Mean Patient Satisfaction Score Research Articles

Coverage of radial forearm flap donor site with full thickness skin graft and Matriderm®: An alternative reliable solution?

After harvesting a radial forearm flap (RFF) an optimal aesthetic and functional restitution of the donor site is required. In order to cover the secondary defect of the donor site, several solutions are currently available, but there is still no real evidence of the most reliable option. A retrospective study was conducted in order to evaluate a new technique of forearm coverage with artificial dermis: the association of full thickness skin graft (FTSG) with Matriderm®. Our study included all RFF performed during a 34-month period. Forty-three forearm secondary defects after harvesting a RFF (16 men, 27 female) were included. Forearm donor site was covered using three techniques: a simple FTSG, split thickness skin graft (STSG) with Matriderm® or FTSG with Matriderm®. Clinical evaluations based on residual functionality, skin quality and aesthetic result were assessed using respectively the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Vancouver Scar Scale (VSS) score and a blind panel questionnaire. FTSG with Matriderm® showed an improved DASH (10.6/100) and VSS score (5.5/13) if compared to the other techniques, mean surgeon satisfaction score was 3/5, mean patient satisfaction score was 3/5 in the FTSG with Matriderm® group. The results of this study revealed that the new association of FTSG with Matriderm® improves the DASH score and the aesthetic outcomes resulting to be a reliable solution in treating full thickness forearm skin defects after RFF harvesting.

Prospective comparative study of tolerance to refractive errors after implantation of extended depth of focus and monofocal intraocular lenses with identical aspheric platform in Korean population

BackgroundTo evaluate the clinical outcomes of extended depth of focus (EDOF) and monofocal intraocular lenses (IOLs) that share identical aspheric platform and compare their visual acuity tolerance to postoperative refractive errors.MethodsThis non-randomized, prospective comparative study included 120 eyes undergoing cataract surgery with implantation of either Tecnis ZCB00 IOL (Abbott Medical Optics Inc., Santa Ana, CA) (monofocal group: 60 eyes of 30 patients) or Tecnis Symfony IOL (Abbott Medical Optics, Inc.) (EDOF group: 60 eyes of 30 patients). Monocular and binocular visual outcomes, changes in refraction, defocus curve, contrast sensitivity, and perception of photic phenomena (Halo & Glare Simulator; Eyeland Design Network, Vreden, Germany) were evaluated 3 months postoperatively. To compare the refractive tolerance, each group was divided into three subgroups according to the postoperative uncorrected distance visual acuity (UDVA) and postoperative spherical equivalent (SE).ResultsIn the EDOF group, the mean 3-months postoperative monocular UDVA, intermediate (UIVA), and near (UNVA) visual acuities were 0.03 ± 0.07, 0.09 ± 0.15, and 0.24 ± 0.16 logMAR, respectively. A total of 100, 96.55, and 68.97% of eyes in the EDOF group achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. In respect to refractive tolerance, the EDOF group showed higher SE values and statistically significantly better mean UDVA than the monofocal group in all subgroups, with UDVA of − 0.013 and 0.028 logMAR for EDOF and monofocal groups (p = 0.037), respectively, in the subgroup where SE was within ±0.50 D, UDVA of 0.004 and 0.048 logMAR for EDOF and monofocal groups (p = 0.046), respectively, in the subgroup where SE was within − 1.00 D, and UDVA of 0.020 and 0.083 logMAR for EDOF and monofocal groups (p = 0.026), respectively, in the subgroup where SE was more than − 1.00 D. The mean patient satisfaction scores for spectacle-free distance, intermediate, and near visual acuities were 86.0, 85.0, and 66.0, respectively.ConclusionsThe EDOF IOL provided excellent postoperative visual outcomes in far and intermediate distances, with high patient satisfaction rate. Regarding the postoperative refractive tolerance to SE, the Tecnis Symfony IOL showed better tolerance to residual postoperative refractive error than the monofocal IOL with the same material and optical platform.

