Managing Patient Expectations Research Articles

Poster 220: Outcomes of Hip Arthroscopy in Patients with Hip-Spine Syndrome: A Matched-Pair Controlled Study with Minimum Two-Year Follow-Up

Objectives: Hip–spine syndrome is a phenomenon commonly seen in the geriatric population presenting with concurrent hip osteoarthritis and lumbar spine degenerative disease. Secondary hip-spine syndrome can develop when compensatory stresses are placed on the lumbosacral spine due to pathologies that limit hip range of motion, such as femoroacetabular impingement (FAI). The literature remains conflicted on the impact of hip arthroscopy in hip-spine syndrome and there is a paucity of studies that report long term outcomes. The purpose of this study was to conduct a matched-pair analysis to assess the effects of lumbar spine pathology on minimum two-year clinical outcomes of patients undergoing hip arthroscopy for FAI. Methods: An institutional review board-approved retrospective review of a prospectively collected, single-surgeon database was performed to identify patients who underwent hip arthroscopy for FAI with evidence of concomitant lumbar spine pathology. Importantly, all patients participated in the same postoperative protocol and underwent capsular management via the previously published puncture capsulotomy technique. Additionally, included patients had failed conservative treatment, a minimum of two-year follow-up, and symptoms of low back pain with objective evidence of lumbar pathology (i.e., herniation, degenerative disc disease, stenosis, spondylosis, etc.) at the time of surgery. Patients were excluded if they had any previous hip surgery, evidence of hip dysplasia (lateral center edge angle ≤25°), or advanced osteoarthritis (Tönnis ≥2). Patients in the hip-spine (HS) cohort were matched 1:1 by age within 5 years, body mass index (BMI) within 5.0 kg/m2, and sex to a matched control (MC) cohort. The MC cohort lacked subjective or objective evidence of lumbar spine pathology. The following patient- reported outcomes (PROs) were recorded in each cohort: Modified Hip Harris Score (mHHS), International Hip Outcome Tool-33 (iHOT-33), Non-Arthritic Hip Score (NAHS), rates of revision arthroscopy, and conversion to total hip arthroplasty (THA). Results: A total of 60 patients with lumbar disease (HS; age = 39.5 ±10.2, BMI = 26.3 ±4.0, 48.3% Female) were matched with 60 control patients (MC; age = 39.4 ±11.6, BMI = 25.7 ±4.1, 48.3% Female). At baseline, all PROs were significantly lower in the HS cohort (all p<0.05). At one-year follow-up, the HS cohort exhibited a greater magnitude of improvement in all PROs, with significant differences in the NAHS (p = 0.006). Additionally, a higher percentage of patients in the HS cohort achieved the minimal clinically important difference (MCID) threshold for all outcome measures at one-year, and a significant difference was identified in the NAHS (p = 0.026; Tables 1&2). At two-year follow-up, all PROs were significantly lower in the HS cohort (all p<0.05), however at three- and five-year follow-up no differences were identified between cohorts in mean PROs, magnitude of improvement, or percentage of patients achieving MCID thresholds (all p>0.05). No significant differences in the rates of revision (0% vs. 0%) or conversion to THA (5.3% vs. 3.4%) were identified between cohorts (all p>0.99). Conclusions: While patients with a history of lumbar spine pathology achieved lower short-term outcomes after hip arthroscopy, these differences were mitigated when follow-up was expanded to 3- and 5- years (Figure 1). While the HS cohort exhibited lower baseline PROs at the time of surgical intervention, these patients had an equal or greater magnitude of improvement across all time points. This study’s findings have implications for the shared decision-making process and managing patient expectations prior to undergoing hip arthroscopy for FAI. Although it may take greater than two years, patients with hip-spine syndrome can attain clinically meaningful improvement in hip function following hip arthroscopy for FAI. [Table: see text][Table: see text]

Elevating Aesthetics: Patient-Specific Treatment with Hyaluronic Acid Fillers to Improve Appearance and Psychosocial Wellbeing

