Patient-reported Satisfaction Research Articles

A Clinical Care Pathway for Patients With Chronic Mechanical Low Back Pain Having Restorative Neurostimulation for Multifidus Muscle: Description, Patient Compliance, Clinical Outcomes, and Satisfaction in the First Two Years.

Restorative neurostimulation for multifidus muscle is a novel therapy for chronic low back pain (CLBP). Optimal outcomes require interdisciplinary follow-up. We describe a clinical care pathway (CPW) for this therapy and report patient compliance, clinical outcomes, and patient satisfaction with the CPW. This study aimed to develop, at a single center, a CPW with derivation, practical basis, description, and evolution. Included in the study were audits of 1) patient compliance with attendance over 24 months, 2) medical and paramedical attendance at the clinic, 3) clinical outcomes in terms of reductions in both patient and cohort disability (Oswestry Disability Index, ODI) and CLBP numeric rating score (NRS), and 4) adverse events; and a prospective cross-sectional survey of patient satisfaction with the CPW. A CPW that involved both preoperative and postoperative education and integrated interdisciplinary care was developed and incorporated into the clinical service with a dedicated clinic. In the two years under study, 172 patients attended the education session, and 92 proceeded to restorative neurostimulation for multifidus muscle therapy; 15 patients who had this therapy before the CPW also were incorporated into the CPW. Patient compliance with the pathway was 88% (95% CI 79%-94%) at 12 months. Attendance at the dedicated CPW clinic by the various subspeciality clinicians ranged between 74% and 100%. There were serial reductions in both ODI (38.9 [95% CI 35.9-41.9] to 30.0 (95% CI 26.7-33.8) and CLBP NRS (6.3 [95% CI 6.0-6.7] to 3.3 (95% 2.7-3.9) after 12 months; 76 of the 99 patients assessable (77%: 95% CI 67%-85%) had a minimally important clinical difference reduction in either ODI or pain NRS, whereas eight were unassessable. Patient satisfaction with the CPW was very high (mean 26.9; median 27, maximum 28). The CPW facilitated clinical management and optimized outcomes in patients having restorative neurostimulation. Its design and delivery were very well accepted by patients.

Patient satisfaction and feasibility with a novel drug-injectable urethral catheter set for hyaluronic acid administration: a multicenter randomized trial

Reducing the risk of urethral strictures after transurethral surgery for patients with bladder cancer requires effective strategies. We compared the clinical outcomes of a novel drug-injectable urethral catheter set (NIUS) with hyaluronic acid (HA) with those of the conventional intraurethral HA injection method. This six-center, prospective, randomized, single-blind trial included 192 male patients aged ≥ 20 years scheduled to undergo transurethral surgery. The primary outcome was patient-reported satisfaction. Secondary outcomes were patient-reported pain intensity, clinician-reported convenience, and urethral strictures. Cystourethroscopy was performed under direct visualization. Outcomes of the experimental (NIUS with HA) and control (HA) groups were compared using the chi-square test and t-test. The post-transurethral surgery rate was significantly higher in the experimental group than in the control group (p < 0.001). Overall, 40% and 21.7% of patients in the experimental and control groups, respectively, were very satisfied (p < 0.001). The experimental group had lower postoperative pain intensity scores (p < 0.001), higher clinician-reported convenience scores (p < 0.001), and fewer urethral strictures within 3 months postoperatively (p < 0.001) than the control group. The NIUS with HA after transurethral surgery significantly enhanced patient satisfaction, reduced pain, improved clinician convenience, and was associated with a reduction in grade 1 urethral strictures. Thus, NIUS with HA enhances post-surgery outcomes through improved patient satisfaction and reduced urethral strictures.Trial registration: Cris.nih.go.kr (KCT0007010).

Sulcus-Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction Provide Good Clinical Outcomes in Addressing Patellar Instability at Mid-Term Follow-Up: A Retrospective Case Series.

To update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R), at mid-term follow-up, and monitor trends in patient reported outcome scores and satisfaction. Using the same cohort of patients from our previously published short-term series of 2-year follow up, interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar-stabilization procedures. Patients with less than 2-year follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores. 37 patients (45 knees) were included in the current study, with mean follow-up of 6.1 years postoperatively (Standard deviation [SD] 2.7 years). Two interval re-operations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of re-operation for recurrent patellar instability. Patient reported outcomes were largely stable from early (mean 3.6 years) to mid-term (mean 6.1 years) follow up with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47) or VAS (Visual analog scale) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow up (mean 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up. At mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates, and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis. IV, Case Series.

