Lower Satisfaction Ratings Research Articles

The effect of COVID-19 restrictions on rehabilitation and functional outcome following total hip and knee arthroplasty during the first wave of the pandemic.

AimsThe primary aim was to assess the patient-perceived effect of restrictions imposed due to COVID-19 on rehabilitation following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Secondary aims were to assess perceived restrictions, influence on mental health, and functional outcome compared to patients undergoing surgery without restriction.MethodsDuring February and March 2020, 105 patients underwent THA (n = 48) or TKA (n = 57) and completed preoperative and six-month postoperative assessments. A cohort of 415 patients undergoing surgery in 2019 were used as the control. Patient demographic data, BMI, comorbidities, Oxford Hip Score (OHS) or Knee Score (OKS), and EuroQoL five-domain (EQ-5D) score were collected preoperatively and at six months postoperatively. At six months postoperatively, the 2020 patients were also asked to complete a questionnaire relating to the effect of the social restrictions on their outcome and their mental health.ResultsNearly half of the patients (47.6%, n = 50/105) felt that the restrictions imposed by COVID-19 had limited their rehabilitation and were associated with a significantly worse postoperative OKS (p < 0.001), EQ-5D score (p < 0.001), and lower satisfaction rate (p = 0.019). The reasons for the perceived limited rehabilitation were: being unable to exercise (n = 32, 64%), limited access to physiotherapy (n = 30, 60%), and no face-to-face follow-up (n = 30, 60%). A quarter (n = 26) felt that their mental health had deteriorated postoperatively; 17.1% (n = 18) felt depressed and 26.7% (n = 28) felt anxious. Joint-specific scores and satisfaction for the 2020 group were no different to the 2019 group, however patients undergoing THA in 2020 had a significantly worse postoperative EQ-5D compared to the 2019 cohort (difference 0.106; p = 0.001) which was not observed in patients undergoing TKA.ConclusionHalf of the 2020 cohort felt that their rehabilitation had been limited and was associated with worse postoperative Oxford and EQ-5D scores, and lower rates of patient satisfaction, but relative to the 2019 cohort their overall outcomes were no different, with the exception of THA patients who had a worse general health score.Level of evidence: Prospective study, Level 2Cite this article: Bone Jt Open 2021;2(6):380–387.

The First Year Acculturation: A Longitudinal Study on Acculturative Stress and Adjustment among the First Year International College Students

We analyzed 192 first year international college students in Mid-Atlantic region to examine change of international students’ acculturative stress, adjustment, and collegiate experiences during their first year in the U.S. higher education. We found that male students, students from low socio-economic status, and students majored in humanity showed higher rate of acculturative stress and lower rate of satisfaction with college experiences compared to their counterparts. International students reported decreased acculturative stress and homesick, and increased English proficiency, social connectedness, and satisfaction with college experiences during the last week of the first year compared to the first week of their first semester. Satisfaction with college experiences, English proficiency, social connectedness, and self-esteem were significant predictors of acculturative stress. Lastly, acculturative stress in the first week of the first year and satisfaction with college experience in the last week of the first year were on each other reciprocally over one year internal.

Implementation and Status of Biogas Technology in Ethiopia- Case of Tigray Region

In Ethiopia, like most developing countries, the majority of households depend on wood and charcoal as their cooking energy resources. This energy has a direct impact on the forest coverage and its emissions have significant health issues. Biogas technology has introduced to address these problems and reduce energy poverty in developing countries. However, the success of this technology depends on many factors such as technology appropriateness, available skill, proper introduction, and government support to create favorable financial incentives. The objective of this paper is to make an overview assessment of biogas development programs in Ethiopia, identify development barriers and provide suggestions to mitigate these barriers. The national and regional biogas program of Ethiopia has implemented to give energy for cooking and to some extent for lighting. However, it has shown limited success over the years. The National Biogas Programme of Ethiopia has shown an overall 50% achievement while the Tigray region registered 55% achievement. In addition, the owner of the biogas facility in Tigray reported a 57% functionality rate but the lowest satisfaction level of 15%. Generally, the region has shown relatively better performance in terms of dissemination and functionality but a low satisfaction rate due to technical limitation, unsteady input, and financial factors.