Perception of beauty is changing from a rigid concept (i.e., the universal idea of beauty) to a multifaceted and personalised view of one’s appearance. One of the main concerns of patients is looking artificial and losing their unique facial expressions, which encourages them to seek aesthetic procedures that yield the most natural results. Patients also wish to increase their self-esteem and, ultimately, improve their quality of life. It is now well-established that treatment with hyaluronic acid (HA)-based dermal fillers improves the psychosocial state of patients. The assessment of facial anatomy and patient needs, accompanied by the proven holistic benefit and good safety profile of HA dermal filler treatment, is also a key factor for an optimal outcome. In addition, clear communication between patient and physician is crucial to manage patient expectations, maximise satisfaction, and minimise procedural risks. The availability of a wide range of HA dermal fillers, customised for specific anatomical areas and facial movements, allows physicians to develop patient-specific treatment plans. This review of the ‘Elevating Aesthetics’ symposium held at the International Master Course on Aging Science (IMCAS) 2023 shares insights into the patient’s facial anatomy and possible danger zones presented during a cadaver workshop. Several successful treatment plans tailored to different patient profiles (i.e., patients seeking full-face aesthetic improvement, patients with facial asymmetry, low lip volume in mature and millennial women) were also implemented live. A comprehensive and patient-specific HA dermal filling treatment should be considered by physicians to achieve natural outcomes and improve the general wellbeing of the patient.

Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review

BackgroundRates of return to physical activity after anterior cruciate ligament reconstruction surgery are sub-optimal. Optimising presurgical treatment may improve return rates. The purpose of this systematic review was to identify modifiable preoperative predictors for return to physical activity after anterior cruciate ligament reconstruction.MethodsSeven electronic databases (CINAHL, MEDLINE and SPORTDiscus via EBSCOhost, AMED, PsycINFO and EMBASE via OVID and Web of Science) were searched from inception to 31 March 2023. The population of focus was adults aged 18–65 who had undergone primary anterior cruciate ligament reconstruction. Studies needed to identify at least one potential modifiable preoperative predictor variable and the relationship between the predictor(s) and return to physical activity. All time-points of assessment and study designs were included. Data extraction was completed by one reviewer and verified by a second reviewer. Two reviewers completed the risk of bias assessment using the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development and Evaluation system.ResultsThe search identified 2281 studies, eight met the inclusion criteria. Five studies scored ‘high’, and three studies scored ‘moderate’ risk-of-bias. All preoperative predictors were of very low-quality evidence. Five different outcome measures were used to assess return to physical activity including Tegner, Marx, Physical Activity Scale, return to play at the elite level and return to preinjury level (undefined). This was measured between 1- and 10-years post-surgery. Nine preoperative physical, six psychosocial and five demographic/clinical factors were assessed and four were found to be predictive. These included quadriceps strength, psychological profile, patient estimated ability to return and graft type (patella tendon, BPTB).ConclusionVery-low level evidence suggests that increasing quadriceps strength, managing patient expectations of their treatment outcomes, improving motivation to resume preinjury activity levels and considering the use of a BPTB graft will support return to physical activity after ACLR.Trial registrationThis study was prospectively registered in PROSPERO: CRD 42020222567.

Differences in Time to Achieve Minimum Clinically Important Difference Between Patients Undergoing Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement

To compare patients undergoing anterior cervical discectomy and fusion (ACDF) versus cervical disc replacement (CDR) for time to minimum clinically important difference (MCID) achievement and predictors of delayed MCID achievement for the patient-reported outcomes (PROs), Patient-Reported Outcomes Measurement Information System Physical Function, Neck Disability Index, Visual Analog Scale (VAS) neck, and VAS arm. PROs of patients undergoing ACDF or CDR were collected preoperatively and postoperatively at 6-week/12-week/6-month/1-year/2-year periods. MCID achievement was calculated through comparison of changes in Patient-Reported Outcomes Measurement to previously established values in literature. Time to MCID achievement and predictors for delayed MCID achievement were determined through Kaplan-Meier survival analysis and multivariable Cox regression, respectively. One hundred ninety-seven patients were identified, with 118 and 79 undergoing ACDF and CDR, respectively. Kaplan-Meier survival analysis demonstrated faster time to achieve MCID for CDR patients in Patient-Reported Outcomes Measurement Information System Physical Function (P= 0.006). Early predictors of MCID achievement through Cox regression were CDR procedure, Asian ethnicity, elevated preoperative PROs of VAS neck and VAS arm (hazard ratio, 1.16-7.28). Workers' compensation was a late predictor of MCID achievement (hazard ratio, 0.15). Most patients achieved MCID in physical function, disability, and back pain outcomes within 2 years of surgery. Patients undergoing CDR achieved MCID faster in physical function. Early predictors of MCID achievement were CDR procedure, Asian ethnicity, and elevated preoperative PROs of pain outcomes. Workers' compensation was a late predictor. These findings may be helpful in managing patient expectations.