The Effects of the Thai Traditional Medicine of Abdominal Massage on Defecation in Post Lumbar Laminectomy Patients

Objective: This prospective study examined the defecation enhancement effects in post-lumbar laminectomy patients who received Thai traditional medicine of abdominal massage (TTMAM) in combination with standard nursing care, compared with patients receiving only standard nursing care. Methods: This prospective, randomized, controlled trial was conducted at Siriraj Hospital between 2011 and 2015. Eighty-eight patients with spinal stenosis scheduled for lumbar laminectomy with or without fusion were enrolled. The patients were randomly assigned to two groups: the first group underwent standard nursing care combined with TTMAM (the TTMAM group), and the second group underwent standard nursing care (the non-TTMAM group). The clinical outcomes regarding the first defecation within 3 days after surgery, abdominal distension, and patient satisfaction with defecation care were evaluated. Results: When comparing the first defecation within 3 days after surgery, no significant differences were found in the number of patients between the two groups. The number of the patients who had their first defecation within 3 days after surgery was higher in the TTMAM group (46.5%) than the non-TTMAM group (27.3%). There was significantly less abdominal distension on the third day after surgery in the TTMAM group than in the non-TTMAM group. Moreover, the mean score of patient satisfaction of the TTMAM group was higher than that of the non-TTMAM group. Conclusion: Thai traditional medicine of abdominal massage tends to help defecation in post-lumbar laminectomy patients as it relieves abdominal distension and increases satisfaction with defecation care. Therefore, the use of TTMAM with other bowel care methods could provide additional benefit for lumbar laminectomy patients.

Fixation of Metacarpal Fractures Using Intramedullary Headless Compression Screws: A Tertiary Care Institution Experience.

IntroductionMetacarpal fractures account for the majority of hand fractures. Inadequate management can cause functional deficit which can lead to loss of fine hand movements. Adequate management has proven to give good outcomes. The use of intramedullary screws has given better results than the use of Kirschner wires (K-wires).MethodThis study was conducted at Dr. Ruth Phau Civil Hospital, Karachi (CHK) between August 1, 2018 and January 31, 2019. A total of 32 patients presented with metacarpal fractures. They were surgically managed with intramedullary headless screw fixation. Post-operatively, grip strength, range of motion, and presence of any disabilities were recorded. Patients were followed up to three months.ResultsOut of 32 patients, six were females. Mean age was found to be 29.1 ± 10.5 years. Post-operatively the mean grip strength was found to be 37.8 ± 7.3 kilograms. The mean total active range of motion was found to be 242.8 ±14.5 degrees. The mean days to return back to work were 25 ± 5.4 days. The mean patient satisfaction score was 8.1 ± 0.79. Three patients developed post-operative stiffness of the joint.ConclusionPatients with intramedullary screw fixation have good post-operative results with early return to work.

Lumbar Transforaminal Epidural Steroid Injection in Patients with Lumbar Radicular Pain; Outcome Results of 2-Year Follow-Up.

Objective:To evaluate the effectiveness of transforaminal lumbar epidural steroid injections (TFESI) in patients with unilateral radiculopathy due to lumbar intervertebral disc protrusion regarding pain intensity, functional disability, current opioid intake and patients’ satisfaction. Methods:The study is conducted in a pain management center (Tehran, Iran), during 2018. Inclusion criteria were age ≥18 years, radiculopathy for more than 6 months due to imagine-proved lumbar intervertebral disc protrusion and no response to conservative treatments. Exclusion criteria were spinal canal stenosis, lumbar surgery, and inability to communicate in Persian language. During a phone call interview, cases were instructed to rate their pain intensity according to the visual analogue scale (VAS), functional ability, satisfaction according to the patient satisfaction score (PSQ) and report current opioid use and additional injection and/or surgery. Results:Forty-three (89.5%) of the 48 subjects were reachable for study with mean age of 59.14 years and 16 subjects were men (37.2 %). Mean VAS after intervention was 4.67 and before the intervention was 6.91 (p=0.002). Mean functional disability before intervention was 47.23 and after intervention was 37 (p<0.001). Mean patient satisfaction score was 3.07 while 18 cases reported a PSQ level ≥4. 10 cases reported using opioid for analgesia, 23 cases reported receiving additional TFESIs and 11 reported having undergone lumbar surgery.Conclusion:Lumbar Epidural steroid injection is an effective non-surgical treatment option with regard to pain relief and improvement in functional ability with an average patients’ satisfaction during 2 years follow up although nearly 25% of patients may need additional injections and half of the patients may finally proceed to surgery.

