Patient Satisfaction Outcomes Research Articles

Trends in Racial, Ethnic, and Gender Diversity Among Hand Surgery Fellows From 2007 to 2021

There is a paucity of research on the demographic trends of orthopedic and plastic hand surgery fellows. The purpose of this study was to ascertain the current state of racial and gender demographic trends in hand surgery fellowship from 2007 to2021. We analyzed fellowship demographic data from the Accreditation Council for Graduate Medical Education public database from 2007-2008 through 2020-2021. The gender of hand surgery fellows was categorized as male, female, or not reported and their race/ethnicity as White, Non-Hispanic; Asian or Pacific Islander, Hispanic; Black, Non-Hispanic; American Indian or Alaskan Native; other; or unknown. We extracted the number of fellows per year for each category and calculated the percentage equivalents and average percentages. We performed the chi-square test for trend (Cochran-Armitage test) to identify any significant changes in the percentages of gender and race/ethnicity between 2007 and2021. There was a significant increase in the percentage of hand surgery fellows who are women (20.7% to 30.7%) and Asian or Pacific Islander (13.3% to 25.3%). There was no significant change in the percentage of Hispanic or Black, Non-Hispanic fellows. Although there have been some increases, hand surgery fellows continue to be underrepresented by women and minorities, consistent with the demographic of orthopedic and plastic surgery residents. There have been increasing trends in the number of women and minorities in medical schools, which leaves room for improvement from the downstream prospective applicant pool. The physician-patient relationship can potentially be strengthened by race and gender concordance; however, many minority and female hand surgery patients do not have physicians who are women or of the same ethnic background. Patient satisfaction, trust, and potential health outcomes may be improved with a physician workforce that reflects the diversity of their patients.

Disparities in accessing open notes at a comprehensive cancer center.

e18507 Background: Patient use of open access medical notes can promote understanding of and engagement in disease management, in turn improving patient satisfaction, trust, medication adherence and clinical outcomes. Previous studies have shown that racial minorities were less likely to utilize personal health records online, as were patients with lower incomes compared to those with higher incomes. The CURES Act, enacted as of April 5 2021, is a national policy that requires healthcare providers to give patients access to the information and notes available on their own electronic medical registry. Given the recency of this legislation, little is known about who is accessing this information or how we can help it to be more widely accessible. Methods: We extracted demographic data available for all patients with an outpatient oncology encounter at UCSD between 1/1/21-12/31/21. Data available included age, gender, ethnicity, preferred language, and type of insurance. Mann-Whitney U test and Fisher’s exact test were used to compare continuous and categorical variables between the two groups, respectively. This analysis was approved by the UCSD ACQUIRE committee and met criteria for IRB excusal. Results: There were 22,419 patients who met inclusion criteria, 21,892 (97.3%) of whom were registered on MyChart and 4,114 (18.4%) of whom had accessed an oncology note. There was no significant difference in age or gender between those who did or did not access notes. Patient race, ethnicity, preferred language, and insurance type were all significantly different between groups (p<0.001), with those who were non-White, Hispanic, Spanish speaking, or on Medicaid less likely to access their notes through OpenNotes. Conclusions: There are significant differences in the demographics of patients who do and do not access notes. Targeted outreach efforts (e.g., translation efforts) may help in making access to open notes more equitable. [Table: see text]

Sometimes it is better to just make it simple. De-escalation of oncoplastic and reconstructive procedures.

Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients' psychosocial well-being and cosmetic outcome. Although OBP are time-consuming and expensive, we are witnessing an increase in their use, even for cases that could be managed with sBCS. The choice between keeping it simple or opting for more complex oncoplastic procedures is difficult. This review proposes a pragmatic approach in assisting this decision. Medical literature suggests that OBP and sBCS might be similar regarding local recurrence and overall survival, and patients seem to have higher satisfaction levels with the aesthetic outcome of OBP when compared to sBCS. However, the lack of comprehensive high-quality research assessing their safety, efficacy, and patient-reported outcomes hinders these supposed conclusions. Postoperative complications after OBP may delay the initiation of adjuvant RT. In addition, precise displacement of the breast volume is not effectively recorded despite surgical clips placement, making accurate dose delivery tricky for radiation oncologists, and WBRT preferable to APBI in complex OBP cases. With a critical eye on financial toxicity, patient satisfaction, and oncological outcomes, OBP must be carefully integrated into clinical practice. The thoughtful provision of informed consent is essential for decision-making between sBCS and OBP. As we look into the future, machine learning and artificial intelligence can potentially help patients and doctors avoid postoperative regrets by setting realistic aesthetic expectations.

Skull base dural reflection models: tool for teaching neuroanatomy at resource-scarce centers.

Skull base dural reflections are complex, and along with various ligaments joining sutures of the skull base, are related to most important vessels like internal carotid arteries (ICA), vertebral arteries, jugular veins, cavernous sinus, and cranial nerves which make surgical approaches difficult and need thorough knowledge and anatomy for a safe dissection and satisfactory patient outcomes. Cadaver dissection is much more important for the training of skull base anatomy in comparison to any other subspecialty of neurosurgery; however, such facilities are not available at most of the training institutes, more so in low- and middle-income countries (LMICs). A glue gun (100-Watt glue gun, ApTech Deals, Delhi, India) was used to spread glue over the superior surface of the bone of the skull base over desired area (anterior, middle, or lateral skull base). Once glue was spread over the desired surface uniformly, it was cooled under running tap water and the glue layer was separated from the skull base. Various neurovascular impressions were colored for ease of depiction and teaching. Visual neuroanatomy of the inferior surface of dural reflections of the skull base is important for understanding neurovascular orientations of various structures entering or exiting the skull base. It was readily available, reproducible, and simple for teaching neuroanatomy to the trainees of neurosurgery. Skull base dural reflections made up of glue are an inexpensive, reproducible item that may be used for teaching neuroanatomy. It may be useful for trainees and young neurosurgeons, especially at resource-scarce healthcare facilities.

Communication skills in primary care settings: aligning student and patient voices

ABSTRACT Introduction Effective communication is essential for patient-centred relationships. Although medical graduates acquire communication skills during undergraduate training, these have been shown to be inadequate in early practice. Both students’ and patients’ perspectives are required to improve readiness for the workplace, patient satisfaction, and health outcomes. Our research question was: to what extent are medical students prepared with patient-centred communication skills in primary care settings? Methods A qualitative descriptive research study using in-depth semi-structured interviews was conducted with Year 3 medical students and patients to study their experiences at a primary care clinic, over two weeks. Data were transcribed verbatim and analysed using Braun and Clark’s thematic analysis. Both students’ and patients’ views on communication skills were obtained. Results Three themes were established based on student-patient communication in primary care settings: socio-cultural elements in student-patient communication; cognitive and emotional challenges for effective communication; and enablers for effective student-patient communication. The themes and sub-themes describe both students and patients valuing each other as individuals with socio-cultural beliefs and needs. Conclusion The findings can be used to structure new approaches to communication skills education that is patient-centred, culturally sensitive, and informed by patients. Communication skills training should encourage students to prioritise and reflect more on patient perspectives while educators should engage patients to inform and assess the outcomes.