The Physician Assistant Student Experience: Diversity, Stress, and School Membership.

This article investigates whether students' stress and psychological sense of school membership (PSSM), which influence their ability to navigate the rigors of PA education, vary by their demographic characteristics. In 2017, 4050 matriculating and 2718 graduating PA students reported their demographics and feelings of stress. Graduating students also reported their PSSM. Multiple regressions explored whether students' demographics were associated with their stress and PSSM. Stress analyses controlled for student type (ie, matriculating versus graduating). Female, underrepresented minority (URM), and graduating students reported more stress when compared to male, non-URM, and matriculating students. URM students reported lower PSSM relative to non-URMs. URM students' experiences from entering a profession that is predominantly non-Hispanic White may increase stress and reduce PSSM, possibly contributing to lower educational satisfaction and on-time completion rates identified in previous research.

P27: INTRODUCTION OF A PILOT VIRTUAL FRACTURE CLINIC: A TIME AND COST ANALYSIS

Abstract Introduction The British Orthopaedic Association Standards for Trauma and Orthopaedics(BOAST) have produced guidelines advising that all patients be reviewed by an orthopaedic consultant within 72 hours of presentation. However, data from traditional fracture clinics rarely fulfil this criterion. Furthermore, data from the National Health Service(NHS) has determined that traditional fracture clinics have become unfit for purpose with low patient satisfaction rates, excessive waiting times and over 6.9 million missed appointments every year. Our aim is to test the feasibility of a virtual fracture clinic(VFC) with a view to reducing service costs and improving adherence to BOAST guidelines specified timeline for orthopaedic consultant review. Method A retrospective analysis of 103 patients referred to our pilot VFC from January 1st to 31st 2019 was carried out. We included shoulder dislocations, clavicle injuries, simple distal radius fractures, radial head fractures, metacarpal and metatarsal injuries, undisplaced fractures of the medial and lateral malleolus of the ankle and soft tissue injuries. The primary outcome measured time from presentation to review by an orthopaedic consultant. A cost analysis was also performed to estimate the overheads and potential savings associated with VFC introduction. Statistical analysis was done via SPSS. Result Following VFC establishment, time from ED presentation to review by orthopaedic consultant reduced from a mean of 229 hours to 72 hours(P=0.0001). Cost analysis demonstrated that the VFC created savings of €3170 per week, amounting to projected savings of €38,040. Conclusion VFC has the potential to improve clinical performance while delivering substantial financial savings. Take-home message Virtual fracture clinic improves patients review times bringing them in line with BOAST guidelines while providing significant reductions in overheads leading to potential savings of over 38,000 euro.

Evaluation of Patients' Satisfaction with Food and Nutrition Service in Selected Hospitals Affiliated to Yazd Shahid Sadoughi University of Medical Sciences in 2016-2017

Background: Food and nutrition services in hospitals are one of the factors effecting patients’ satisfaction. Appropriate management and supervision in the nutrition sector is an essential factor in reducing the costs and gaining patient satisfaction. The optimal performance of the nutrition sector accelerates improvement and can be useful in their satisfaction. The purpose of this study was to evaluate patients’ satisfaction with food and nutrition services in 2016-2017, Yazd, Iran. Methods: This was a descriptive cross-sectional study. The study population included patients referring to the selected hospitals affiliated to Yazd Shahid Sadoughi University of Medical Sciences. A researcher-made questionnaire was used for data collection. This questionnaire had 19 questions that should be answered on a 5-point Likert scale (strongly agree, agree, no idea, disagree, and strongly disagree). At the end of this questionnaire, a question was presented about the individual’s overall satisfaction with nutrition. Results: The average of patients’ satisfaction with food services was 4.40 ± 0.90. The lowest satisfaction rate was related to the inappropriate quality of dinner with an average of 4.02 ± 1.50. The highest level of satisfaction was related to the hygiene of food with an average of 4.69 ± 0.55. Conclusion: Hospital managers are required to take measures to increase the awareness of nutrition service personnel regarding the health and quality of food, their active presence by patients’ beds, give patients the right to choose, and take the necessary supervision to increase the variety of meals.