Managing patient expectations and potential complaints

Managing patient expectations and potential complaints

MP62-03 DECISIONAL REGRET AND PATIENT-REPORTED OUTCOMES AFTER PENILE PROSTHESIS SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP62-03 DECISIONAL REGRET AND PATIENT-REPORTED OUTCOMES AFTER PENILE PROSTHESIS SURGERY Michael Schumeister, Kevin Labagnara, Mustufa Babar, Justin Loloi, Emely Tejeda, Mukhlisa Zakirova, Lindsay Kramer, Nick Winokur, Bryan Nolasco, Matthew Wysocki, Nitya Abraham, Pedro Maria, and Susan Macdonald Michael SchumeisterMichael Schumeister More articles by this author , Kevin LabagnaraKevin Labagnara More articles by this author , Mustufa BabarMustufa Babar More articles by this author , Justin LoloiJustin Loloi More articles by this author , Emely TejedaEmely Tejeda More articles by this author , Mukhlisa ZakirovaMukhlisa Zakirova More articles by this author , Lindsay KramerLindsay Kramer More articles by this author , Nick WinokurNick Winokur More articles by this author , Bryan NolascoBryan Nolasco More articles by this author , Matthew WysockiMatthew Wysocki More articles by this author , Nitya AbrahamNitya Abraham More articles by this author , Pedro MariaPedro Maria More articles by this author , and Susan MacdonaldSusan Macdonald More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Few studies have explored patient-reported outcomes and decisional regret after penile prosthesis implantation. In this study we explore decisional regret after penile prosthesis surgery in a high volume, racially diverse urban center. METHODS: Patients who underwent penile prosthesis surgery from 2016 to 2022 at a single center were identified using CPT codes 54400, 54405, 54410, 54411, and 54415. After IRB approval, patients were called to administer the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire along with questions evaluating decisional regret. We defined regret as being unsatisfied/ambivalent about one’s decision to get the prosthesis or unsure about undergoing the procedure again. Demographic, medical, and implant characteristics were collected through chart review. Statistics were performed using SPSS. RESULTS: Out of 676 patients, 381 were successfully contacted and 182 completed the survey (response rate 50%). 41 (23%) patients experienced regret while 177 (78%) did not. The regret group was less likely to have rear tip extenders (RTE) (29% vs 51%, p=0.015) and more likely to have had a post-operative infection (12% vs 4%, p=0.032), 30-day ED visit/readmission (27% vs 11%, p=0.014), and be a revision (42% vs 16%, p<0.001). (Table 1) The regret group had significantly lower mean scores in all of the QoL domains compared to the no regret group (p<0.001). (Table 2) On multivariate analysis, obesity (OR: 0.16, CI 0.05-0.57), RTE (OR: 0.33, CI 0.13-0.83), and infrapubic approach (OR: 0.09, CI 0.03-0.26) were associated with less regret after adjusting for age, preferred language, BMI, approach, and revision. CONCLUSIONS: One out of 4 men in this study reported decisional regret after penile prosthesis surgery. These men more frequently experienced post-operative infection or required surgical revision. Obesity, RTE use, and infrapubic approach were associated with less regret. Pre-operative counseling to ensure understanding of potential complications and manage patient expectations may reduce decisional regret. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e861 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Schumeister More articles by this author Kevin Labagnara More articles by this author Mustufa Babar More articles by this author Justin Loloi More articles by this author Emely Tejeda More articles by this author Mukhlisa Zakirova More articles by this author Lindsay Kramer More articles by this author Nick Winokur More articles by this author Bryan Nolasco More articles by this author Matthew Wysocki More articles by this author Nitya Abraham More articles by this author Pedro Maria More articles by this author Susan Macdonald More articles by this author Expand All Advertisement PDF downloadLoading ...