Analyzing the Impact of Organizational Culture on Performance: A Study of Public and Private Hospitals in India

This study aimed to analyze the impact of organizational culture on performance in public and private hospitals in India. A mixed-methods research design was used, involving a survey of hospital employees and interviews with hospital managers. The Organizational Culture Assessment Instrument (OCAI) was used to measure the four types of organizational cultures: clan, adhocracy, market, and hierarchy. Performance was measured using a composite score of patient satisfaction, clinical outcomes, financial performance, and employee satisfaction. The results showed that hierarchical culture was predominant in both types of hospitals, followed by clan, market, and adhocracy cultures. Private hospitals outperformed public hospitals in terms of overall hospital performance and employee satisfaction with the organizational culture. The findings suggest that healthcare managers and policymakers in India need to adopt more flexible and collaborative approaches to management, address the systemic issues facing public hospitals, and improve the work environment and employee engagement in public hospitals. Further research is needed to explore the relationship between organizational culture and other outcomes, such as patient satisfaction and clinical outcomes. The study adds to the growing body of literature on organizational culture in healthcare and provides valuable insights for healthcare managers and policymakers in India.

Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review

Purpose To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. Methods Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. Results Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. Conclusions There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DA

Micropenis.

Micropenis, i.e., a structurally normal but abnormally small penis is defined as stretched penile length (SPL) 2.5 SD below the mean for age and sexual stage. Several studies worldwide have published country-specific normative data on SPL; an appropriate cutoff for evaluation of micropenis as per international standards would be below 2cm at birth and below 4cm after 5 y of age. Testosterone production by fetal testes, its conversion to dihydrotestosterone (DHT) and its action on the androgen receptor is necessary for normal penile development. Hypothalamo-pituitary disorders (gonadotropin or growth hormone deficiencies), genetic syndromes, partial gonadal dysgenesis, testicular regression, disorders of testosterone biosynthesis and action constitute the various etiologies of micropenis. Associated hypospadias, incomplete scrotal fusion, and cryptorchidism are suggestive of disorders of sex development (DSD). Along with basal and human chorionic gonadotropins (HCG)-stimulated gonadotropins, testosterone, DHT, and androstenedione levels, karyotype assessment is equally important. Treatment aims at attaining penile length sufficient enough for urination and to perform sexual function. Hormonal therapy with intramuscular or topical testosterone, topical DHT or recombinant follicle stimulating hormone (FSH) and luteinizing hormone (LH) should be attempted in the neonatal or infancy period. The role of surgery for micropenis is limited and has variable patient satisfaction and complication outcomes. There is a need for long-term studies on the adult SPL achieved following treatment for micropenis in infancy and childhood.

Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory in Belgium: Value Based Healthcare-Change in Practice

AimsTo assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital. Methods and resultsOutcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021.The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income. ConclusionImplementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.

Clinical outcome of ambulatory anterior cruciate ligament reconstruction compared with the standard in-patient surgery

Purpose There is a current trend toward performing anterior cruciate ligament reconstruction (ACLR) as a day surgery procedure. However, the full evaluation of this process compared with the traditional inpatient ACLR was not accomplished particularly from the perspective of patient satisfaction, pain improvement, and final outcome. Furthermore, several centers described refusal of patients to pass through the day surgery protocol with more preference to admission. The aim of this study is the evaluation of early/late results of short-term hospital stay following arthroscopic ACLR with regard to patient recovery, complications, patient satisfaction, and return to daily activities through our algorithm. Patients and methods Through a prospective randomized study, 284 patients were operated for ACLR through two pathways; G1 is the day surgery pathway and G2 is the traditional inpatient pathway. Patients were evaluated postoperatively for pain severity, satisfaction, the need for additional analgesia, any readmission, complications, and final outcome. Results Patients in both groups showed similar pain and satisfaction levels with no difference regarding the amount of extra-analgesia needed and with no readmission from the day surgery group. However, seven patients were recorded as reattending the hospital seeking for pain medication which was given in ER and the patient was satisfied to return home with no need for readmission. Conclusions In conclusion, day surgery can be considered as the protocol of choice for patients undergoing ACLR with no difference from the former standard in-patient ACLR.

Ankle Arthrodesis: Indications, Outcomes, and Patient Satisfaction.