Optimal near and distance stereoacuity after binocular implantation of extended range of vision intraocular lenses

To evaluate stereopsis and visual quality after bilateral implantation of extended range of vision intraocular lenses (ERV IOLs). R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. Prospective interventional study. Patients underwent phacoemulsification with bilateral implantation of ERV IOLs. The primary outcome measures were stereopsis (distance and near Randot) and visual quality (ray-tracing aberrometry). The secondary outcome measures were visual acuity and patient satisfaction. Follow-up was performed on day 1 and at 1, 3, 6, and 12months postoperatively. The study comprised 50 patients (100 eyes). The mean age of the patients was 58.9years±8.9 (SD). At 1year, the mean distance stereopsis was 103.6±49.1seconds of arc (arcsec) and near stereopsis was 21.1±2.3 arcsec. Perfect near stereopsis of 20 arcsec was present in 80% of cases, and 82% had good distance stereopsis of 100 arcsec or better. Stereopsis correlated well with the patient satisfaction score (P<.001) and average internal modulation transfer function (MTF) (P<.015). The mean Strehl ratio was 0.029±0.021, MTF was 0.24±0.08, total higher-order aberrations were 0.62±0.41μm, and coma was 0.25±0.18μm. The mean binocular uncorrected decimal visual acuities were 0.98±0.07 (distance), 0.82±0.09 (intermediate) and 0.64±0.08 (near). The mean patient satisfaction score was 9.08±1.1, and no case required IOL explantation because of visually disturbing phenomena or patient dissatisfaction. Excellent stereoacuity was observed after bilateral implantation of ERV IOLs, which correlated well with patient satisfaction and quality of vision.

Telemedicine for Follow-Up of Rare Neurological Disease.

Background and Purpose- Providing ongoing care for rare neurological conditions is challenging. Telemedicine can reduce patient travel. We set up and evaluated a telemedicine service for patients with a genetic form of stroke and dementia cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Methods- One hundred fourteen patients with mutation-positive cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (64 telemedicine and 50 face-to-face) were recruited. Patient and clinician satisfaction questionnaires rated the service to create a mean satisfaction score for both face-to-face and telemedicine follow-up appointments. Results- There was no difference in mean (SD) patient or clinician satisfaction scores between telemedicine and face-to-face appointments (patient: 4.57 [0.56] and 4.69 [0.42]; P=0.99; clinician: 4.55 [0.49] and 4.60 [0.43]; P=0.44). Conclusions- Telemedicine follow-up was suited to patients with stroke and dementia and offered satisfaction levels similar to that for face-to-face consultations.

Long-term outcomes after high-energy open tibial fractures: Is a salvaged limb superior to prosthesis in terms of physical function and quality of life?

The aim of this study was to describe complication rates and long-term functional outcomes among patients with amputated versus reconstructed limb after high-energy open tibial fractures. Patients treated operatively for a high-energy open tibial fracture, classified as Gustilo-Anderson (GA) grade 3, at our hospital in the time period 2004-2013 were invited to a clinical and radiographic follow-up at minimum 2years after injury. Eighty-two patients with 87 GA grade 3 fractures were included. There were 39 type GA 3A, 34 GA 3B, and 14 GA 3C. The GA 3A reconstruction group had the lowest complication rate and the best long-term outcome scores at mean 5years (range 2-8years) after injury. Within the group of GA 3B and 3C fractures, we found no significant differences in long-term outcomes among patients with reconstructed versus amputated limbs. The mean physical component summary score of the SF-36 in the reconstruction versus amputation group was 54.2 (95% CI 46.3-62.1) versus 47.7 (95% CI 32.6-62.2), respectively (p = 0.524), while the mean mental component summary score was 63.7 (95% CI 50.6-71.8) versus 59.2 (95% CI 48.8-68.0), respectively (p = 0.603). On the 6-minute walk test, the reconstruction group walked on average 493m (95% CI 447-535m) versus 449m (95% CI 384-518m) in the amputation group. The return to work rate was 73% (16 of 22) in the reconstruction group versus 50% (7 of 14) in the amputation group (p = 0.166). The mean patient satisfaction score (VAS 0-100) was 67 (95% CI 67-77) in the reconstruction group versus 65 (95% CI 51-76) in the amputation group (p = 0.795). Regardless of the treatment strategy, the complication rate was high. Amputation should be considered as a viable treatment option, equal to limb salvage, after high-energy open tibial fracture with severe vascular damage or soft tissue loss.