The Success Rate of Glaucoma Drainage Device Revision.

We report the survival of surgical revision to glaucoma drainage devices for several indications in a large cohort of patients, with an overall success rate of 45% at 36 months. To evaluate the outcomes of surgical revision for complications of glaucoma drainage devices. Three hundred thirty-five eyes of 318 patients who underwent tube revision or removal at University of California Los Angeles (UCLA) Jules Stein Eye Institute between 1997 and 2019 were included. The pre-defined primary outcome measure was surgical success of the initial revision, defined as resolution of the condition with no additional revisions required, no functionally significant change in vision, and no instances of intraocular pressure > 21mmHg at 2 consecutive visits postoperatively. Kaplan-Meier survival analysis was applied to evaluate survival at 36 months based on these criteria. The Wilcoxon paired test was used to compare mean preoperative and postoperative intraocular pressure, medication usage, and visual acuity. Overall, survival of revised tubes at 36 months was 45%. The 4 most common indications for revision were exposure of the implant (42% of all revisions), occlusion (14%), corneal failure or threat of failure (12%), and hypotony (11%). Survival at 36 months for each of these indications was 44%, 45%, 52%, and 37%, respectively. These results suggest that eyes with glaucomatous damage with long-term glaucoma drainage device complications can still have a reasonably successful outcome when a revision is performed. However, with substantial rates of vision loss and a frequent need for additional revisions to manage complications, managing patient expectations for success and making them aware of the likelihood of additional surgeries or failure is important.

Managing patient expectations about recovery after a distal radius fracture based on patient reported outcomes

IntroductionPROMs are increasingly used by clinicians to evaluate recovery after distal radius fractures, but can also be used as benchmark data to help patients managing their expectations about recovery after DRF. Purpose of the StudyThe study aimed to determine the general course of patient-reported functional recovery and complaints during 1 year after a DRF, depending on fracture type and age. The study aimed to determine the general course of patient-reported functional recovery and complaints during one year after a DRF, depending on fracture type and age. MethodsRetrospectively analyzed PROMs of 326 patients with DRF from a prospective cohort at baseline and at 6, 12, 26 and 52 weeks included PRWHE questionnaire for measuring functional outcome, VAS for pain during movement, and items of the DASH for measuring complaints (tingling, weakness, stiffness) and limitations in work and daily activities. The effect of age and fracture type on outcomes were assessed using repeated measures analysis. ResultsPRWHE scores after one year were on average 5.4 points higher compared to the patients’ pre-fracture scores. Patients with type B DRF had significantly better function and less pain than those with types A or C at every time point. After six months, more than 80% of the patients reported mild or no pain. Tingling, weakness or stiffness were reported by 55-60% of the overall cohort after six weeks, while 10-15% had persisting complaints at one year. Older patients reported worse function and more pain, complaints and limitations. ConclusionsFunctional recovery after a DRF is predictable in time with functional outcome scores after one-year follow-up that are similar to pre-fracture values. Some outcomes after DRF differ between age and fracture type groups.

Cellulite: Current Treatments, New Technology, and Clinical Management.

Cellulite is a well-known concern for many women; however, treatment can prove challenging because of the complexities of cellulite etiology, the various factors contributing to its appearance, and the multitude of therapies and procedures available. To discuss current cellulite treatment options and effective clinical management. A roundtable meeting was convened to discuss and share views on current cellulite treatment options, new technologies, and clinical management. The participants' views helped guide a narrative review on this topic. Advanced interventions for cellulite treatment-such as physical and acoustic subcision, radiofrequency, and injectable biostimulators-are gradually being established, with accumulating evidence showing efficacy, patient satisfaction, and potentially long-lasting outcomes. Cellulite severity rating scales are necessary for assessing treatment outcomes, but these can be complex to use in clinical practice, and the majority do not include patient or clinician perspectives. With the advent of new treatments and technologies, cosmetic surgeons and dermatologists will need to tailor their approach to each patient's needs and manage patient expectations because multimodal methods are likely to be required to address the various factors underlying cellulite appearance.