HEALTH SYSTEMS ISSUES IN GERMANY RELEVANT TO WELL-BEING AND BURN-OUT

Background: The German ambulatory care sector is mainly sustained by more&#x0D; than 177 000 statutory health insurance physicians and psychotherapists. They&#x0D; provide approximately 650 million high quality treatments per year (versus around&#x0D; 20 million treatments in hospitals) including ambulatory emergency care around&#x0D; the clock. The system is based on self-employment with doctors and psychotherapists&#x0D; running their own practices. They are organized within a system of self-government&#x0D; on a regional and a national level. Satisfaction with working conditions and income&#x0D; is high.&#x0D; Objectives: This article considers the difference between employed and selfemployed&#x0D; doctors as the main key to understanding reasons by which employed&#x0D; doctors are prone to a higher risk of suffering from burn-out than self-employed&#x0D; doctors. It further describes how working conditions are changing and which&#x0D; challenges arise for doctors both in the ambulatory sector and in hospitals.&#x0D; Method: In addressing these objectives, this article considers databases and several&#x0D; surveys performed by the Kassenärztliche Bundesvereinigung and German health&#x0D; profession organizations.&#x0D; Results and Discussion: Owing to several factors, the number of employed doctors&#x0D; in the ambulatory care sector is rising. As for employed physicians in the hospital&#x0D; sector, the employed doctors in the ambulatory care sector show significantly&#x0D; lower satisfaction rates with their working conditions. This group is at higher risk&#x0D; of experiencing burn-out or at least limited well-being within their professional&#x0D; lives.&#x0D; Conclusion: To prevent doctors in the ambulatory care sector from suffering&#x0D; burn-out it is important to reinforce the principles of self-employment within&#x0D; owner-run practice structures. It is also important to improve the efficiency of&#x0D; doctoral working hours by reducing the currently expanding bureaucracy and by&#x0D; cautiously considering the appointment of non-medical professionals that operate&#x0D; under strict guidance of doctors in addressing aspects of ambulatory care that&#x0D; would be suitable for this task-shifting. It is also essential to improve and&#x0D; implement e-health technologies, and for instance facilitate remote treatment in&#x0D; rural areas.

Professional satisfaction of nurses in psychosocial rehabilitation services

IntroductionThe increase of job satisfaction in mental health nurses, working in community mental facilities, helps them to become more efficient and understand the needs of individuals suffering from mental health problems.ObjectivesTo investigate sociodemographic and job characteristics, as well as the level of professional satisfaction of nurses working in psychosocial rehabilitation facilities of the psychiatric hospital of Athens, named Dafni.Methods220 nurses, working in the field of psychosocial rehabilitation completed (a) a sociodemographic questionnaire, (b) Spectοr’s Job Satisfaction Survey (JSS).ResultsNursing staff consists of mental health nurses (44.1%) and nursing assistants (55.9%) in the present study. 90% of the participants were female; while the 65% were married, the 19.5% had a university-level education and the 25% had administrative responsibilities. The 44.1% of our sample worked in hostels, 41.8% in nursing homes and 6.8% in Community Mental Health Centers. More specifically, moderate levels of total professional satisfaction were observed. Concerning the dimensions of satisfaction, low satisfaction rates were recorded in “salary”, “promotion” and in “privileges and benefits”. High satisfaction rates were recorded in “supervision by their superiors”, “cooperation between colleagues” and “the nature of their work”, while moderate satisfaction rates were reported in “communication” within facilities, as far as the explanation of tasks and objectives is concerned.ConclusionsThe results can be exploited by those with administrative and scientific responsibilities in the field of mental health in order to recognize nurses’ difficulties and solve their problems in psychosocial rehabilitation facilities.

Comparison of surgical gloves: perforation, satisfaction and manual dexterity

The purpose of this study was to assess the effectiveness of two different surgical gloves (powdered latex and powder and latex free) for glove perforation frequency, problems and satisfaction with glove usage and manual dexterity levels during surgical operations that include scrub nurses. Scrub nurses wore antiallergenic gloves (powder and latex free) gloves during three operations, double latex and powdered gloves during three operations and single latex and powdered gloves during three operations. The gloves were checked for punctures after each surgery with a water-inflation test. In our study, 19% of single gloves and 18.1 % of double gloves and 4.8% of powder and latex free worn by scrub nurses were punctured during surgery. None of the inner gloves in double gloves were punctured. Although wearing double gloves restricts manual dexterity, results in discomfort problems such as perspiration and fetor and results in a low satisfaction rate among scrub nurses, double gloves are protective against injuries and punctures.

Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.

Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.

Effect of the transcutaneous electrical stimulation system on esophageal-acid exposure in patients non-responsive to once-daily proton-pump inhibitor: proof-of-concept study.

BackgroundGastroesophageal reflux disease (GERD) is a common disorder. Overall, ≤35% of GERD patients fail the standard dose of proton-pump-inhibitor (PPI) treatment. Due to the high prevalence and low satisfaction rate with treatment failure, there is an unmet need for new treatment. Our aim was to evaluate whether the use of the transcutaneous electrical stimulation system (TESS) can reduce esophageal-acid exposure in GERD patients unresponsive to standard-dose PPI.MethodsWe enrolled 10 patients suffering from heartburn and regurgitation with an abnormal esophageal-acid exposure (off PPIs) who failed standard-dose PPI. After the placement of a wireless esophageal pH capsule, all patients were treated with TESS. The primary end point was the reduction in the baseline (pretreatment) 24-hour percent total time pH <4 and/or DeMeester score by 50%.ResultsSeven GERD patients (five females and two males, aged 49.3 ± 10.1 years) completed the study. At baseline, the mean percent total time pH <4 was 12.0 ± 4.9. Following TESS, the mean percent total time pH <4 dropped to 5.5 ± 3.4, 4.5 ± 2.6, 3.7 ± 2.9, and 4.4 ± 2.5 on Days 1, 2, 3, and 4, respectively. At baseline, the mean DeMeester score was 39.0 ± 18.5. After TESS, the mean DeMeester score dropped to 15.8 ± 9.2, 13.2 ± 6.8, 11.2 ± 9.4, and 12.0 ± 6.8 on Days 1, 2, 3, and 4, respectively.ConclusionTESS is a safe and potentially effective modality in reducing esophageal-acid exposure in GERD patients unresponsive to standard-dose PPI. A larger and prospective controlled study is needed to verify these preliminary results.

Real-life patient experiences of TTNS in the treatment of overactive bladder syndrome.

Introduction and objectives:Overactive bladder syndrome (OAB) is defined as urinary urgency, with or without urgent urinary incontinence; it is often associated with urinary frequency and nocturia, in the absence of any pathological or metabolic conditions that may cause or mimic OAB. The aim of this study was to evaluate the long-term real-life adherence of transcutaneous tibial nerve stimulation (TTNS) in the treatment of OAB, patient satisfaction of the treatment, and reasons for quitting therapy.Materials and methods:In this single center study, all patients who had a positive effect on percutaneous tibial nerve stimulation (PTNS) and continued to receive home-based treatment with TTNS since 2012 were included for analysis. Patients were retrospectively asked to fill out a questionnaire regarding satisfaction, reasons for quitting, and additional or next line of therapy.Results:We included 42 patients for this study, 81% of these patients were female (n = 34). The median age was 67 years (range 36–86). Most of the patients (64%, n = 27) were diagnosed with OAB wet. The median TTNS treatment persistence was 16 months (range 1–112 months). Reasons and percentages for stopping therapy were: 55% stopped treatment due to loss of effect, and 24% stopped because of preferring other type of neuromodulation. The mean satisfaction score (scale 1–10) in patients who continued TTNS was 6.2 (n = 9, SD 1.30) versus 5.4 (n = 29, SD 2.24) for patients who quit therapy. We did not find a statistically significant difference between the two groups (p = 0.174).Conclusion:TTNS, although effective in the short-term, is not effective in the long-term. In combination with a low satisfaction rate among patients, there is a need for improvement in terms of OAB treatment modalities.

Factors Affecting Periprosthetic Bone Loss after Hip Arthroplasty.

