significance of Research: It was observed initially before the accreditation that there was a lower satisfaction rate in in-patient department services, which was affecting the study hospitals’ business. Hypothesis: Null Hypothesis (H0) and Alternative Hypothesis (H1) were used and tested to compare the before and after impact of accreditation by applying to each question of the questionnaire. Study Design: The closed ended questionnaire was developed considering the in-patient services process by incorporating the six dimensions of quality Safe, Timely, Effective, Efficient, Equitable, and Patient-centred (STEEP) and tested prior to implementing. Questionnaires were given to the patients for completion upon discharge two months before and two months after the accreditation. Study Population: Simple random sampling method was selected, and the researcher had involved conscious patients of all age groups and gender. Data Collections: Primary data were collected from the survey questionnaires. Secondary data were collected from relevant published journals, articles, research papers, academic literature and web portals. Conclusion: It is very evident from this research that at the 5 % level of significance, the chi-square test indicates that there is a significant difference in the satisfaction with respect to the overall experience in the hospital between before the accreditation group and after accreditation group with p-value &lt;0.001.The responses of satisfaction has improved from N=421 (Satisfied=245, Highly satisfied= 176) from N=241 (Satisfied = 124, Highly satisfied= 117).

The Impact of Hospital Accreditation on the Patients Satisfaction of Haemodialysis Department Services

The quality of hospital Haemodialysis Department Service is one of the most relevant items of health care quality perceived by patients and by their families. Patient satisfaction is considered a way of measuring the quality of services provided. Objectives: To study the impact of National Accreditation Board for Hospitals &amp; Healthcare Providers (NABH) Accreditation, India on Haemodialysis Department Service patient satisfaction. Methods: It is a quantitative, descriptive and inferential research based case study in which sample of a population was studied by structured satisfaction survey questionnaires (before and after the accreditation) in a private tertiary care hospital at Secunderabad, Telangana State, India to determine its characteristics, and it is then inferred that the population has the same or different characteristics. Significance of Research: It was observed initially before the accreditation that there was a lower patient satisfaction rate of the hospital Haemodialysis Department Services, which was affecting the study hospitals’ business. Hypothesis: Null Hypothesis (Ho) and Alternative Hypothesis (H1) were used and tested to compare the before and after impact of accreditation by applying to each question in the questionnaire. Study Design: The closed ended questionnaire was developed considering the Haemodialysis Department Services and incorporated the six dimensions of quality Safe, Timely, Effective, Efficient, Equitable, and Patient-centred (STEEP) and tested prior to implementing. Questionnaires were given to the patients' families for completion upon using the Haemodialysis Department Services two months before and two months after the accreditation. The data were collected in order to cover all three shifts of the Haemodialysis Department Services. Study Population: Simple random sampling method was selected, the researcher had involved all conscious patients (clinical conditions) from all age groups. Data Collections: Primary data were collected from the survey questionnaires. Secondary data were collected from relevant published journals, articles, research papers, academic literature and web portals. Conclusion: At the 5 % level of significance, the t-test results indicate that there is a significant difference in the responses between before (M=51.11, SD=21.89) and after accreditation (M=58.56, SD=17.28) with p-value &lt;0.001. The mean satisfaction score has improved from before accreditation compared to after accreditation.

Revision Abdominoplasty with Truncal Liposculpting: A 10-Year Experience.