Preexisting opioid daily MME and use duration within a national cohort of lumbar spine surgery patients on quality outcomes.

Pain management surrounding lumbar spine surgery is a complex topic. Though some authors suggest that preoperative opioid use is a negative prognostic factor, its association with patient-reported outcomes and satisfaction after surgery remains controversial. We aimed to uncover the effect of preoperative opioid use on long-term outcomes using a national sample. Using deidentified data from the lumbar spine surgery Quality Outcomes Database, we compared functional outcomes and satisfaction in 34,934 patients based on presence of preoperative opioid use. Outcomes included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and satisfaction indices. Regression subanalysis illustrated the effect of preoperative opioid duration and daily MME. 44.1 % used opioids preoperatively. A greater percentage of patients using opioids underwent surgery with instrumentation (p < .005). They exhibited clinically comparable improvement in VAS, ODI, and satisfaction at 3- (p = .069, p < .005, p < .005, respectively) and 12-months (p < .05). Return to work was lower at 3- (74.32 % vs. 80.82 %, p < .005) and 12-months (48.99 % vs. 62.95 %, p < .005). They maintained low postoperative use although greater than opioid naïve patients at 3- (3.1 % vs. 1.2 %, p < .005) and 12-months (3.6 % vs. 0.8 %, p < .005). Preoperative daily MME had no significant effect on outcomes, although increasing duration negatively impacted VAS and ODI scores. Preoperative opioid use by itself should not be used in surgical decision making but rather an individual risk assessment according to chronicity of opioid burden. Longer duration of use appears to impair postoperative improvement but not satisfaction with little influence by daily MME; however, larger, granular analyses remain necessary.

Patient-Reported Outcomes in Children Undergoing the Modified Green Procedure for Treating Sprengel's Deformity: Results from a Multicentric Study.

Sprengel's Deformity (SD) is a rare condition of the shoulder girdle, appearing as the principal congenital anomaly of the shoulder in paediatric patients. The aim of this study is to document the combined experience of two paediatric orthopaedic departments in managing SD using the modified Green Procedure, with a specific emphasis on the clinical and functional outcomes reported by patients; Methods: from June 2010 to February 2023, 42 shoulders in 40 paediatric patients were surgically treated for SD at two paediatric orthopaedic departments. All patients were treated using the modified Green Procedure with or without clavicle osteotomy. To better evaluate the deformity, the Cavendish's classification for aesthetic appearance and the Rigault's classification for radiological aspect were used, while movements of abduction and flexion were quantified to assess shoulder mobility. Several dedicated questionnaires such as QuickDASH, the Shoulder Pain Index and the Shoulder Disability Index (SPADI) and finally the UCLA Shoulder Scale were submitted to assess the quality of life of the subjects and the ability to practice certain activities, including work and sports. Complications were evaluated according to the modified Clavien-Dindo-Sink classification; Results: The mean follow-up was 5 years (range, 1.0-13.6). Clavicular osteotomy, performed in 15 patients, improved post-operative abduction by a mean of 25° (95% CI: 11-39°; p = 0.001). Three patients had complications (7.1%), with two requiring re-operation. At follow-up, 67.5% of patients had a qDASH score < 7, highlighting excellent functional outcomes. Shoulder function showed moderate correlation with pre- and post-operative flexion. The SPADI and UCLASS scores indicated significant improvement, with 70.0% reporting high satisfaction. Factors like sex, associated anomalies, and surgical technique did not impact patient-reported outcomes or satisfaction; Conclusions: The modified Green's technique has proven to be a safe procedure with a low rate of complications and satisfactory clinical and functional patient-reported outcomes.

A propensity score-matched comparison between single-stage and multistage anterior/posterior lumbar fusion surgery: a Michigan Spine Surgery Improvement Collaborative study.