Background Osteoarthritis of the ankle, which has a prevalence of 3.4% in the general population and affects 70% of candidates post-traumatically, is less common than hip or knee arthritis. Despite the recent progress in ankle arthroplasty surgery, ankle arthrodesis is still considered the gold-standard treatment for severe osteoarthritis of the ankle joint and can achieve impressive improvements in pain and function in the majority of patients. Our objective is to assess the clinical and functional outcomes of ankle arthrodesis, postoperative complications, and patient satisfaction. Methodology This was a descriptive cross-sectional study that took place at Future Hospital in Khartoum, Sudan, from July 2015 to July 2022. Our institute performed 102 ankle fusion surgeries; 14 patients were excluded from the study because they did not show up for their follow-up visit, meaning 88 candidates were included. Two cannulated screws (6.5 mm) were used for ankle fixation in all patients. The outcome was assessed two years after surgery. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to assess ankle function before surgery and two years after the procedure. Postoperative complications and patient satisfaction were reported. The primary researcher collected data through direct interviews. Result The mean age of the study participants was 52.2 years, with 36.4% being between 40 and 50 years of age. The study consisted of 43 women and 45 men. The male-to-female ratio was almost 1:1. In 56.8% of candidates, the right ankle was involved. The overall rate of complications was 11.4%. Concerning patient satisfaction, 75% of the patients were fully satisfied. Moreover, significant correlations were found between the mean postoperative AOFAS score and age group, diabetes mellitus, complications, and patient satisfaction. Conclusion Ankle arthrodesis was demonstrated to be an excellent surgical method for reducing pain and enhancing ankle joint function. The most frequent complications were delayed wound healing, infection, and non-union. The functional outcome and patient satisfaction of this procedure were statistically high; patients with a higher functional score had higher levels of satisfaction. In contrast, diabetic and elderly patients had higher rates of complications.

Non-Invasive Treatment of Basal Cell Carcinoma: Photodynamic Therapy Following Curettage.

To investigate the effectiveness, safety, patient satisfaction, and cosmetic outcome of Methyl Aminolevulinate-Photodynamic Therapy (MAL-PDT) following curettage in order to make recommendations for its use in dermatology practices. A retrospective chart review of patients who received MAL-PDT following curettage for the indication of basal cell carcinoma (BCC) between 2009 and 2016 at a single private clinic in Ontario, Canada. Two hundred and seventy-eight patients with 352 BCC lesions were included, consisting of 44.2% males (n=123) and 55.8% females (n=155) with a mean age of 57.24 years. The primary outcome measurement consisted of the cure rate. Secondary outcome measurements included side effects, patient satisfaction, and cosmetic outcome, as reported in the medical charts. The overall cure rate was 90.3% (n=318). After controlling for age, sex, and lesion type, nasal lesions were approximately 2.82 (95% CI: 1.24-6.40, P=0.01) times more likely to experience a recurrence. 18.3% of patients (n=51) reported side effects, the most common being burning (n=19). Of those who expressed satisfaction, 100% (n=25) reported being happy. Of lesions with cosmetic data, 90.3% displayed a good response (n=149). MAL-PDT following curettage is an effective and safe treatment option for BCC lesions with a good cosmetic outcome and suggested high patient satisfaction. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7133.

MP77-13 OUTPATIENT VERSUS INPATIENT ROBOTIC ASSISTED RADICAL PROSTATECTOMY: COMPLICATIONS, TIME DRIVEN ACTIVITIES BASED COSTING AND PATIENT SATISFACTION