Assessment of patient satisfaction following revision total knee arthroplasty.

Patient satisfaction is becoming an increasingly important measure of healthcare quality. Satisfaction following RTKA is poorly described within the literature, resulting in difficulty for clinicians to manage patient expectations and obtain informed consent. We investigated postoperative satisfaction of RTKA patients by a single surgeon, using a single prosthesis, at a single institution. Patient satisfaction was assessed using structured telephone assessment questionnaires and review of orthopaedic/hospital records. The effect of patient and surgical characteristics on satisfaction was assessed using correlation coefficients and binary logistic regression in SPSS. Two hundred and two RTKAs were performed in 178 patients between 2004 and 2015 inclusive. One hundred and twenty-four patients (143 RTKAs) were contactable to complete satisfaction assessment. Eighty-five percent of patients were satisfied and would have the RTKA again, 8% were unsure, 7% would not. Mean reported satisfaction on a numerical scale (1-10) was 8.17 (range 1-10), with 74% of patients scoring 8 or above, and 35% of patients scoring 10. The Mahomed Satisfaction Scale outcomes demonstrated a mean score of 87.7. High positive correlation was found between assessment tools. Logistic regression analysis identified factors contributing to satisfaction included ROM, OKS, BMI, and surgical time. This cohort demonstrated high patient satisfaction rate following RTKA, utilizing simple and reliable outcome measurement tools. We found a high positive correlation between methods of assessment, and moderate positive correlation between satisfaction and functional outcomes. These results contribute to the understanding of satisfaction in RTKA patients, which may assist in informing patients of expected post-operative outcomes.

Deep learning-based prediction model for postoperative complicationsof cervical posterior longitudinal ligament ossification.

Postoperative complication prediction helps surgeons to inform and manage patient expectations. Deep learning, a model that finds patterns in large samples of data, outperform traditional statistical methods in making predictions. This study aimed to create a deep learning-based model (DLM) to predict postoperative complications in patients with cervical ossification of the posterior longitudinal ligament (OPLL). This prospective multicenter study was conducted by the 28 institutions, and 478 patients were included in the analysis. Deep learning was used to create two predictive models of the overall postoperative complications and neurological complications, one of the major complications. These models were constructed by learning the patient's preoperative background, clinical symptoms, surgical procedures, and imaging findings. These logistic regression models were also created, and these accuracies were compared with those of the DLM. Overall complications were observed in 127 cases (26.6%). The accuracy of the DLM was 74.6 ± 3.7% for predicting the overall occurrence of complications, which was comparable to that of the logistic regression (74.1%). Neurological complications were observed in 48 cases (10.0%), and the accuracy of the DLM was 91.7 ± 3.5%, which was higher than that of the logistic regression (90.1%). A new algorithm using deep learning was able to predict complications after cervical OPLL surgery. This model was well calibrated, with prediction accuracy comparable to that of regression models. The accuracy remained high even for predicting only neurological complications, for which the case number is limited compared to conventional statistical methods.

Acne vulgaris: navigating the National Institute for Health and Care Excellence recommendations for specialist referral, patient expectations and the isotretinoin product licence.

Oral isotretinoin is a highly effective drug for severe acne but with ongoing serious safety concerns and we are cautiously reminded by the Medicines and Healthcare products Regulatory Authority to prescribe this drug within licence. We review the National Institute for Health and Care Excellence recommendations for considering referral of acne to specialist care and propose some improvements. This may help manage patient expectations of treatment, ensure only appropriate patients are seen in secondary care and help prescribers remain within the isotretinoin product licence.

The PEAK Aesthetic Consultation.