Patients undergoing anterior/posterior lumbar fusion surgery can undergo either a single-stage or multistage operation, depending on surgeon preference. The goal of this study was to assess different patient outcomes between single-stage and multistage lumbar fusion procedures in a multicenter setting. The Michigan Spine Surgery Improvement Collaborative database was queried for anterior/posterior lumbar fusion surgeries between July 2018 and January 2022. Patients who underwent either single-stage or multistage procedures were included. For multistage procedures, the first surgery included both anterior lumbar interbody fusions and lateral lumbar interbody fusions. Primary outcomes included postoperative complications and improvement in patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Physical Function, EQ-5D, and satisfaction. The two cohorts were propensity score matched, while Poisson generalized estimating equation models were used for multivariate analyses. After one-to-one propensity score matching, 355 patients were identified in the single-stage and multistage cohorts. Single-stage procedures were associated with a lower risk of complications (p = 0.024), fewer emergency department visits (p = 0.029), and higher patient satisfaction after 1 year (p = 0.026) and 2 years (p = 0.007), compared with multistage procedures. After adjusting for baseline patient and operative characteristics, patients undergoing multistage procedures had a higher risk of complications (relative risk [RR] 1.17, 95% CI 1.02-1.34; p = 0.026), were less likely to be satisfied after 1 year (RR 0.83, 95% CI 0.74-0.93; p < 0.001), and were less likely to experience improvement in back pain after 90 days (RR 0.86, 95% CI 0.75-0.99; p = 0.039) and 2 years (RR 0.76, 95% CI 0.60-0.96; p = 0.023). The authors observed that patients who undergo lumbar fusion surgery using a multistage approach have higher postoperative complication rates and are less likely to report satisfaction compared with a matched, single-stage procedure cohort.

Intraoperative virtual reality for older patients undergoing total knee arthroplasty: study protocol for a randomized clinical trial

BackgroundIn an aging surgical patient population, preventing complications such as oversedation has taken increasing priority in perioperative care. Intraoperative use of virtual reality (VR) may decrease sedative requirements. We hypothesize that the use of immersive VR during total knee arthroplasty (TKA) will lead to decreased propofol requirements, improved patient-reported satisfaction, and reduced postoperative opioid requirements compared to active and usual care controls.MethodsThis is a single-center, randomized clinical trial of older (age > 60) patients undergoing TKA. Participants will be randomized into three groups (2:2:1): VR immersion, music, and sham VR plus usual care. All patients will receive a regional block and spinal anesthesia. Patients in the immersive VR and music groups will use patient-controlled sedation (PCS) with propofol, while those in the sham VR group will act as the standard of care control group and will receive monitored anesthesia care (MAC) with propofol infusion.Statistical analysisAnalyses will be conducted using IBM SPSS Statistics Version 25, considering a two-sided p-value < 0.05 to be statistically significant. The primary outcome is the intraoperative dose of propofol (mg kg−1 min−1). Secondary outcomes include patient satisfaction, post-anesthesia care unit (PACU) length of stay, postoperative pain scores and analgesic requirements, functional outcomes, postoperative delirium, and postoperative neurocognition.DiscussionVR used as a non-pharmacological adjunct to regional and spinal anesthesia during TKA may reduce sedative requirements while maintaining patient satisfaction. If true, this approach to minimizing sedation may impact clinical outcomes including perioperative complications and length of stay for older patients, while maintaining a high degree of patient satisfaction.Trial registrationThis trial was registered on ClinicalTrials.gov on January 29, 2021. The registration number is NCT04748549.

Patient satisfaction study for the new Rigicon Infla10 inflatable penile prosthesis including single surgeon safety and outcomes data.

Rigicon is a newer inflatable penile prostheses (IPP) manufacturer that has produced the Infla10 IPP for countries outside the United States (US) since 2019, with Food and Drug Administration studies for approval of Infla10 in the US presently underway. This study aims to report the first patient satisfaction, efficacy, and safety from revision data for the newly available Rigicon Infla10 IPP. A single surgeon's first 58 patients who underwent Rigicon Infla10 IPP implantation between 2019 and 2023 were included. Most patients (70%) received the Infla10 X (girth expansion) cylinder, and 30% received the Infla10 AX (length and girth expansion) model. Follow-up ranged from 4 to 42months (median 19months). Outcomes measured were intraoperative and postoperative complications as well as patient-reported satisfaction. Reoperation was required in 5 patients (8.6%). Complication rates were 1.7% urethral erosion (n= 1), 1.7% infection requiring explant (n= 1), and 5% mechanical malfunction due to tubing breakage at pump junction (n= 3). The tubing issue was addressed by the manufacturer, resulting in no additional mechanical concerns. Kaplan-Meier analysis demonstrated rates of cumulative survival of the device at 12, 24, and 36months were 96.6%, 93.8%, and 78.2%, respectively. Overall, 53 patients (91.4%) were satisfied at 6months postoperatively and would recommend the procedure. Diminished satisfaction was due to perceived penile shortening in 3 patients (5.1%) and difficulty learning pump cycling in 2 patients (3.4%). This single surgeon series demonstrates high rates of patient satisfaction with appropriate early safety from revision. Limitations include the retrospective nature of this study and short-term follow-up. Additional prospective studies incorporating a larger number of patients are warranted. While very new in the marketplace, the Infla10 IPP shows promising early satisfaction, efficacy, and safety from revision.