Abdominoplasty is one of the most popular body-contouring procedures. Despite its popularity, classic abdominoplasty is still associated with a significant rate of complaints from patients such as: fullness of flanks and epigastric areas, lack of a posterior lumbar curve, hanging skin over the incision line, and visible scars over the flanks and beyond underwear or swimming suit coverage. This study reviews the authors' experience in redo abdominoplasty when the patient is not or partially satisfied with the primary procedure. A total of 115 female and 32 male patients underwent revision abdominoplasty with truncal liposculpting between 2007 and 2016. The age distribution of patients ranged from 33 to 73years, with a mean of 43.1years. All the patients included in the study had undergone classic abdominoplasty in a different institution. Overall satisfaction with the body appearance after the combined procedure was rated on a scale of 1-5, where 1 is 'poor,' 2 is 'fair,' 3 is 'good,' 4 is 'very good,' and 5 is 'excellent.' The evaluation was made 12months after the composite body-contouring procedure. Four hundred to 1500ml of fat were obtained with liposuction (mean 840ml). The amount of clean, adipose tissue transplanted to the buttocks varied from 95 to 425 (mean 286ml) and to the lower limbs from 75 to 270ml (mean 195ml). The stromal-enriched lipograft technique was used in all the cases to enrich the fat transplantation. There was no hematoma, infection or deep vein thrombosis. Seventy-five percent reported that their appearance after composite body contouring was 'very good' to 'excellent' (30% 'excellent' and 45% 'very good') and 20% responded that their appearance was 'good.' Only 5% of patients thought their appearance was less than good ('fair'). The average follow-up time for this group of patients has been 6.3years (range 1-10years). Truncal liposculpting with modified abdominoplasty accomplishes very good aesthetic results in a single surgical procedure with a low rate of complications and high patient satisfaction in cases of revision abdominoplasties. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Increased symptoms of stiffness 1\xa0year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

PurposeSymptoms of stiffness after total knee arthroplasty (TKA) cause significant morbidity, but there is limited data to facilitate identification of those most at risk after surgery. Stratifying risk can aid earlier directed treatment options.MethodsA retrospective cohort consisting of 2589 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short form (SF) 12 scores were collected pre-operatively and 1 year post-operatively. In addition, patient satisfaction was assessed for 1 year. Patients with a worse WOMAC stiffness score in 1 year were defined as the “increased” stiffness group and the other cohort as the non-stiffness group.ResultsAt 1 year after surgery 129 (5%) patients had a significant increase in their stiffness symptoms (20%, 95% confidence interval (CI) 17.9–22.0, p < 0.001), and had significantly (all p < 0.001) less of an improvement in their pain, function and total WOMAC scores, and SF-12 scores compared to the non-stiffness group (n = 2460). Patient satisfaction was significantly lower (odds ratio (OR) 0.178, CI 0.121 to 0.262, p < 0.001) for the increased stiffness group. Logistic regression analysis identified male gender (OR 1.66, p = 0.02), lung disease (OR 2.06, p = 0.002), diabetes (OR 1.82, p = 0.02), back pain (OR 1.81, p = 0.005), and a pre-operative stiffness score of 44 or more (OR 5.79, p < 0.001) were significantly predictive of increased stiffness.ConclusionPatients with increased symptoms of stiffness after TKA have a worse functional outcome and a lower rate of patient satisfaction, and patients at risk of being in this group should be informed pre-operatively.Level of evidenceRetrospective prognostic study, Level III.

An empirical study on the growth factors and environmental satisfaction of medical innovative talents in Xinjiang

Objective Though the research on the satisfaction of environment and factors influencing the growth of the talented in medical science in Xinjiang, the author focuses on the shortcomings and reasons of current development of the talented, and provides specific suggestions and improvement for the cultivation of the talented. Methods Using Xinjiang Medical University First Affiliated Hospital as the research object, author investigates the influential factors of growth, and the satisfaction of environment though the questionnaires. Results According to the principal components analysis, the factors which influence the growth the talented in medical science are put in flowing order: political factor>environmental factor>education factor>family factor. According to the data envelopment analysis, in the satisfaction of environment of hospital technological innovation, the talented in hospital technological innovation consider that the cultivation plan, research expenses, support for scientific research, recruitment, and social welfare are at a better satisfaction rate; but the duration of academic research, income policies, selection of the talented, and the outcome of the research are at a low satisfaction rate. Conclusions Based on the current development and cultivation of the talented in the innovation of medical science, there are still many shortcomings. Hospital must continue international cooperation, insist to do the cultivation of the talented and the innovation team, and complete the selection mechanisms, in order to give enough time for the scientific research, and create a good atmosphere of medical science innovation at the same time. Only when the services for the talented are well-prepared, Xinjiang medical science innovation can achieve enough support and motivation for the development of the talented. Key words: Medical science; Scientific talents; Satisfaction