Aesthetic practitioners work diligently to perfect the depth of the needle injection, find the right products regimen, and create a perfect before and after visual. However, the true work of an aesthetic nurse lies in the conversations we have with our patients. Consultation may be overlooked by practitioners who are starting out and consultation is almost always the first item to be put aside by patients seeking aesthetic treatments. It is imperative for aestheticians to incorporate an effective consultation into the patient experience. The longevity of your career lives in the effectiveness of your patient consultation. This article explores the aesthetic consultation process and evaluates the importance of providing meaningful conversation that includes the patient while also managing patient expectations and creating a long-term care plan. Here, I share my own concept regarding aesthetic consultation. This concept allows me to consistently create a plan of care for my patients, while building trust and longevity in my practice. The PEAK Aesthetic Consultation process incorporates four elements: Prioritize the patient story; Education and expectations; Aesthetic treatment; and Kinetic plan.

Mexiletine in the Treatment of Non-dystrophic Myotonia: Interviews with Six Medical Experts

Evidence from randomised controlled clinical trials demonstrates that mexiletine effectively controls myotonic symptoms with a well-described safety profile. Despite this, there are still a limited number of patients on this treatment, and physicians from expert neuromuscular centres may not be fully aware of the potential benefits of mexiletine treatment, including improvements in patients’ quality of life (QoL), the impact on activities of daily living, and the favourable safety profile, even in younger patients. During this ‘Meet the Experts’ interview series, five neurologists experienced in the management of non-dystrophic myotonias (NDM), and one specialist cardiologist offered their expert insights on the clinical data and real-world evidence supporting the use of mexiletine in NDM. Addressing patient concerns and encouraging treatment acceptance were highlighted as key steps to optimise outcomes from mexiletine therapy. The medical experts emphasised the importance of contextualising the favourable benefit-to-risk profile of mexiletine, particularly regarding cardiac safety concerns and drug monitoring requirements. The expert cardiologist further explained that, in their experience, the cardiac safety profile of mexiletine was no different in patients with NDM when compared to healthy controls used in clinical studies when used as directed. When considering anti-myotonia treatment in patients with NDM, medical experts stressed that decision-making should be driven by the overall degree of myotonia. Healthcare professionals (HCP), therefore, need to look beyond basic clinical assessment to understand the true impact of myotonia on patients’ everyday lives. Overall, these interviews highlighted the critical role that HCPs can play in leveraging the clinical data and managing patient expectations to ensure maximum treatment success when recommending mexiletine to patients with NDM.

Analysis of the risk factors influencing complications in surgical treatment of mandibular fractures: A retrospective study

The study aim was to identify risk factors associated with complications following open reduction and internal fixation of mandibular fractures.A retrospective cohort study was conducted in patients who were treated for mandibular fractures in a single center between January 2010 and December 2020. Authors classified postoperative complications as overall complications, infections, and reoperations. Factors that may be associated with these complications were grouped as patient, wound, and management variables. Statistical analysis was performed to determine whether these factors influenced complications.Among 175 patients, 125 underwent open reduction and internal fixation. Among patient variables, alcohol consumption was a risk factor for overall complications (p = 0.03) and reoperation (p = 0.02). Among wound variables, the more severe the external wound, the greater the incidence of overall complications (p = 0.001) and infections (p < 0.001). Presence of two or more fracture sites was a risk factor for reoperation (p = 0.038). Among management variables, intraoral and extraoral approaches increased the rates of overall complications, infections, and reoperation. In the multivariate analysis, only intraoral and extraoral approaches were associated with significant risks for overall complications (OR = 5.63, p = 0.017) and infections (OR = 11.53, p = 0.005).Alcohol consumption, external wound severity, multiple fracture site, and incision approach were related to postoperative complications. These findings can help guide surgical decisions and manage patient expectations after surgery.

Prognostic Factors for the Postoperative Improvement of Spinal Cord-Related Neuropathic Pain in Patients with Degenerative Cervical Myelopathy.