Comparing ambulatory to inpatient percutaneous nephrolithotomy: systematic review and meta-analysis.

To investigate the differences in perioperative characteristics and postoperative outcomes between inpatient and ambulatory percutaneous nephrolithotomy (PCNL) with a subgroup analysis of same-day discharge (SDD) patients, summarise published ambulatory pathways and compare cost and satisfaction data. This study was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered a priori with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023438692). Ambulatory PCNL was defined as patients who were discharged after an overnight stay (≤23 h) and SDD was considered a subgroup discharged on postoperative Day 0. A total of 25 studies were included in the systematic review, of which 12 comparative studies were utilised for meta-analysis. We had a pooled population of 2463 patients, of which 1956 (79%) ambulatory (747 [30%] SDD) and 507 (21%) inpatients. The ambulatory PCNL cohort had fewer overall complications (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.47-0.90; P = 0.010); however, there were no differences in major complications (i.e., Clavien-Dindo Grade ≥III; RR 0.46; 95% CI 0.17-1.21; P = 0.12), emergency department visits (RR 1.09, 95% CI 0.69-1.74; P = 0.71), 30-day readmission (RR 1.09, 95% CI 0.54-2.21; P = 0.81) or readmission at any point (RR 1.00, 95% CI 0.53-1.88; P = 0.99). The ambulatory PCNL cohort was more likely to be stone-free defined by imaging (RR 1.35, 95% CI 1.09-1.66; P = 0.005); however, when stone-free was inclusive of any definition there was no difference in stone-free rates (RR 1.10, 95% CI 0.98-1.23; P = 0.10). Subgroup analysis of SDD did not result in any significant differences. Cost savings ranged from $932.37 to a mean (standard deviation) $5327 (442) United States Dollars per case. No studies reported patient satisfaction data. Ambulatory PCNL seems to be a safe and efficacious model for select patients. Selection bias likely influenced ambulatory outcomes; however, this supports overall safety of current ambulatory inclusion criteria.

Telehealth vs face-to-face consultations in a urological oncology clinic: a randomised controlled trial.

To determine the effectiveness of telehealth, among patients reviewed for urological oncological diseases, compared with standard face-to-face (F2F) consultations with regard to patient-reported satisfaction through use of a validated questionnaire. We conducted a single-centre randomised controlled trial in 126 patients recruited from the Crown Princess Mary Cancer Centres urological oncology clinics. Patients were randomised to either a telehealth audio-only (telephone) consultation group or a standard F2F consultation group for their next routine appointment. Validated questionnaires, using a 4-point Likert index scale, were completed at the end of the appointments. Questionnaire scores were analysed using the Mann-Whitney U-test. The primary outcome measured was patients' preference for type of consultation on subsequent follow-up. Secondary outcomes involved evaluation of efficiency, quality of care, ease of understanding, overall satisfaction, professionalism, limitations, and convenience. A total of 63 patients in the F2F group and 53 patients in the telephone group completed and returned the validated questionnaires. Patients' preference for next follow-up was statistically significant, favouring the telephone group (P = 0.012). For the secondary outcomes, patients in the telephone group also reported greater satisfaction with regard to the efficiency and timing of the consultation (P = 0.005). Conversely, patients in the F2F group reported higher rates of satisfaction with regard to 'tests and follow-up' and the clinician's ability to deal with their issues, as compared to the telephone group (P = 0.002). Also, patients in the F2F group reported higher rates of perceived quality of consultation (P = 0.027). Our study demonstrates that patients with urological oncological diseases attending routine follow-up generally prefer telehealth over F2F appointments. However, patients in the F2F group perceived that there was a higher quality of care in their consultation, and that the services provided were superior, in comparison to patients in the telehealth group. These are barriers to the widespread adoption of telehealth in urological oncology follow-up care and are rarely reported in the current literature.

Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics.