Sexual satisfaction among individuals in monogamous and consensually non-monogamous relationships

Monogamous individuals are believed to have better sex lives than those who are consensually non-monogamous (CNM). We compared the sexual satisfaction of CNM and monogamous individuals and also considered the relationship satisfaction of participants utilizing a non-targeted sample of CNM participants. We found that monogamous people reported slightly lower sexual satisfaction and lower orgasm rates than those who are CNM. Moreover, the type of CNM in which a person engages is important: swingers consistently reported higher sexual satisfaction than monogamous individuals, whereas those in open relationships had equivalent levels of satisfaction to those in monogamous relationships. Relationship satisfaction did not differ between CNM and monogamous groups. These findings do not support the perception that people in monogamous relationships have better sex than CNM individuals.

Maniobras quirúrgicas adyuvantes en el implante de prótesis de pene para mejorar su resultado estético y funcional

Penile prosthetic surgery is the definitive treatment for those patients with erectile dysfunction refractory to medical treatment. Although it associates satisfaction rates>90%, it is known that men with Peyronie's disease, body mass index>30kg/m2 or those previously operated on radical prostatectomy have lower satisfaction rates than the general population. The main reasons for dissatisfaction are the subjective loss of penile length and glans’ flaccidity. Given such circumstance, several adjuvant surgical techniques have been described to improve aesthetic and functional outcomes after the implant. In our review, we wanted to investigate the different maneuvers used in patients with Peyronie's disease, those used to avoid the reduction of penile length and those used to avoid the floppy glans syndrome.

Satisfaction with Healthcare Received at an Interprofessional Student-run Free Clinic: Invested in Training the Next Generation of Healthcare Professionals.

Most medical schools in the United States have an associated student-run free clinic (SRFC) providing medical care to the underserved population around the campus. SRFCs provide students with opportunities to practice history-taking and diagnosis skills. There have been a few studies that have evaluated patient satisfaction within SRFCs; however, these studies report limited aspects of care within these clinics. This study hopes to determine the levels of satisfaction with clinical staff and operations and to ensure that the medical needs of patients are being met. Results showed that 91% of the patients were satisfied or very satisfied with their overall clinic experience. The highest scoring parameters were “courtesy/respect of staff”, “availability of free or affordable medications”, and “doctor’s knowledge”. Overall, the patients are satisfied with the staff, care, and availability of medicine provided by the Keeping Neighbors in Good Health Through Service (KNIGHTS) clinic. Most patients enjoy participating in the training and education of future physicians and would recommend this clinic to a friend or family member. The lowest satisfaction rates were associated with length of visit and wait time. In the future, SRFCs should work together to assess patient satisfaction in the clinics, identify problem areas, and develop generalizable interventions for improvement.

Clinical characteristics and patient-reported outcomes in patients with inadequately controlled rheumatoid arthritis despite ongoing treatment

BackgroundDespite the wide array of treatments available for rheumatoid arthritis (RA), some patients continue to report unmet clinical needs. We investigated the extent of inadequate disease control in patients with...

1115 - Prevalence of sexual dysfunction and its association with lower urinary tract symptoms in men and women over 18 years old: Results from the Colombian Overactive Bladder and Lower urinary Tract symptoms (COBaLT) study