You have accessJournal of UrologyCME1 Apr 2023MP77-13 OUTPATIENT VERSUS INPATIENT ROBOTIC ASSISTED RADICAL PROSTATECTOMY: COMPLICATIONS, TIME DRIVEN ACTIVITIES BASED COSTING AND PATIENT SATISFACTION Emily Cheng, Aaron Laviana, Spyridon Basourakos, Sofia Gereta, Alec Zhu, Leonardo Borregales, Xiangmei Gu, Miko Yu, Chunmei Mckernan, Siwen Xie, Christopher Barbieri, Douglas Scherr, and Jim Hu Emily ChengEmily Cheng More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Sofia GeretaSofia Gereta More articles by this author , Alec ZhuAlec Zhu More articles by this author , Leonardo BorregalesLeonardo Borregales More articles by this author , Xiangmei GuXiangmei Gu More articles by this author , Miko YuMiko Yu More articles by this author , Chunmei MckernanChunmei Mckernan More articles by this author , Siwen XieSiwen Xie More articles by this author , Christopher BarbieriChristopher Barbieri More articles by this author , Douglas ScherrDouglas Scherr More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy lengths of stay decreased with ketorolac analgesia and adoption of robotic assisted radical prostatectomy (RARP). During the COVID-19 pandemic, the transition to outpatient RARP freed up critically needed hospital beds. The healthcare cost reduction afforded by the shift to outpatient RARP and its effect on patient satisfaction has yet to be explored. We compared healthcare costs, patient satisfaction and complications for outpatient vs. inpatient RARP. METHODS: We identified and compared a series of consecutive RARP performed as outpatient vs. inpatient and determined the capacity cost rate for every resource, including personnel, equipment, and space. After the lifting of hospital restrictions, men were given the option of inpatient vs. outpatient RARP. We also administered a validated Patient Satisfaction Outcome Questionnaire (PSOQ) post-operatively and compared median scores in perceived outcomes and satisfaction. A time-driven activity-based costing (TDABC) analysis was applied to compare the total costs of care for RARP performed. Finally, we captured complications within 30 days of surgery using the Clavien-Dindo classification. We used multivariable regression to adjust for age, race, BMI, and ASA classification to assess the impact of outpatient vs. inpatient RARP on complications. RESULTS: There were no significant differences in patient characteristics for outpatient (n=145) vs. inpatient (n=80) RARP. When given the choice, 86.6% of men elected for outpatient vs. inpatient RARP. Outpatient RARP netted a $1387 (13.5%) cost reduction compared to inpatient RARP. There were no significant differences in outpatient vs. inpatient median satisfaction survey scores or complications within 30 days (11.0% vs. 11.3%, p=0.961). CONCLUSIONS: Outpatient RARP can be safely performed, with similar outcomes and compared to inpatient RARP. Outpatient RARP has significantly lower costs compared to inpatient RARP while maintaining similar patient satisfaction outcomes. Source of Funding: Jim C. Hu receives research support from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. Jim C. Hu also receives salary support from NIH R01 CA241758, R01 CA259173, R01 CA273031, PCORI CER-2019C1-15682 and CER-2019C2-17372 and a Prostate Cancer Foundation Challenge Award. The remaining authors report no further disclosures related to this work © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1107 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily Cheng More articles by this author Aaron Laviana More articles by this author Spyridon Basourakos More articles by this author Sofia Gereta More articles by this author Alec Zhu More articles by this author Leonardo Borregales More articles by this author Xiangmei Gu More articles by this author Miko Yu More articles by this author Chunmei Mckernan More articles by this author Siwen Xie More articles by this author Christopher Barbieri More articles by this author Douglas Scherr More articles by this author Jim Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP36-09 EXPERIENCE WITH EXTRATUNICAL GRAFTING (ETG) FOR CORRECTION OF INDENTATION DEFORMITY WITHOUT BUCKLING IN MEN WITH PEYRONIE’S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-09 EXPERIENCE WITH EXTRATUNICAL GRAFTING (ETG) FOR CORRECTION OF INDENTATION DEFORMITY WITHOUT BUCKLING IN MEN WITH PEYRONIE’S DISEASE Jose Quesada-Olarte, Spencer Mosack, Daniel Roadman, and Laurence Levine Jose Quesada-OlarteJose Quesada-Olarte More articles by this author , Spencer MosackSpencer Mosack More articles by this author , Daniel RoadmanDaniel Roadman More articles by this author , and Laurence LevineLaurence Levine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie's Disease (PD) can be surgically challenging, especially in men with indentation deformity. Extratunical grafting (ETG) is a relatively new surgical option that be employed to treat corporal indentation in those without buckling or hinge effect. Objective: To report our experience with the ETG procedure, including different grafts or graft location (under or over Buck’s fascia) pre and post-operative patient characteristics, and patient satisfaction. METHODS: We performed a retrospective chart review of patients following ETG, collecting data including baseline demographics, prior treatments, pre-operative deformity, erectile function, type of graft, grafting location (under or over Buck’s), patient satisfaction, and clinical outcomes at our tertiary-care referral center. RESULTS: From December 2018 to July 2022, 33 patients presenting with PD underwent an ETG and TAP and/or PEG (partial plaque excision and grafting) for indentation deformity with a mean follow-up of 14.6 months. Overall, patient satisfaction, specifically for the correction of indentation was 94%. Grafting location under or over Buck's fascia showed no statistical difference in patient satisfaction with penile appearance (54.5% and 72.7%, respectively, p>=0.05). Patients undergoing ETG, with PEG had significantly lower satisfaction with their erect appearance than TAP and ETG (0% and 71.4%, respectively, p=0.003). Several different grafts were used, there was no difference in satisfaction between the grafts used. Palpable graft was reported in 30 patients (91%), but only two were bothered by the graft (6%). Statistical analysis showed no difference in patient satisfaction according to the size of the graft or degree of curve correction. CONCLUSIONS: ETG has emerged as a less invasive and less risky surgical option than PEG to correct indentation deformities which are not associated with buckling or axial instability. Our initial results demonstrate a high rate of satisfaction with correction of indentation, but multiple factors contributed to lower overall satisfaction with appearance of the penis including loss of length (9%), residual curvature (6%), sensory changes (9%), and erectile dysfunction (15.1%). Further studies are needed to determine the optimum approach. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e482 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose Quesada-Olarte More articles by this author Spencer Mosack More articles by this author Daniel Roadman More articles by this author Laurence Levine More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of scar outcomes of alar base and columella using irradiated polyglactin 911: a single-blind study