Inadequate health literacy in people with chronic kidney disease is associated with poorer disease management and greater complications. Adherence to the renal diet is known to be suboptimal and patient feedback about the renal diet suggests that patients leave nephrology clinics feeling confused. The present study aimed to evaluate the impact of a health literacy sensitive model of care (MOC) in outpatient nephrology dietetic clinics. This quasi-experimental non-randomised pre-post study recruited adults attending three renal dietitian clinics. The revised MOC consisted of a renal diet question prompt sheet, teachback, and plain language materials and instructions. Outcomes assessed included clinical, dietary, patient-reported satisfaction and quality of life. Differences between and within groups were analysed using paired t-tests, independent sample t-tests (or non-parametric equivalent), chi-squared and McNemar's tests. Linear mixed models evaluated change in total diet quality score, fruit, vegetable, protein and dairy intake with time as a fixed effect and a random subject specific effect. Fail to attend rates at the initial appointments were lower in the revised MOC (21.5% vs. 9.1%). The revised MOC was associated with significantly improved fruit (p = 0.03) and vegetable (p = 0.003) intake and an improved proportion with adequate diet quality (p = 0.03). These impacts were of moderate effect size (d = 0.5, 95% confidence interval = 0.0-1.0). The revised MOC was also associated with greater satisfaction at baseline (p = 0.04) and higher acceptability scores for all questions at the review appointments. Quality of life improved clinically but not significantly in the revised MOC (p = 0.92). This low-cost health literacy sensitive intervention is a promising strategy to improve fruit and vegetable intake in adults attending renal dietitian clinics. Further research to determine fidelity of teachback use and cost utility analysis would be beneficial. Larger scale trials powered to detect changes in quality of life would also be informative.

Transient Ischaemic attack Emergency Referral (TIER): randomised feasibility trial results

BackgroundEarly assessment of patients with suspected transient ischaemic attack (TIA) is crucial to provision of effective care, including initiation of preventive therapies and identification of stroke mimics. Many patients with...

Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis

Patients with painful chronic pancreatitis and a dilated pancreatic duct can be treated by early surgery or an endoscopy-first approach. To compare long-term clinical outcomes of early surgery vs an endoscopy-first approach using follow-up data from the ESCAPE randomized clinical trial. Between April 2011 and September 2018, 88 patients with painful chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach in 30 hospitals in the Netherlands collaborating in the Dutch Pancreatitis Study Group as part of the ESCAPE randomized clinical trial. For the present cohort study, long-term clinical data were collected after the initial 18-month follow-up. Follow-up was completed in June 2022, and data analysis was performed in June 2023. Patients with chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach. The primary end point was pain, assessed by the Izbicki pain score; secondary end points included patient-reported complete pain relief and satisfaction. Predefined subgroups included patients who progressed from endoscopy to surgery and those with ductal clearance obtained by endoscopy. Analysis was performed according to the intention-to-treat principle. In this cohort study, 86 of 88 overall patients could be evaluated, with a mean (SD) follow-up period of 98 (16) months. Of 88 initial patients, 21 patients (24%) were female, and mean (SD) patient age was 61 (10) years. At the end of long-term follow-up, the mean (SD) Izbicki pain score was significant lower (33 [31] vs 51 [31]) in the early surgery group, as was the rate of patient-reported complete pain relief (14 of 31 patients [45%] vs 6 of 30 patients [20%]), compared to the endoscopy-first group. After the initial 18-month follow-up, 11 of 43 patients in the early surgery group (26%) underwent reinterventions vs 19 of 43 patients in the endoscopy-first group (44%). At the end of follow-up, more patients in the early surgery group were "very satisfied" with their treatment (22 of 31 patients [71%] vs 10 of 30 patients [33%]). Patients who progressed from endoscopy to surgery (22 of 43 patients [51%]) had significantly worse mean (SD) Izbicki pain scores (33 [31] vs 52 [24]) compared to the early surgery group and had a lower rate of complete pain relief (55% for early surgery vs 12% for endoscopy first). In the endoscopy-first group, patients with endoscopic ductal clearance had similar mean (SD) Izbicki pain scores as the remaining patients (49 [34] vs 53 [28]). In this cohort study evaluating long-term outcomes of the ESCAPE randomized clinical trial, after approximately 8 years of follow-up, early surgery was superior to an endoscopy-first approach in patients with painful chronic pancreatitis and a dilated main pancreatic duct in pain scores and patient satisfaction. Notably, patients who progressed from endoscopy to surgery had worse outcomes compared to patients undergoing early surgery, and obtaining endoscopic ductal clearance did not improve outcomes.