Abstract WP500: Stroke Transitions of Care Coordination Program is Feasible and May Reduce 30-day Readmissions

Introduction: Transitions of care from the acute hospital to other medical facilities and home is a national health care priority. We designed a randomized pilot study to assess the feasibility of a Transitions of Care Coordinator (TOCC) program led by a nurse navigator. We hypothesized that the navigator would complete all portions of TOCC program in at least 75% of acute ischemic stroke (AIS) pts. Methods: Consecutive AIS patients admitted from April to July 2018 were randomized to TOCC group or usual care group. Pts discharged to subacute rehab, nursing home and hospice or died during hospitalization were excluded. In TOCC, the navigator met patient/caregiver on admission, followed up discharge pending diagnostics, attended multi-disciplinary rounds, facilitated rehab referrals, provided stroke education, and arranged clinic follow-up. Demographics, NIHSS, mRS and discharge disposition were collected. Hospital length of stay (LOS) was calculated from date/time of patient registration to discharge. Patient satisfaction questionnaire and readmission rate was assessed at 30 days by phone. Continuous variables were analyzed using Wilcoxon rank-sum and categorical variables using Fisher’s exact test. Results: TOCC pts were older, but other demographics were well matched (table 1). The navigator completed all portions of the TOCC program in 80% of pts. The mean time spent by the navigator per TOCC pt was 111 minutes (SD 23). There was no difference in distribution of LOS between the TOCC and usual care groups (5.7 vs. 5.1 days, p=0.51). There was no difference in the mean patient satisfaction scores between TOCC and usual care groups (30.3 vs. 29.6, p=0.66). There were no 30-day readmissions or ER visits in TOCC group vs. 3 and 2 in the usual care (p=0.25, p=0.50). Conclusion: A nurse navigator-led TOCC program is feasible and may be associated with decreased 30-day readmissions. The ongoing TOCC study will assess any association with LOS and patient satisfaction.

Efficacy of 0.5-L vs 1-L polyethylene glycol containing ascorbic acid as additional colon cleansing methods for inadequate bowel preparation as expected by last stool examination before colonoscopy.

BACKGROUNDNo consensus has been reached in patients suspected of having inadequate bowel preparation regarding optimal salvage methods, which negatively affects the efficacy and quality of colonoscopy. The most ideal and reasonable rescue option involves early suspicion and identification of patients with inadequate preparation before sedation, additional oral ingestion of a suitable preparation formulation, and same-day colonoscopy.AIMTo compare 0.5-L and 1-L polyethylene glycol containing ascorbic acid (PEG + Asc) as additional bowel cleansing methods after a 2-L split-dose PEG + Asc regimen in patients with expected inadequate bowel preparation before colonoscopy.METHODSIndividuals with expected inadequate bowel preparation based on last stool form, such as turbid liquid, particulate liquid, or liquid with small amounts of feces, were randomized to either a 0.5-L PEG + Asc group or a 1-L PEG + Asc group. The primary endpoint was bowel preparation as assessed using the Aronchick bowel preparation scale (ABPS) and Boston bowel preparation scale (BBPS) scores. The secondary endpoints were cecal intubation time, withdrawal time, polyp detection rate (PDR), adenoma detection rate (ADR), individual compliance with additional PEG + Asc, and patient satisfaction.RESULTSInitially, 98 patients were included, but 8 were later excluded due to withdrawal of consent to participate in the study. Adequate bowel preparation (as assessed by ABPS) was observed in 80.9% (38/47) of subjects in the 0.5-L group and in 88.4% (38/43) of subjects in the 1-L group (P = 0.617). Mean total BBPS was 6.7 points in the 0.5-L group and 7.0 points in the 1-L group (P = 0.458). ADRs and PDRs were similar in the two groups, and cecal intubation and withdrawal times were not significantly different. However, mean patient satisfaction score was significantly higher in the 0.5-L group (P = 0.041).CONCLUSIONThe bowel cleaning efficacy of additional 0.5-L PEG + Asc was not inferior to that of 1-L PEG + Asc. Additional 0.5-L PEG + Asc is worthwhile when inadequate bowel preparation is expected before colonoscopy.