Aim: The formation of scars on the face after open septorhinoplasty (SRP) with alar base reduction may disturb the patient due to cosmetic concerns. This study aimed to compare scar outcomes of the columella and alar base in patients undergoing SRP.&#x0D; Material and Method: Twenty-seven patients who underwent alar base reduction during primary open SRP were divided into two groups according to the intervened area as the Columella (CLM) group (n=27) and the Alar Base (AB) group (n=27). Irradiated polyglactin 911 was used in all patients. The modified Stony Brook Scar Evaluation Scale (SBSES) and a questionnaire form were used to measure scar outcomes and patient satisfaction. Columellar and alar base scar outcomes were compared.&#x0D; Results: Patient satisfaction and scar outcomes were better in the CLM group. There was no significant difference, except for the first month total SBSES scores, between the CLM and AB groups. There was no significant difference in patient questionnaire scores between groups. In the early period, there were more signs of inflammation in the alar base than in the columella, without statistical significance.&#x0D; Conclusion: Patient satisfaction and scar outcomes in the columellar area were favorable. Scar outcome on the alar base was statistically significantly worse than columella in the early period. There was no statistically significant difference between both areas in the long-term. Irradiated rapid vicryl can be used for closure of the alar base and columella, considering its advantages and disadvantages, in patients undergoing open septorhinoplasty with alar base reduction.