Introduction & Objectives: There is an age-independent association between sexual dysfunction (SD) and LUTS. Few studies have been conducted in Latin America addressing these issues. We aim to determine the prevalence of SD and its association with LUTS in Colombia. Materials & Methods: This is a sub-analysis of a cross-sectional, population-based study conducted in subjects ≥18 years old to evaluate LUTS and overactive bladder (OAB). A sample size of 1,054 subjects was estimated (prevalence of LUTS/OAB 15%, CI 95%, statistical power 80%, precision 3%). We used a multi-stage probabilistic sampling technique to randomly select individuals in the community. SD was defined as ≤21 points in the SHIM and ≤19 in the FSFI-6. For LUTS, we used the 2002 ICS definitions and validated questionnaires. Descriptive and inferential statistics were employed. Results: We included 1,060 participants. Sixty-three (12%) men and 175 (33%) women were sexually inactive. The prevalence of SD was 47% (men 53%, women 39%). The most common SD symptoms were diminished erection maintenance after penetration in men (13%) and poor lubrication in women (43%). Individuals with SD had higher rates of LUTS (Figure 1). Patients with moderate-to-severe LUTS had lower sexual satisfaction rates (men 89% vs 95%, women 72% vs 88%). The multivariate logistic regression model found that diabetes (DM), menopause, urge urinary incontinence (UUI) and nocturia>2 were associated with SD in women. In men, age, depression, high-school education or less and LUTS were associated with SD (Table 1).

The extra-tunical grafting procedure for Peyronie's disease hourglass and indent deformities.

BackgroundTo describe a novel, tunica-sparing surgical technique—extra-tunical grafting (ETG)—for the treatment of penile indent and hourglass (HG) deformities and to describe patient-reported outcomes after the ETG procedure.MethodsAn IRB-approved, retrospective chart review of ETG patients was performed to collect data including pre-operative deformity, operation performed, and post-operative patient-reported perception of deformity, erectile function, penile sensation, and overall satisfaction with the ETG operation. The indications for surgery were difficulty with sexual intercourse due to deformity and/or poor cosmesis of the penis. Pre-operatively all patients had erections adequate for intercourse with or without medications. The ETG procedure is performed through a ventral longitudinal penile skin incision. The dissection is continued to the level between Dartos and Bucks fascia, circumferentially for HG deformity and focally for indent deformity. The neurovascular bundle (NVB) is left undisturbed. A cadaveric fascia graft is applied, singly or in multiple layers, to fill the exposed tunical depressions. Our preferred graft material is Tutoplast Suspend® (Coloplast, Minneapolis, MN, USA). The graft is sutured into position with multiple interrupted, long-lasting absorbable sutures to achieve the desired penile shaft contour. The urethra is excluded from the graft.ResultsFrom October 2013 to June 2017, 36 patients had the ETG procedure for HG and/or indent with or without penile curvature. Results with a minimum of 6 months of follow-up could be extracted for 18 of the patients. One was excluded as he required concurrent excision of a large calcified tunical plaque, which necessitated incision into the tunica albuginea (TA). Follow-up was between 6 and 44 months (average 21 months). All patients reported satisfactory resolution of the HG or indent. No patient reported worsened erectile function. Two patients (11.8%) reported slight penile hypoesthesia, with one of these having had multiple previous penile degloving surgeries for trauma. Ten of the patients reported being “very satisfied” and six reported being “satisfied” with the procedure. One was neutral. All reported that they would recommend the ETG procedure to a friend, and all would repeat the same surgery again.ConclusionsThe ETG procedure is a straightforward approach to HG and indent deformities to correct the penile deformity and to provide structural support to prevent penile buckling during intercourse. The procedure does not violate the TA and does not require dissection of the NVB. Thus, ETG carries a very low risk of de novo impotence or hypoesthesia as highlighted by this patient series. With such low risk and high patient-reported satisfaction rates, the ETG procedure is a valuable surgical technique for the treatment of complex penile deformities.

The Influence of the Tri-reference Points on Fairness and Satisfaction Perception.