Arthroscopic Repair of Acetabular Labral Tears Associated with Femoroacetabular Impingement: 7-10 Years of Long-Term Follow-up Results.

BackgroundThe purpose of this study is to report the long-term follow-up results of arthroscopic repair of acetabular labral tears with femoroacetabular impingement (FAI).MethodsOf 45 patients who underwent arthroscopic labral repair under the diagnosis of acetabular labral tears with FAI from January 2008 to December 2010 and met our inclusion criteria, 41 patients who were available for a long-term follow-up were included in the analysis. We compared the long-term follow-up results with the previously reported short-term follow-up results of the same patients. The mean follow-up period was 92.4 months (range, 85 to 117 months). There were 21 males and 20 females, and their mean age at surgery was 34.6 years (range, 16 to 54 years). A modified Harris hip score (mHHS), visual analog scale (VAS), hip outcome score-activity of daily living (HOS-ADL), hip outcome score-activity-sport-specific subscale (HOS-SSS), and patient satisfaction were used for evaluation of the clinical results and Tönnis grade for detection of early osteoarthritis (OA).ResultsThe mean VAS score decreased from 6.4 points to 1.8 points (p < 0.001), the mean mHHS increased from 59.5 points to 86.8 points (p < 0.001), and the mean HOS-ADL and HOS-SSS increased from 58.3 and 51.2, respectively, to 85.2 and 82.4, respectively (p < 0.001), between the preoperative and last follow-up assessment. The mean patient satisfaction score was 7.6 of 10. The average Tönnis grade at the last follow-up (0.67; range, 0 to 3) was not significantly different from the preoperative average (0.51; range, 0 to 1). Only one case was converted to total hip arthroplasty because of progression of OA at 8 years after surgery. Five cases of secondary arthroscopic surgery were performed before maximum 5 years postoperatively because of labro-synovial adhesion (three cases), pullout of the suture anchor (one case) or symptomatic heterotrophic ossification (one case).ConclusionsThe clinical and radiological long-term follow-up revealed that improvement after arthroscopic labral repair and osteoplasty for FAI were maintained in most cases without significant progression of arthritis. Anatomical recovery of the acetabular labrum was associated with the improvement of clinical symptoms.

Autologous Fat Graft for Soft Tissue Camouflage in Craniofacial Microsomia.

Introduction:In India, a large majority of patients with craniofacial microsomia are unable to undergo complex reconstructions owing to unaffordability, lack of access to good craniofacial centers, or reluctance of parents to accept the surgical risk. There is also considerable social stigma attached to the resultant facial scars of surgery, especially in a girl child. Hence, we have explored autologous fat graft transfer as a “stand-alone” reconstructive option for soft tissue camouflage and aesthetic correction of facial deformity in unilateral craniofacial microsomia of Pruzansky–Kaban Grades I and II.Materials and Methods:Twelve patients who were seeking aesthetic correction of facial deformity in unilateral craniofacial microsomia of Pruzansky–Kaban Grades I and II, and who had adequate fat in the preferred donor sites of lower abdomen and antero-medial thighs, were selected. Patients with Grade III deformity, facial palsy, and previous skeletal surgeries were excluded. Autologous fat harvesting was done with the standardized Coleman’s technique and injected after decantation. Volumetric augmentation was assessed by clinical comparison with normal side for facial symmetry, skin pinch thickness at four reference points, and by two-dimensional analysis of pre- and postoperative standardized photographs at periodic intervals.Results and Analysis:Eleven of our patients were female and one was a male (N = 12). In each session, 20–40mL (mean 28.75 ± standard deviation [SD] 5.69) fat was aspirated and 12–35mL (mean 23.67 ± SD 6.07) fat was injected. The average operating time was 35min (mean 32.91 ± SD 4.05). Majority of our patients needed three sessions (mean 2.8 ± SD 1.03) of serial fat injections to achieve bilateral facial symmetry. Increase in skin pinch thickness was 6.4167 ± 1.31 mm. The mean patient satisfaction score was 8.83 ± SD .717.Conclusion:Based on our results, we conclude that autologous fat transfer, when used for soft tissue camouflage, is a versatile, easy, effective, and inexpensive method for obtaining consistent long-term aesthetic goals in mild to moderate cases of craniofacial microsomia.

Predictors of Patient Satisfaction with Nursing Care in an Orthopedic and Urologic Population.