Surgical outcome of lower limbs radiculopathy “due to degenerative lumbar canal stenosis” 12-24 months after decompression

Objectives: Interlaminar decompression is a surgical procedure that decompresses the lumbar spinal canal in order to release neuro-vascular components that have been compromised by degenerative stenosis. It can significantly improve patient quality of life and reduce morbidity and the effects of lumbar canal stenosis.&#x0D; Methods: A retrospective study of 57 patients, surgically operated for degenerative lumbar canal stenosis, at the Sulaymaniyah teaching hospital between Mar. 2018 and Mar. 2020.&#x0D; Diagnosis was achieved via history and clinical examination and radiological imaging (Lumbo-sacral spine MRI). Surgical procedure was standardized for all patients that was interlaminar decompression of the lumbar spinal canal, the postoperative follow up was after 12-24 months.&#x0D; Results: In total, 57 patients with degenerative lumbar canal stenosis (due to ligamentum flavum hypertrophy) were included, male (26%) and female (74%), age of the cases were between 34 – 85 years, mean 57.39 and median 57 and standard deviation 10.96, there were no deference in the outcome of different ages and genders.&#x0D; chief complain of patients were back pain and both lower limbs radiculopathy in the majority of the cases, associated with paresthesia and numbness of the lower limbs, which were improved modestly after surgical decompression.&#x0D; Conclusion: Interlaminar decompression of the stenosed lumbar spinal canal is an effective and generally safe surgical procedure with high patient satisfaction and good functional outcomes expected.

Modern implants in total knee arthroplasty are more patellofemoral joint friendly compared to their traditional design: a systematic review and meta-analysis.

Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and meta-analysis aimed to explore the evidence in the literature regarding the outcomes of the Attune knee system over the PFC Sigma knee design and investigate the advantage of one over the other. A systematic review and meta-analysis of published studies till August 2021 was performed using the defined eligibility criteria. This was a systematic review of the literature published in the Cochrane Central Register of Controlled Trials (CENTRAL) Library, PUBMED, and EMBASE. The analysis included prospective and retrospective comparative trials comparing TKA by PFC sigma or Attune posterior stabilized (PS) or cruciate-retaining (CR), fixed bearing, or rotating platform systems. Patient-reported outcome measures (PROM) and postoperative patellar complications were analysed in the studies utilizing attune knee system (modern implants) to its counterpart PFC sigma (traditional implants) for TKA. Quality assessment was conducted using NIH Quality Assessment Tool for controlled intervention studies (RCTs and case-control studies). This review included 3 RCTs and the rest, 10 of which were non-RCT, including 5852 patients. ATTUNE designs suggested a statistically significant improvement in KSS over PFC Sigma designs. Other PROMs such as OKS and WOMAC scores yielded comparable results between the two groups. ATTUNE knee prosthesis did not result in better knee range of motion, patient satisfaction, or radiological outcomes than the PFC design. Regarding the complications, attune knee prosthesis demonstrated favourable results over PFC Sigma for anterior knee pain and patellofemoral (PF) crepitus. The present systematic review highlights better KSS and lesser chances of PF complications favouring a modern implant design over its traditional counterpart. Other patient-reported outcome analyses at a short-term follow-up period were comparable among patients undergoing total knee replacements with two different implant designs. Radiological outcomes for component positioning also suggested similar results among the two groups.

A Histological and Clinical Study of MatriDerm® Use in Burn Reconstruction.

Dermal substitutes are well established in the reconstructive ladder. MatriDerm® (Dr. Otto Suwelack Skin & Health Care AG, Billerbeck, Germany) is a single-layer dermal substitute composed of a bovine collagen (type I, III, and V) and elastin hydrolysate, that allows for immediate split-thickness skin grafting (SSG). The aim of this study was to histologically characterize the integration of MatriDerm® when used during burns surgery reconstruction. Eight subjects with nine burn scars and one acute burn wound underwent reconstruction with MatriDerm® and an immediate SSG. MatriDerm® integration and skin graft take were assessed with serial biopsies performed at weeks 1, 2, 3, and 4 and months 2, 3, 6, 9, and 12. Biopsies were assessed with standard special stains and immunohistochemistry, and representative slides were imaged with a transmission electron microscope. Patient satisfaction and clinical scar outcome were assessed with the Vancouver Scar Scale and a patient questionnaire. Histological analysis showed similar stages of wound healing as shown in other dermal templates but on a different timescale. There is early evidence of vascularization and an inflammatory infiltrate in the first 2 weeks. MatriDerm® is resorbed earlier than other dermal substitutes, with evidence of resorption at week 3, to be completely replaced by a neodermis at 2 months. The use of MatriDerm® in reconstruction with immediate skin grafting is supported histologically with early evidence of vascularization to support an epidermal autograft. Future histological studies may help further characterize the ideal dermal substitute.