Periprosthetic bone loss may lead to major complications in hip arthroplasty, including aseptic loosening, implant migration, and even periprosthetic fracture. Such a complication leads to revision surgeries, which are expensive, technically demanding, and result in a low satisfaction rate. Therefore, a study was conducted of the factors affecting the periprosthetic bone loss around the stem that caused these complications. Factors influencing periprosthetic bone loss include demographic factors such as age, sex, obesity, smoking, and comorbidity including diabetes and osteoporosis. The implant design and fixation method are also factors that are determined before surgery. In addition, there are surgical factors, such as surgical approach and surgical technique, and we wish to investigate the factors affecting periprosthetic bone loss around the stem by comparing the effects of postoperative rehabilitation protocols and osteoporosis drugs.

Are Diabetic Older Adults Equally Satisfied with Remote Consultation vs. Face to Face Consultation?

Background and Hypothesis: &#x0D; The COVID-19 pandemic has likely made remote consultation (RC) a permanent part of healthcare. Older adults could greatly benefit from RC, and current literature indicates older adults are equally satisfied with RC vs. face to face consultation (FTFC). However, there is selection bias in the literature towards adults who feel comfortable enrolling in a technology study. We hope to fill this dearth by surveying diabetic older adults who were strongly encouraged by their physicians to utilize RC during the COVID-19 quarantine. We hypothesize older adults will be less satisfied by RC vs. FTFC. &#x0D; &#x0D; Experimental Design or Project Methods: &#x0D; We propose a retrospective case control cross-sectional telephone survey (data collected in RedCap) examining satisfaction with consultation in diabetic older adults who received care via RC during the spring 2020 COVID-19 quarantine. We will compare the RC condition to the FTFC sample (appointments that occurred before quarantine) using an unpaired t test. We also propose measuring commute time/distance and hearing difficulty as possible mediating factors on satisfaction, analyzed with a regression analysis and a chi square analysis respectively &#x0D; &#x0D; Results: &#x0D; We expect to see lower satisfaction rates in the RC vs. the FTFC condition. However, we expect this effect to be mediated by patients’ typical commute time/distance to their clinic. We also expect to see lower rates of satisfaction in the RC condition than the FTFC condition for patients with hearing difficulty. &#x0D; &#x0D; Conclusion and Potential Impact: &#x0D; The population is continuing to age, suffering from increased rates of diabetes and other chronic conditions that require more frequent, and more burdensome appointments. While RC has incredible potential to help older adults keep important appointments, their satisfaction is an integral part of successful care. This study could help dictate clinical decisions by informing providers and patients on older adults’ satisfaction with RC.

PMU47 Patient Satisfaction and Willingness to Pay for Primary Dental Care Services in the Prefercture of Drama, Greece

Patients have an increasingly active role in assessing dental care provided at the primary and secondary care system and participate in decision making process. The aim of this study is to evaluate the satisfaction of users of public dental services, the factors that affect them, and their willingness to pay for various dental operations in the Prefecture of Drama. A cross-sectional survey was conducted from January 1st to end of February 2020 (two month period), in the 90% of the public dental care services of the prefecture of Drama, where primary dental care is provided. A structured questionnaire was used comprising of 51 questions, (5-point Likert scale), covering demographic, socio-economic, dental and nursing satisfaction, administrative services, facilities, accessibility, overall satisfaction and willingness to pay. The 40% of the sample visited dental services for fillings, and only 13% visited for preventive screening. Patient satisfaction was particularly high (92%). The majority of the sample, 97% would visit again public dental services. A high proportion 51% would prefer to visit the private dental sector. Regarding the willingness to pay, the 75% of the population would be willing to pay a fee for dental prostheses with an average price of 124.3 ± 75.3 €, a 72% would pay 484.7 ± 367.5 € for orthodontic work and the 73% would pay on average 62.2 ± 65.7 € for endodontic work. The results of the multivariate analysis showed that income is not a factor influencing the willingness to pay, while people with a higher educational level would pay higher amount of money. Patient satisfaction in public primary dental care services in prefecture of Drama is very high. Impressions of dental care are getting the highest rate and facilities are getting the lower rate of satisfaction.