Background: Patient satisfaction is a multi-dimensional concept that can be influenced by social, cultural, and economic factors. This study was designed to evaluate the determinants that could predict patient satisfaction with nursing care in an orthopedic and urologic Population at a selected surgical ward in Kashan, Iran during 2018. Materials and Methods: This cross-sectional study was performed on 250 male patients with orthopedic and urologic diagnosis that were hospitalized in men surgical ward of Shahid Beheshti hospital affiliated to Kashan University of Medical Sciences. Patients satisfaction was assessed by a researcher-made questionnaire. The data was analyzed by the independent t-test, analysis of variance, correlation, and multiple regression analysis statistical tests.Result: The mean score of patient satisfaction was 136.05±48.10 (possible range 45-225). The age, marital status, education, diagnosis, the length of stay in the hospital, and the verbal communication of nurses with patients showed a significant correlation with patient satisfaction (P<0.001). Regression analysis revealed that age (P=0.013), marital status (P<0.001), education level (P=0.038), the length of stay in hospital (P=0.002), and verbal communication (P<0.001) could make a meaningful model with patient satisfaction in surgical wards. Conclusion: Many personal and professional factors can determine patient satisfaction in orthopedic and urologic population. Verbal communication between nurses and patients is an important factor for patient satisfaction.

Predictors of Patient Satisfaction with Nursing Care in an Orthopedic and Urologic Population

Background: Patient satisfaction is a multi-dimensional concept that can be influenced by social, cultural, and economic factors. This study was designed to evaluate the determinants that could predict patient satisfaction with nursing care in an orthopedic and urologic Population at a selected surgical ward in Kashan, Iran during 2018.Materials and Methods: This cross-sectional study was performed on 250 male patients with orthopedic and urologic diagnosis that were hospitalized in men surgical ward of Shahid Beheshti hospital affiliated to Kashan University of Medical Sciences. Patients satisfaction was assessed by a researcher-made questionnaire. The data was analyzed by the independent t-test, analysis of variance, correlation, and multiple regression analysis statistical tests.Result: The mean score of patient satisfaction was 136.05±48.10 (possible range 45-225). The age, marital status, education, diagnosis, the length of stay in the hospital, and the verbal communication of nurses with patients showed a significant correlation with patient satisfaction (P&lt;0.001). Regression analysis revealed that age (P=0.013), marital status (P&lt;0.001), education level (P=0.038), the length of stay in hospital (P=0.002), and verbal communication (P&lt;0.001) could make a meaningful model with patient satisfaction in surgical wards.Conclusion: Many personal and professional factors can determine patient satisfaction in orthopedic and urologic population. Verbal communication between nurses and patients is an important factor for patient satisfaction. [GMJ.2018;7:e1305]

Predictors of Patient Satisfaction with Nursing Care in an Orthopedic and Urologic Population

Background: Patient satisfaction is a multi-dimensional concept that can be influenced by social, cultural, and economic factors. This study was designed to evaluate the determinants that could predict patient satisfaction with nursing care in an orthopedic and urologic Population at a selected surgical ward in Kashan, Iran during 2018.Materials and Methods: This cross-sectional study was performed on 250 male patients with orthopedic and urologic diagnosis that were hospitalized in men surgical ward of Shahid Beheshti hospital affiliated to Kashan University of Medical Sciences. Patients satisfaction was assessed by a researcher-made questionnaire. The data was analyzed by the independent t-test, analysis of variance, correlation, and multiple regression analysis statistical tests.Result: The mean score of patient satisfaction was 136.05±48.10 (possible range 45-225). The age, marital status, education, diagnosis, the length of stay in the hospital, and the verbal communication of nurses with patients showed a significant correlation with patient satisfaction (P&lt;0.001). Regression analysis revealed that age (P=0.013), marital status (P&lt;0.001), education level (P=0.038), the length of stay in hospital (P=0.002), and verbal communication (P&lt;0.001) could make a meaningful model with patient satisfaction in surgical wards.Conclusion: Many personal and professional factors can determine patient satisfaction in orthopedic and urologic population. Verbal communication between nurses and patients is an important factor for patient satisfaction. [GMJ.2018;7:e1305]

Recurrence of Patellar Instability in Adolescents Undergoing Surgery for Osteochondral Defects Without Concomitant Ligament Reconstruction