The number of patients with degenerative cervical myelopathy (DCM) requiring surgical treatment has markedly increased in today's aging society. Such patients often exhibit impaired activities of daily living because of motor dysfunction as well as neuropathic pain (NeP). Although many studies have demonstrated the safety and efficacy of surgical treatment for DCM, residual postoperative NeP has not been well described. Therefore, this study aimed to identify the predictors of postoperative NeP improvement in patients with DCM. This retrospective study included 92 outpatients with postoperative chronic NeP (≥3 months) related to DCM. Data were obtained from clinical information, magnetic resonance imaging (MRI) findings, and patient-based questionnaires using the Neuropathic Pain Symptom Inventory (NPSI) and the Brief Scale for Psychiatric Problems in Orthopaedic Patients. Univariate and multivariate analyses were performed for patients with NPSI improvement rates <30% and ≥30% to identify prognostic factors. Among 92 patients, 61 (66.3%) had residual NeP, with a low improvement rate even after surgery. The independent negative prognostic factors for NeP improvement after surgery were older age at operation (odds ratio (OR): 0.932), longer symptom duration before surgery (OR: 0.589), and higher preoperative NPSI score (OR: 0.932). The cut-off value of symptom duration before surgery for postoperative NeP improvement was 1 year. By contrast, the preoperative Japanese Orthopaedic Association score and MRI findings, including signal intensity change and the degree of spinal cord compression, were not associated with postoperative NeP improvement. Moreover, even in patients with an NPSI improvement rate ≥30%, the NPSI subscores for deep pain and paresthesia/dysesthesia remained high. Discrepancies between physician- and image-based assessments and patient-based assessments were identified as factors associated with improvement in postoperative NeP. Our findings are important for both spine surgeons and patients to manage patient expectations with respect to recovery during the postoperative course.

The Effect of Laparoscopic Sleeve Gastrectomy on Symptoms of Gastroesophageal Reflux Disease.

Background Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure for weight loss. LSG is becoming prevalent worldwide because it is a relatively simple procedure with high efficacy. Reduced intraabdominal pressure may improve gastroesophageal reflux disease (GERD) symptoms and reduce the GERD medication needed following LSG. However, the main long-term drawback of LSG is the development of de novo GERD. Therefore, we conducted this study to determine the relationship between GERD symptoms and LSG. Methods We conducted a retrospective chart review involving 390 patients who underwent LSG. Study participants were evaluated for GERD symptoms six months before and three, six, and nine months after the procedure, and proton-pump inhibitors (PPIs) were used to control the symptoms. Participants were distributed into two groups: one group for patients with GERD symptoms (36.1%) and one group for asymptomatic patients (62.8%). We collected demographic data and assessed PPI use in both groups after three, six, and nine months postoperatively. Data were collected using Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using IBM SPSS Statistics for Windows, Version 20.0(Armonk, NY: IBM Corp.). We compared data using the student's t-test for independent groups. The quantitative data were summarized using mean and standard deviation (SD), and p < 0.05 was considered statistically significant. Results Of the 390 participants who underwent LSG, 83.8% were women (n=327)and 16.2% were men (n=63), with a median age of 42 ± 11.9 years. PPI use was statistically significantly greater after LSG (34.1%) than before LSG (24.6%, p=0.019). The difference in PPI use between symptomatic and asymptomatic groups was not statistically significant three months after LSG. Conclusions Our study focuses on using PPI after LSG due to GERD symptoms. We found GERD symptoms improved three months following LSG, but de novo GERD symptoms occurred nine months after the surgery. Health providers need to discuss with their patients the potential outcomes of the surgery and manage patient expectations. Physicians should work with their patients to assess whether the benefits of bariatric surgery in controlling overweight-associated conditions, such as blood pressure, diabetes,sleep apnea, and weight loss, outweigh the risk of GERD symptoms and PPI use.

Physicians' Perspectives on Inpatient Portals: Systematic Review.