Is neuroticism relevant for old cancer survivors? A controlled, population-based study (the Norwegian HUNT-3 survey)

PurposePersonality traits, particularly neuroticism, have an impact on people’s health and lifestyle. Due to lack of previous studies, we examined old cancer survivors (OCSs) versus cancer-free age-matched controls aged ≥ 70 years, regarding prevalence of high neuroticism, health problems in those with high and low neuroticism, and sociodemographic and clinical variables that were significantly associated with high neuroticism.MethodsWe merged data from a Norwegian population–based health study (the HUNT-3) and from the Cancer Registry of Norway identifying OCSs. Three cancer-free controls were drawn at random for each OCS. Neuroticism was self-rated on a brief version of Eysenck Personality Questionnaire. Between-group statistical comparisons were made between OCS and controls, and among their subgroups with high and low neuroticism. Logistic regression analyses were used to investigate independent variables significantly associated with high neuroticism.ResultsTwenty-nine percent of OCSs reported high neuroticism while controls reported 30%. OCSs showed significantly lower rate of good life satisfaction than controls. All other between-group comparisons were nonsignificant. Being OCSs was not significantly related to high neuroticism in the regression analyses. Sociodemographic, general health, and lifestyle issues, lack of energy, and low life satisfaction remained significantly associated with high neuroticism in the multivariable analysis.ConclusionsThe prevalence of high neuroticism was similar in OCSs and controls. High neuroticism was associated with negative health and lifestyle issues in both groups.

Survey Based Evaluation of Indoor Environment in an Administrative Military Facility

Military facilities feature distinctive requirements with regards to building technical and structural design, material use and indoor environmental conditions (IEC), as these buildings serve specific purpose and the personnel occupying the premises may wear uniform or protective clothing (administrative staff, special forces, training personnel etc.), that can greatly affect their satisfaction level with thermal comfort and productivity.&#x0D; In order to acquire data on the actual indoor environment conditions and obtain a feedback from the occupying personnel on their satisfaction level with the IEC in an administrative military building situated in a special purpose military compound, a series of IAQ measurements (temperature, humidity, CO2 level) and a survey on indoor air quality and thermal comfort was conducted in different premises of the administrative office building. A total of 73 respondents occupying the building participated in the survey.&#x0D; The results of the conducted survey revealed that there is a high degree of dissatisfaction with the IEC in military buildings, that is attributed to inadequate ventilation and overtemperature. That matched the collected indoor environmental quality (IEQ) data, forming a direct relationship between the poor energy efficiency and low satisfaction rate with IEC.&#x0D; The study reiterates the need to address the poor current technical state of unclassified building stock, emphasizes the call for developing clear regulatory requirements for newly-constructed unclassified buildings and thorough feasibility assessment for renovation projects. &#x0D;

S1223 Automated Endoscopy Template Improves Provider Adherence to Esophageal Varices Surveillance Guidelines

INTRODUCTION: Esophageal variceal (EV) hemorrhage is a significant cause of morbidity and mortality in patients with cirrhosis. Though timely endoscopic follow-up for EV surveillance improves outcomes, there remains significant practice variation regarding recommended follow-up interval after variceal detection on esophagogastroduodenoscopy (EGD). In this quality improvement study, we aimed to improve adherence to EV surveillance recommendations per American Association for the Study of Liver Diseases (AASLD) and American Society for Gastrointestinal Endoscopy (ASGE) by implementing prescriptive templates in an endoscopy reporting software. METHODS: A pre-post study was conducted at a single academic center between 1/2018 and 3/2020. Interventions included (1) surveying faculty/fellows to identify barriers of knowledge/adherence to guidelines, (2) disseminating uniform follow-up recommendations derived from AASLD/ASGE best practices, and (3) developing an automated prescriptive template in PENTAX endoPRO software to standardize procedural documentation and follow-up recommendations. Outcomes included adherence to standardized follow-up recommendations of (1) ≤2 years for small varices, (2) ≤3 months for medium/large varices or endoscopic variceal ligation (EVL), or (3) initiation of a non-selective beta blocker. RESULTS: Among 2,363 EGDs performed prior to the intervention in 2018, EV were noted on 218 EGDs with the majority (54%) without documentation of EV size. Of the 127 EGDs with documented EV size and/or EVL, only 63% provided guideline-based follow-up recommendations. On the pre-intervention survey (n = 24), suboptimal adherence was due to variability in provider practices with regards to follow-up intervals due to conflicting guidelines and low satisfaction rate (19%) with the current endoscopy reporting template. Development of an automated template to standardize guideline-based follow-up was implemented on 6/2019. After template implementation, the rate of adherence to guideline-based recommendations improved quarterly from a baseline of 69% to 74%, 80%, and 94%, respectively (Figure 1). CONCLUSION: Suboptimal adherence to recommended guidelines for EV-related care was due to variability in provider practices based on differing recommendations between societal guidelines and inadequate documentation of variceal size. Our intervention utilizing standardized automated prescriptive templates in endoPRO led to improved overall adherence to guideline-based EV surveillance recommendations.Figure 1.: Compliance Rate of Esophageal Varices Surveillance Recommendations.