Doctor Attributes That Patients Desire during Consultation: The Perspectives of Doctors and Patients in Primary Health Care in Botswana.

Doctor attributes contribute significantly to the quality of the doctor-patient relationship, consultation, patient satisfaction, and treatment outcomes. However, there is a paucity of research on this topic in many settings in developing countries, including Botswana, where accessibility and availability of care itself are a challenge. The study examined doctor attributes that patients in Botswana desire from the perspectives of doctors and patients in selected public clinics located in four health districts of Botswana. We used a qualitative design and conducted face-to-face interviews with 32 adult patients and 17 doctors selected through the purposive sampling technique. Interviews were audio-recorded and transcribed. Data analysis followed the six steps of qualitative thematic data analysis. We found both discordance and congruence between the doctors and patients on key attributes that patients desire in a doctor during consultation. Both agreed that effective communication and listening skills were key desirable doctor attributes that improve the doctor-patient relationship. Conducting the consultation in the language of the patients enhances effective communication. Doctors cited clinical expertise and competence as key desirable doctor attributes, whereas patients cited interpersonal and social attributes including kindness, empathy, and respect as key doctor attributes that increase trust in the doctor. However, patients expected the doctor to have clinical knowledge, which they perceived as essential to improve doctor-patient interaction and health outcomes. The findings highlight a need to enhance the interpersonal and communication skills of doctors to improve the quality of doctor-patient interactions. To optimise and enhance the consultation, continuing professional development should be adopted as a strategy to improve the communication and interpersonal skills of doctors.

The Use of Extracorporeal Circulation to Facilitate the Resection of a Large Retroperitoneal Sarcoma With Major Vessel Involvement: A Single-Center Review of 20 Cases

To describe the introduction of extracorporeal corporeal oxygenation (ECMO) to facilitate the surgical resection of large retroperitoneal sarcomas involving major vessels and to report preliminary outcomes. A case series. At a tertiary university hospital and state sarcoma center. Patients undergoing retroperitoneal sarcoma resection requiring inferior vena cava (IVC) reconstruction between June 2018 and March 2022. ECMO for retroperitoneal tumor resection requiring IVC reconstruction. A total of 20 patients underwent ECMO-assisted retroperitoneal sarcoma resection and IVC reconstruction. The median age was 60.5 years (IQR 48-69); 15 women and 5 men. The median procedure and ECMO durations were 10.8 hours (IQR 8.5-12.4 hours) and 2.2 hours (IQR 62-218 minutes), respectively. The median intensive care unit and hospital lengths of stay were 4 days (IQR 3-5 days) and 21 days (IQR 14-31 days), respectively. All 20 patients received packed cell transfusions (median 8 per patient [IQR 4-14]); 11 patients required fresh frozen plasma, 6 required platelets, and 11 required fibrinogen supplementation. One patient required recombinant activated factor VII. Sixteen patients experienced acute kidney injury, with 12 patients progressing to chronic kidney disease. Three patients were required to return to the operating room within 7 days, with no returns within the first 24 hours. There was no in-hospital or 30-day mortality. Survival at 3 years was 84%. ECMO for resecting large retroperitoneal tumor resection was introduced successfully and facilitated satisfactory outcomes for many patients who might otherwise have been considered too high risk.