Background: First-time patellar dislocation with an associated chondral or osteochondral loose body is typically treated operatively to address the loose fragment. The incidence of recurrent instability in this patient population if the medial patellofemoral ligament (MPFL) is not reconstructed is unknown. Purpose: To determine the recurrent instability rate in patients undergoing surgery for patellar instability with chondral or osteochondral loose bodies, as well as to identify and stratify risk factors for recurrent instability. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective analysis of adolescent patients treated operatively for acute patellar dislocation with associated chondral or osteochondral loose bodies between 2010 and 2016 at a single pediatric level I trauma center with minimum 2-year follow-up. Potential demographic, injury-related, radiographic, and surgical risk factors were recorded. The primary outcome variable was recurrent subluxation and/or dislocation. Secondary outcome variables included need for additional procedures, Kujala score, Single Assessment Numerical Evaluation (SANE) score, and patient satisfaction. Results: Forty-one patients were included. In total, 61% experienced recurrent instability at a mean follow-up of 4.1 years and 39% required subsequent MPFL reconstruction. Tibial tubercle-trochlear groove (TT-TG) distance greater than 15 mm was a risk factor for recurrent instability (P = .03). Patients with TT-TG distance greater than 15 mm and greater than 20 mm had recurrent instability rates of 75% and 86%, respectively. MPFL repair did not reduce the rate of recurrent instability (P = .87). Recurrent instability was associated with significantly worse mean Kujala (93.9 vs 83.0; P = .01), SANE (88.9 vs 73.1; P = .01), and patient satisfaction scores (9.4 vs 7.3; P = .002). Conclusion: If the MPFL is not reconstructed during index loose body treatment, children have a 61% recurrent instability rate. Patients with TT-TG distance greater than 15 mm, and particularly greater than 20 mm, are at highest risk for recurrent instability.

Home administration of filgrastim (Nivestim™) in primary prophylaxis of chemotherapy-induced febrile neutropenia.

BackgroundThe granulocyte-colony stimulating factor (G-CSF) biosimilar filgrastim (Nivestim™) reduces the duration and severity of neutropenia and the frequency of occurrence of febrile neutropenia (FN). Administration of this biosimilar filgrastim and the patient population receiving it at home have not been sufficiently documented in day-to-day medical practice. Insight into home administration may help optimize the management of FN in this setting, potentially at a reduced cost and patient burden vs hospital administration.Materials and methodsThis was a prospective, non-interventional, non-comparative, multisite study involving 171 patients across 29 sites treated with at least one dose of filgrastim. Mean age was 59.3 years, and most patients were female and G-CSF-naïve. The data collected originated from paper-based patient questionnaires and routine documentation by the treating physicians. The primary endpoint was the characterization of patients treated with filgrastim. Secondary endpoints were satisfaction with filgrastim, effectiveness, safety and tolerability, and compliance with prescription.ResultsMost patients had solid tumors (95.9%), mainly located in the breast, while 4.7% had malignant hematological disease. Solid tumors were recorded as grade 1 (7.9%), grade 2 (28.0%), grade 3 (45.7%), and grade 4 (3.0%), and the majority of patients classified at TNM Stages I and II. Many patients (71.0%) could self-inject filgrastim and 72.2% found the handling instructions “extremely straightforward and easy to understand” at least once. Nearly all (99.4%) patients found the syringes “easy to use” at least once and 91.7% were willing to continue home administration. The mean patient satisfaction score for home administration was 1.9±0.9, ranging from 1 (very satisfied) to 6 (absolutely dissatisfied). No cases of neutropenia were observed and only one event of FN occurred.ConclusionHome-based prophylaxis for FN with filgrastim was found to be effective, well tolerated, and well received by patients (ClinicalTrials.gov Identifier: NCT02956967).

Compliance and satisfaction with intensive physiotherapy treatment during chemotherapy in patients with bone tumours and evaluation of related prognostic factors: An observational study.