Do Total Ankle Replacements have Worse Outcomes when Compared to Total Knee and Hip Replacements at 10 Years Post-Operatively? A Prospective Clinical Study

Category:Ankle Arthritis; AnkleIntroduction/Purpose:There is paucity of literature comparing patient reported outcomes (PROMs) between total joint arthroplasties. There is a need to study the PROMS data to understand outcomes of treatment and factors affecting outcomes. We aimed to to study the PROMs data for total ankle replacement (TAR) to 10 years. To study how PROMS outcomes of TAR compare to total hip replacement (THR) and total knee replacement (TKR) at 10 yearsMethods:This is a prospective data collection from local hospital joint registry. 10 year follow up data was collected from patients who underwent a total joint replacement (Hip, Knee or ankle), provided informed consent for their data. Patients who refused consent, or had cognitive language problems were not approached for participation in the registry. Self-administered questionnaire data included WOMAC scores, Foot and ankle outcomes scores (FAOS), SF-36 scores and patient satisfaction data. Data was collected at pre-op, 3 years, 5 years and 10 years post operatively. Statistical tests including ANOVA, GLM univariate tests and chi-square tests were used for analysis.Results:There were 119 patients who underwent TAR for the duration of 2006-2009. 74 patients were male (62.18%). Average age of patients was 59.1 yrs. Data was available on 2672 THR and 3520 TKR patients. At 5 years, TAR patients reported lower scores for stiffness, similar outcomes to THR and TKR for mental health score, similar to TKR for ¾ physical domains (p<0.05), but lower satisfaction rates for ADL and recreation when compared to THR (p<0.05). We are currently processing the questionnaires for 10 year mailing returns (completion expected March 2020).Conclusion:The outcomes for TAR were similar to outcomes reported by TKR patients at 10 years but lower than THR. The lower score of TAR was due to stiffness and recreational activity comparing to THR. We aim to present the complete set of results if the abstract is accepted (data completion March 2020).

Depression Is Not Independently Associated with a Clinically Worse Functional Improvement but Associated with a Lower Reported Satisfaction Rate after Total Knee Arthroplasty.

The aim of this study was to assess whether depression had a clinically significant influence on the functional improvement of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and whether it influences patient satisfaction at 1 year. A retrospective cohort of 3,510 primary TKA was identified from an arthroplasty database. Patient demographics, comorbidities, WOMAC, and Short Form-12 (SF-12) scores were collected preoperatively and 1 year postoperatively. Patient satisfaction (overall, pain relief, return to work, and recreational activity) was assessed at 1 year. There were 444 (12.6%) patients who self-reported depression. Patients with depression were younger (p < 0.001), had a higher body mass index (BMI; p < 0.001), were more likely to be female (p < 0.001), had lung (p < 0.001), neurological (p = 0.018), kidney (p = 0.001), liver (p < 0.001), and gastric (p < 0.001) disease, report associated diabetes (p = 0.001), and back pain (p < 0.001) relative to the subgroup without depression. All preoperative WOMAC functional measures were significantly (p < 0.001) worse in patients with reported depression. When adjusting for these confounding differences, patients with depression had a clinically equal improvement in their WOMAC scores at 1 year compared to those patients without. Depression was not associated with a clinically significant difference in improvement of knee-specific outcome (WOMAC) but was independently associated with a lower rate of patient satisfaction 1 year after TKA. Patients with depression were approximately twice as likely to be dissatisfied at 1 year when compared with those without depression. This is a prognostic retrospective cohort study and reflects level of evidence III.