Managing High Anisometropia with Blended Refractive Surgery: A Comparative Study on Patient Outcomes

Purpose: To compare patient-reported outcomes (PROs) and satisfaction results after blended refractive surgery with one eye Lasik laser/ PRK and another eye ICL. Patients and Methods: A Quality of life and Patient reported spectacle independence (PRISQ) questionnaire was administered to patients who had undergone blended Refractive surgery at 2 months of follow-up. Results: Overall PROs and satisfaction was similar among all the groups. Refractive outcome and accuracy were similar among the groups, Refractive outcome differences were not meaningful among the groups and were not a differentiating factor in PROs. Substantially fewer patients in the third group noticed glare and halo compared with the 3.0/3.0 group (P&lt;0.0001. chi-square test). No new safety concerns were reported. Conclusion: The choice of blended refractive surgery resulted in a higher percentage of patients who were deemed unfit for LVC being satisfied with Near, intermediate, and distance vision, overall the fewer PRO differences were not statistically significant.

Patient and Parent/Caregiver Satisfaction with Efficacy and Cosmetic Elegance of Tapinarof Cream 1% Once Daily in a Long-term Extension Trial in Adults and Children Down to Age 2 Years with Atopic Dermatitis

Introduction: Patients with atopic dermatitis (AD) report low satisfaction with currently available topical therapies. Satisfaction and patient preference are closely linked to treatment adherence, and understanding preferences may contribute to improving the quality of AD care and adherence. In the pivotal 8-week, phase 3 ADORING 1 and 2 trials, tapinarof cream 1% (VTAMA®, Dermavant Sciences, Inc.) once daily (QD) demonstrated superior efficacy versus vehicle and was well tolerated in adults and children down to age 2 years with AD. We report Patient Satisfaction Questionnaire© (PSQ) results from ADORING 3, a 48-week, open-label extension trial. Methods: In ADORING 3, eligible patients from ADORING 1 and 2, from a 4-week maximal usage pharmacokinetics trial, and tapinarof-naive patients with mild AD, or moderate or severe AD, that did not meet inclusion criteria for ADORING 1 or 2, were followed for up to 48 weeks. The PSQ was completed at Week 48 or at early termination visit and assessed patient or parent/caregiver satisfaction with tapinarof efficacy, cosmetic elegance (look and feel of tapinarof cream), application ease, impact on daily life, and preference for tapinarof versus prior AD therapies. Patients aged ≥16 years self-completed the PSQ; parents/caregivers completed for children aged 2 to 15 years. Results: 505 patients or parents/caregivers completed the questionnaire. Respondents consistently reported high rates of satisfaction across all parameters. Most patients or parents/caregivers strongly agreed or agreed with PSQ questions assessing satisfaction with cosmetic elegance (91.5%), quick absorption (89.5%), application ease (97.6%), impact on daily life (94.3%), efficacy (92.3%), and confidence in tapinarof (92.7%). For patients or parents/caregivers who reported prior use of other topical therapies to treat AD, most strongly agreed or agreed that tapinarof was more effective (86.3%), easier to use (68.6%), and that they preferred tapinarof to prior topicals (88.0%). Compared with systemic drugs used previously for AD, most strongly agreed or agreed that tapinarof was more effective (84.6%), easier to use (77.6%), and that they preferred tapinarof to prior systemic drugs (85.9%). Conclusion: Patient or parent/caregiver satisfaction data from ADORING 3 showed a consistent and highly positive perception of long-term use of tapinarof cream across all parameters, including satisfaction with tapinarof efficacy, cosmetic elegance, application ease, impact on daily life, and preference for tapinarof compared with prior AD therapies. Satisfaction with tapinarof is likely to contribute to long-term adherence and improved outcomes for patients with AD.

Disability and Patient-Reported Satisfaction in Women with Idiopathic Intracranial Hypertension: A Comparative Study of Venous Sinus Stenting and Medical Management.