The purpose of this study was to evaluate compliance and satisfaction of adult patients to intensive rehabilitation treatment during chemotherapy cycles after surgery for bone-musculoskeletal tumours, as well as to identify possible predictive factors. An observational, prognostic, prospective study was conducted. The study enrolled 27 patients who previously had undergone modular knee prosthesis surgery in the period between October 2014 and October 2015. The outcome was compliance to intensive rehabilitation treatment during hospitalisations in the chemotherapy unit and patient satisfaction 6months' post-surgery. The variables taken into account were linked to the patient's characteristics, to the oncological pathology and to the chemotherapy treatment administered. Patients' compliance was 100% (range, 61-100). The presence of surgery complications (29.6%) produced 5% loss in compliance to treatment; likewise, chemotherapy treatment with prevalent use of ifosfamide reduced compliance to rehabilitation by 6%. The mean patient satisfaction score was 7.9 in the Likert scale from 0 to 10. Intensive physiotherapy starting during chemotherapy administration is a feasible treatment for bone tumour patients that have shown to be able to positively adhere to it. Rehabilitation treatments, within chemotherapy wards, should therefore be promoted according to satisfaction level as reported by patient.

124 Use of a Standardized Communication Tool Improves Patient Experience in the Emergency Department

Improved communication between providers and patients during an emergency department (ED) visit can mitigate negative perceptions of the clinical delays patients often experience. Pilot data at our institution suggested patient satisfaction could be improved by utilizing a standardized form to inform patients about their care plan during their ED visit. The goals of this study are to evaluate if patients perceive written communication to be more informative, and encounter more satisfying, than verbal communication alone by providers regarding their ED clinical plan of care. This study was performed in an academic, urban, tertiary care ED with an annual volume of 100,000 adult visits per year. Our ED utilizes a split flow model to promote throughput and evaluation of lower and high acuity patients. A convenience sample of patients evaluated in both low and high acuity areas of the ED over a 1-year period was included. Volunteer research assistants accompanied providers during patient encounters and completed plan of care forms for patients. These forms contained pertinent information for patients, including providers’ names, laboratory or imaging studies ordered, NPO status, and estimated wait times for results. At the end of the visit (either admission or discharge), study patients received an in-person survey regarding their experience during the ED visit. A control group, who did not receive the form, was also surveyed about their experience. Primary outcomes were 1) Overall satisfaction with one’s care, 2) Feeling involved in one’s care, 3) Feeling informed about one’s plan of care, and 4) Quality of communication with providers. Chi square analysis was done for bivariate relationships, and t-test analysis was used for comparison of continuous data between groups. A p value less than 0.05 determined statistical significance. A total of 711 patients participated, 303 (43%) of which received the plan of Care form during their ED visit. There were no significant demographic or clinical differences between intervention and control groups or between study participants and our general ED population. Mean patient satisfaction scores were similar between groups (9/10 intervention versus 8.9/10 control). Those receiving the form rated provider communication significantly higher (9.30/10 versus 9/10, p=0.024). Those receiving the form also felt significantly more informed about their care (73.5% versus 60%, p<.001). Patients who received the form also felt significantly more involved in their care (97.4% intervention versus 94% control, p=0.027). While overall satisfaction was high among our patients, instituting an informative, personalized document detailing their plan of care resulted in an enhanced patient experience in this study. In the future, these forms will be integrated into the clinical workflow for all patients in our ED.

PMU50 - Perceived Service Quality and Patient Satisfaction at Pharmacy Department in Yogyakarta, Indonesia

to measure the gap between patients’ expectations and perceptions about services delivered in pharmacy department. A questionnaire concerning the perceived quality of health care sent to out-patients in pharmacy department, in a government hospital in Sleman district, Yogyakarta Province, Indonesia, during a period of 2016. Participants were two hundred patients aged 18 or older responded to the survey and provided their own ratings of the care. The SERVQUAL model was employed, consisting five main dimensions of service, are tangibles, reliability, responsiveness, assurance, and empathy. Description of respondent’s characteristics, quality dimensions and patient satisfaction was examined. In our survey, 54% of patients were female and 46% male. Thirty-one percent of patients were 45-54 years old. Using servqual model we found a gap -0.487 with service quality mean score 2.938; (SD 1.16) and patient satisfaction mean score 3.425 (SD 0.54). Patients with less education were more satisfied than those with more education. Gaps existed between all five expectation categories and ‘overall perception’ of quality. The direction of the gaps indicated higher perceived quality than expected (all statistically significant) with responsiveness domain demonstrating the largest unfavourable gaps. We found the SERVQUAL model to be useful in revealing differences between patients’ preferences and their actual experience in health care service quality.