Inpatient portals are online platforms that allow patients to access their personal health information and monitor their health while in the acute care setting. Despite their potential to improve quality of care and empower patients and families to participate in their treatment, adoption remains low. Outpatient portal studies have shown that physician endorsement can drive patients' adoption of these systems. Insights on physicians' perspectives on use of these platforms can help improve patient and physician satisfaction and inpatient portal uptake. The purpose of this systematic review is to better understand physicians' perspectives toward inpatient portals. A systematic literature review was conducted for studies published between 1994 and November 2021 using keywords for physicians' perspectives toward patient portals and personal health records. Databases included PubMed, MEDLINE, Web of Science, and Scopus. Articles solely focused on nonphysician clinicians or addressing only outpatient settings or shared notes were excluded from this review. Two reviewers performed title, abstract, and full-text screening independently. Bias assessment was performed using the JBI SUMARI Critical Appraisal Tool (Joanna Briggs Institute). Inductive thematic analysis was done based on themes reported by original authors. Data were synthesized using narrative synthesis and reported according to overarching themes. In all, 4199 articles were collected and 9 included. All but 2 of the studies were conducted in the United States. Common themes identified were communication and privacy, portal functionality and patient use, and workflow. In studies where physicians had no prior patient portal experience, concerns were expressed about communication issues created by patients' access to laboratory results and potential impact on existing workflow. Concerns about negative communication impacts were not borne out in postimplementation studies. Physicians perceived inpatient portals to be beneficial to patients and saw improvement in communication as a result. This is consistent with outpatient studies and highlights the need to improve training on portal use and include physicians during the design process. Health care organizations and information technology entities can take steps to increasing clinician comfort. Physician concerns involving patient portal usage and managing patient expectations also need to be addressed. With improved clinician support, initial pessimism about communication and workload issues can be overcome. Limitations of this review include the small number of pre- and postimplementation studies found. This is also not a review of perspectives on open notes, which merits separate discussion.

Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical phenotype study

Symptomatic lumbar disc herniations (LDH) are very common. LDH resorption may occur by a "self-healing" process, however this phenomenon remains poorly understood. By most guidelines, if LDH remains symptomatic after 3 months and conservative management fails, surgical intervention may be an option. The following prospective study aimed to identify determinants that may predict early versus late LDH resorption. Prospective study with patients recruited at a single center. Ninety-three consecutive patients diagnosed with acute symptomatic LDH were included in this study (n=23 early resorption and n=67 late resorption groups) with a mean age of 48.7±11.9 years. Baseline assessment of patient demographics (eg, smoking status, height, weight, etc.), herniation characteristics (eg, the initial level of herniation, the direction of herniation, prevalence of multiple herniations, etc.) and MRI phenotypes (eg, Modic changes, end plate abnormalities, disc degeneration, vertebral body dimensions, etc.) were collected for further analysis. Lumbar MRIs were performed approximately every 3 months for 1 year from time of enrollment to assess disc integrity. All patients were managed similarly. LDH resorption was classified as early (<3 months) or late (>3 months). A prediction model of pretreatment factors was constructed. No significant differences were noted between groups at any time-point (p>.05). Patients in the early resorption group experienced greater percent reduction of disc herniation between MRI-0-MRI-1 (p=.043), reduction of herniation size for total study duration (p=.007), and percent resorption per day compared to the late resorption group (p<.001). Based on multivariate modeling, greater L4 posterior vertebral height (coeff:14.58), greater sacral slope (coeff:0.12), and greater herniated volume (coeff:0.013) at baseline were found to be most predictive of early resorption (p<.05). This is the first comprehensive imaging and clinical phenotypic prospective study, to our knowledge, that has identified distinct determinants for early LDH resorption. Early resorption can occur in 24.7% of LDH patients. We developed a prediction model for early resorption which demonstrated great overall performance according to pretreatment measures of herniation size, L4 posterior body height, and sacral slope. A risk profile is proposed which may aid clinical decision-making and managing patient expectations.

Exploring nurses' experiences of caring for patients participating in cancer clinical trials

Drawing on the experiences of cancer research nurses (CRNs) from the Cancer Research UK Excellence in Research Programme, this article aims to provide an insight into managing cancer patients' expectations of participating in clinical trials. It also outlines what CRNs consider are the key elements when supporting patients through side-effect management. Through group work and discussions, CRNs' reflective experiences were captured by workshop facilitators around three topics by exploring nurses' experiences of caring for patients participating in cancer clinical trials. Reflective CRN experiences for each of the three topics were reviewed and themes were developed by the author, who also facilitated this workshop. Developing relationships, patient education and effective communication were all identified as important factors when helping to manage patient expectations and aid side-effect management. The findings, based on CRN experiences, give an understanding of aspects of the role that nurses have within cancer clinical trials, what patient expectations of clinical trial are and strategies on how best to support patients within this area of nursing.