We examined the influence of three reference points (minimum requirements [MR], the status quo [SQ], and goal [G]) proposed by the tri-reference point (TRP) theory on fairness and satisfaction perceptions of pay in three laboratory experiments. To test the effects, we manipulated these three reference points both implicitly (Experiment 1) and explicitly (Experiments 2 and 3). We also provided the information of the salary offered to a peer person that was lower than, equal to, or higher than the salary offer to the participant. As hypothesized, the results demonstrated the important role of these reference points in judging the fairness of and satisfaction with pay when they were explicitly set (an interaction between reference points and social comparison in Experiments 2 and 3, but not in Experiment 1). Participants altered their judgments when the salary was in different regions. When the salary was below MR, participants perceived very low fairness and satisfaction, even when the offer was equal to/exceeded others. When the salary was above G, participants perceived much higher fairness and satisfaction, even with disadvantageous inequality. Participants were more impacted when they were explicitly instructed of the reference points (Experiments 2 and 3) than when they were not (Experiment 1). Moreover, MR appeared to be the most important, followed by G. A Salary below MR was judged as very unacceptable, with very low fairness and satisfaction ratings.

A Guide for Palliative Medicine Clinicians Taking Care of Lesbian, Gay, Bisexual, and Transgender Patients Using a Whole Person Care Approach (SA516)

•Understand the impact of spiritual and existential distress in LGBT patients with chronic medical illnesses.•Access tools and resources to support LGBT patients and families facing life threatening illnesses and uncertain legal protection state-by-state.•Assess the unique needs of transgender patients who are receiving care from faith-based organizations. In 2011, the Institute of Medicine report on the Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People cited lack of legal protections and lack of social support as significant barriers to the quality of palliative care. LGBT patients have achieved expanded rights and access to health care. State health policy and legislation varies widely across the country and many states offer little legal protection to LGBT patients. LGBT patients living with chronic illnesses experience higher rates of depression and anxiety and more likely to have lower rates of satisfaction with care that they receive from health care providers (Kamen C 2015). Healthcare providers receive little training on caring for LGBT patients and often are unaware of educational and patient support resources for LGBT patients. While LGBT patients and their families are reported to have higher preferences for advance care planning, palliative care, and hospice many palliative care and hospice organizations lack policies and educational resources in regard to care of LGBT patients and families. Our transdisciplinary team of co-presenters includes representatives from medicine, advance practice nursing, social work and chaplaincy. The presenters will use case-based teaching to highlight the role of chaplaincy in assessing LGBT specific spiritual and existential distress. We will address the role of chaplaincy in promoting psychological well-being in LGBT patients by chaplain led Dignity Therapy. We will address the role of social workers to proactively promote formalized surrogate decision makers of LGBT patients’ preference, psychosocial well-being and resources to address variability in state protection for LGBT patients. We will address the role of hospice and palliative medicine teams in caring for transgender patients with advanced illnesses who are receiving care from faith-based and long-term care organizations. We will present resources for providers to educate their teams on caring and advocating for LGBT patients. •Resources to Improve The Quality Of Hospice And Palliative Care For Sexual And Gender Minority Patients And Families•Center of Excellence For Transgender Health - http://transhealth.ucsf.edu/•Hospice Foundation of America LGBT Resources- https://hospicefoundation.org/End-of-Life-Support-and-Resources/Coping-with-Terminal-Illness/How-to-Choose/LGBT-Resources•Lambda Legal Tools for Life and Financial Planning- http://www.lambdalegal.org/publications/take-the-power•LGBT best and promising practices for cancer care for LGBT patients and families throughout the cancer continuum- http://www.lgbthealthlink.org/Cancer-Best-Practices•LGBT Hospice and Palliative Care Network – https://lgbthpm.org/resources/•National Resources Center on LGBT Aging - http://LGBTagingcenter.org/resources•Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders- http://sageusa.care/ Institute of Medicine: The Health of Lesbian, Gay, Bisexual, and Transgender People Building a Foundation for Better Understanding. Washington, DC: National Academy of Science, 2011. Kamen C, Mustian KM, Dozier A, Bowen DJ, Li Y. Disparities in psychological distress impacting lesbian, gay, bisexual and transgender cancer survivors. Psychooncology 2015 24(11):1384-91.

Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes.

BackgroundNursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes.MethodsEmployee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression.ResultsA 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0–100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid.ConclusionJob satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.