Patients with chronic idiopathic intracranial hypertension (IIH) commonly experience a high level of disability and low satisfaction with medical treatment. We aim to evaluate long-term functional improvement and patient satisfaction in IIH patients with similar symptoms by comparing venous sinus stenting (VSS) to standard medical therapy. We conducted a cross-sectional questionnaire study of 111 IIH patients, comparing 37 adult female patients who underwent venous sinus stenting with 74 patients treated medically. Propensity score matching was used to balance age and presence of papilledema at presentation between groups. Headache-related disability was evaluated using the Migraine Disability Assessment Scale (MIDAS), while general function and treatment satisfaction were assessed using custom questionnaires. Electronic medical records and the results of imaging upon diagnosis were reviewed retrospectively. The stented group reported significantly better outcomes in physical well-being (median 4.0 vs. 1.0, p < 0.001), task completion (4.0 vs. 1.0, p < 0.001), work/school persistence (5.0 vs. 1.0, p < 0.001), and mental well-being (4.0 vs. 1.0, p < 0.001). Additionally, the stented group had a lower proportion of patients with severe MIDAS (MIDAS > 4, 24.3% vs. 47.9%, p = 0.017). Logistic regression suggested venous stenting as a protective factor against severe MIDAS scores (OR = 0.174, p = 0.004). Cerebral venous stenting in patients with IIH is associated with lower disability and higher patient satisfaction from medical treatment compared to those treated with medications only. These findings suggest that venous sinus stenting may be a valuable treatment option for selected IIH patients. However, larger prospective studies are needed to further validate our results.

Comparison of clinical outcomes, complications and patient satisfaction following deep anterior lamellar keratoplasty and penetrating keratoplasty

BackgroundKeratoplasty is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor tissue, thereby restoring vision. Recent advancements have led to the replacement of penetrating keratoplasty (PKP) with the more selective deep anterior lamellar keratoplasty (DALK) procedure, especially for treating keratoconus. Although DALK typically has a shorter recovery time, less pain and a lower risk of rejection, PKP is still being performed for more severe corneal diseases. A comparative study of clinical profiles, treatment outcomes and patient-reported satisfaction will provide valuable insights into the cost-effectiveness, impact on quality of life and ability of each procedure to treat different pathologies of the cornea. Here, we aimed to compare the clinical and subjective outcomes of DALK with those of the PKP at a single center in the Kingdom of Saudi Arabia.MethodsThis retrospective cohort study included eyes that underwent either PKP or DALK from January 2017 to January 2021. The demographic features, indications, best corrected visual acuity (BCVA) and complications of the patients were recorded for both groups, analyzed and compared. A subgroup of eyes with keratoconus was analyzed separately and compared to the larger group. A 6-item survey was conducted via telephone to assess patient satisfaction and expectation, and the results were compared between the two procedures. The chi-square test or Fisher’s exact test for categorical variables or the t test or Kruskal‒Wallis test for continuous variables were used as appropriate for all comparisons, and the level of significance was set at α = 0.05.ResultsA total of 97 patients were included. PKP and DALK were performed on 63 and 39 eyes, respectively. Patients who underwent DALK were younger (mean ± standard deviation 31 ± 10.82 years versus 43 ± 26.89 years for patients who underwent PKP). The most frequent indication for PKP was keratoconus (35.5%); however, in 97.4% of the eyes undergoing DALK, the indication was keratoconus. In both groups, visual acuity and refractive error improved, but the postoperative corrected distance visual acuity in the DALK group (0.3 log MAR) was noticeably greater than that in the PKP group (0.6 log MAR). Compared with PKP, DALK may carry a lower risk of early graft edema and rejection. Overall, the reported postoperative patient satisfaction was similar for both procedures.ConclusionThe findings highlight the effectiveness of PKP and DALK in improving visual acuity and emphasize the importance of considering patient-reported outcomes in evaluating success. DALK has been demonstrated to be beneficial for protecting the corneal endothelium and lowering the risk of complications and graft rejection.

Penile constriction devices: a randomized survey study to compare preferences between two medical-grade devices.

Penile constriction devices offer a noninvasive approach to enhance the sexual experience and as the variety of penile constriction devices increases, it is crucial to assess patient preferences and device effectiveness to provide insights into their clinical utility. We aimed to compare the preferences for and effectiveness of two medical-grade penile constriction devices: Eddie by Giddy and FirmTech. Between May and July of 2023, males were recruited via social media and prospectively enrolled into an Institutional Review Board-approved, randomized, questionnaire-based study. Upon enrollment, the participants completed the Sexual Health Inventory for Men and Androgen Deficiency in Aging Males questionnaires. Participants were randomized to which device they received first. They used the device twice either during masturbation or intercourse in a two-week timeframe. Once utilized, the participants completed a 17-question, Likert scale, device satisfaction questionnaire, in which lower numbers indicated positive responses. The process was repeated with the second device. T-test and Chi-Square Analysis were run for statistical analysis. The primary outcomes of this study were patient-reported device satisfaction and efficacy and the secondary outcome was the device preference for patients with and without erectile dysfunction. Fifty men were enrolled and 49 completed the study. The average age was 40years old. Of the participants, 80% recommend the FirmTech device compared to 53% who recommend the Eddie by Giddy device (P= 0.0026). The FirmTech device was overall easier to put on both flaccid and erect (P= 0.0308 and 0.0002), was more comfortable, had better stretch, and was easier to adjust (P= 0.087, <0.0001, and 0.0119, respectively). The FirmTech device had a better overall impression amongst the participants (P= 0.0249). Eddie by Giddy was felt to improve erectile firmness more in those with ED than in those without (P = 0.0178). This study adds to the current literature on penile constriction devices that better guide providers as they counsel patients on these devices to enhance sexual function. The strength of this study is that this is a prospective randomized crossover study. The limitations of this study are that this is a single center study based on patient reported outcomes. The FirmTech device performed better than the Eddie by Giddy with respect to overall impression of the device, likelihood of using the device in the future, and recommending the device to a friend, while the Eddie by Giddy device performed better at improving erectile firmness. NCT05853822.

The Efficacy of Different Tenotomies in the Treatment of Lateral Epicondylitis: A Systematic Review.

Background: Lateral epicondylitis impacts 1-3% of the population. It affects nearly half of all tennis players, primarily due to repetitive forearm muscle use leading to pain at the lateral elbow, particularly at the extensor carpi radialis brevis tendon. While conservative treatments resolve most cases, 4-11% of patients with persistent pain require surgery. Tenotomy is the gold standard for repair, but the research comparing the benefits of specific types of tenotomies (open, arthroscopic, percutaneous, ultrasonically assisted, and Tenex forms) is lacking. Methods: PubMed and Embase searches were conducted for articles focused on four tenotomy techniques. The inclusion criteria allowed for the use of randomized controlled trials (RCTs), prospective cohort studies, and comparative observational studies, while the exclusion criteria excluded meta-analyses. Following the PRISMA guidelines, the initial search resulted in 2327 articles. Once the inclusion and exclusion criteria were applied, 1702 articles underwent abstract screening. Finally, 232 articles proceeded to full-text screening, resulting in 37 articles undergoing data extraction. Results: The primary outcomes included functional improvement, pain relief, overall performance, and postoperative disability. The secondary outcomes included patient-reported satisfaction, return-to-work timeframes, and procedural complications. Conclusions: The tenotomy outcomes were similar, regardless of the method, indicating that discussions with patients about their specific outcome preferences may help guide tenotomy method selection.

Penile inversion vulvo-vaginoplasty with scrotal graft for trans women: surgical technique and results of initial experience.

A significant proportion of trans women is demanding for a genital gender-affirming surgery, with vulvo-vaginoplasty being the most frequently requested procedure. The gold standard for primary vaginoplasty in trans women is the penile skin inversion technique with scrotal skin graft, which allows for increased depth of the vaginal cavity. The assessment of vulvo-vaginoplasty outcomes utilizing penile skin inversion and scrotal skin graft in individuals assigned male at birth in the surgeon's learning curve involves evaluating aesthetics, functionality, and sexual aspects. A total of 76 individuals assigned male at birth were included in 2 French university hospitals from 2020 to 2022. They underwent vulvo-vaginoplasty following 8 key steps: scrotal skin excision; bilateral orchiectomy; dissection between the rectum, bladder, and prostate; penile dissection; clitoroplasty; urethroplasty; penile skin inversion with scrotal skin graft; labioplasty. The average follow-up period was 12.4months, with participants averaging 35.7years of age. Each patient was invited to complete a questionnaire during follow-up. The study's outcomes encompassed the assessment of both early and late surgical complications, postoperative sexuality, aesthetic results, and voiding satisfaction. Of the total patients, 15.8% experienced major early postoperative complications, while 3% encountered major late postoperative complications. No complication was classified 4 or 5 in Clavien-Dindo scale. Most early complications were related to issues in vulvar healing, which did not compromise long-term aesthetic results. Patients-reported satisfaction was 82% after the procedure. Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a reproductive surgery procedure that can be successfully performed by experienced urologist. It achieves high patient-reported satisfaction even during the learning curve. The surgical procedures were consistent, and the sizable cohort of patients accurately reflects the learning curve of both surgeons. However, extrapolating long-term complications is challenging due to the relatively brief follow-up period. Additionally, there is a lack of self-reported sexual function data, and the scales used to assess patient-reported quality of life and urinary satisfaction are not specifically validated for transgender patients. Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a complex surgical procedure. It appears to be achievable by experienced urologists during their learning curve, resulting in similar functional and surgical outcomes, along with high patient satisfaction.