Patient Expectations Research Articles

Return to Sports After Arthroplasty

Arthroplasty of the hip has become one of the most successful surgical interventions and has seen significant advancements over the last century. With these developments, patient expectations have shifted from merely achieving pain-free daily mobility to anticipating a full recovery, including the ability to participate in sports. This shift has driven innovations in prosthetic materials and surgical techniques, such as the development of wear-resistant materials like highly cross-linked polyethylene and the adoption of minimally invasive procedures to enhance recovery.However, concerns persist among patients about the risks of resuming sports postoperatively, particularly the fear of prosthesis-related accidents or failures. A survey of 300 German surgeons identified periprosthetic fractures as the greatest risk, followed by polyethylene wear and implant loosening. The study also examines osteoporosis as a risk factor, suggesting that while sports can help prevent periprosthetic osteoporosis, high-energy trauma may increase the severity of injuries. Although modern prosthetic materials have reduced wear and improved durability, the type and intensity of physical activity continue to influence prosthesis longevity.Therefore, it is recommended that low-impact sports be resumed 3-6 months postoperatively, while high-impact sports should be approached with caution, particularly during the first year after surgery, to minimize the risk of complications. Coordination training before and after surgery is also emphasized to reduce the risk of falls and injuries. In summary, the study highlights that high-impact sports cannot be generally recommended, as coordination deficits may persist for up to 12 months following total hip replacement. Such activities should only be considered later-on and only by patients who are experienced in these specific sports.

Integration of GRC and ESG in Hospital Risk Management and Its Impact On Sustainability

Hospitals face complex and evolving risks as regulations, patient expectations and operational challenges change. Integration of Governance, Risk, and Compliance (GRC) and Environmental, Social, and Governance (ESG) is important to ensure holistic risk management and hospital sustainability. This study aims to analyze the concept of GRC and ESG integration in hospital risk management. This study used qualitative research methods. The data collection technique in this research is literature study. The data that has been collected is then analyzed in three stages, namely data reduction, data presentation and drawing conclusions. The research results show that GRC and ESG in hospital risk management have a significant impact on operational sustainability. GRC ensures that hospitals have a strong framework for managing governance, risk and compliance, which is important for maintaining operational stability and avoiding legal issues. ESG, on the other hand, emphasizes the importance of environmental, social and governance responsibilities in the day-to-day operations of hospitals. So by integrating GRC and ESG, hospitals can identify and manage risks more comprehensively, from compliance with health regulations to the environmental and social impacts of operations.

Patients and Spine Surgeons' Perspectives regarding Decision-Making and Outcomes in Lumbar Surgery: An Exploratory, Qualitative Study.

Decision-making in lumbar surgery for degenerative conditions is influenced by various factors, including patient expectations and empowerment. The role of patient-reported outcomes (PROs) in guiding these decisions is underexplored. This study aims to understand the perspectives of patients and spine surgeons in decision-making for lumbar surgery and explore their perspectives on the relevance and influence of pre- and post-surgery PROs. An exploratory qualitative study was conducted between February 2022 and November 2023. A total of 15 patients with degenerative lumbar conditions and 9 spine surgeons from 5 tertiary public hospitals in Singapore were recruited. Data were analyzed using a framework analysis approach, ensuring validity through member checking, reflexive journals, and data source triangulation. Three overarching categories emerged: "expectations and outcomes," "decision empowerment," and "surgical experiences." There is a shift toward shared decision-making, highlighting the importance of patient-centric approaches. Surgical decisions are primarily influenced by PROs, particularly health-related quality of life (HRQoL) and pain relief. Patients prioritize pain relief and improvements in daily functioning, while surgeons also emphasize avoiding postoperative complications. Decision support tools, including PRO data, are essential but need better accessibility and integration within clinical settings. Positive surgical experiences are driven by clear communication, trust with surgeons, swift recovery, and no regrets post-surgery. Our study emphasizes the importance of patient-centered approaches in lumbar surgery decision-making, particularly regarding pre- and post-surgery PROs. Implementing these approaches may enhance patient satisfaction and surgical outcomes, urging the surgical community to prioritize informed, empathetic decision-making to improve healthcare quality.

Unveiling Patient Expectations: Insights From a Cross-Sectional Study on Facial Aesthetic Treatments.

Patient expectations play a crucial role in aesthetic treatments, influencing satisfaction of treatment outcomes. To explore and assess the expectations of 102 participants undergoing various cosmetic interventions using the FACE-Q expectations scale. Participants, aged 20 to 64 years, seeking different facial aesthetic procedures completed the FACE-Q expectations scale before treatment. Data were analyzed, and the influence of age and treatment type on expectations was investigated. The analysis revealed moderate overall expectations among participants, with no significant differences across different treatment modalities (p = .263). However, age significantly influenced expectations (p = .009), with younger adults (30-39 years) exhibiting higher expectations compared with older age groups. Correlation analysis confirmed a significant weak negative correlation between age and expectations (r = -0.210, p = .034). Multiple linear regression further identified age as a significant predictor of expectations (β = -0.564, p = .037). This study provides insights into patient expectations in facial aesthetic procedures, emphasizing the role of age in shaping expectations. These findings underscored consistent beliefs in positive outcomes, irrespective of the cosmetic procedure to be realized. Future research should consider international collaborations and longitudinal studies to enhance understanding and optimize patient satisfaction in aesthetic treatments.

Turkish Translation and Validation of the Expectations of Aesthetic Rhinoplasty Scale.

The aim of this study was to translate, validate, and culturally adapt the original English version of the Expectations of Aesthetic Rhinoplasty Scale (EARS) into Turkish for use in Turkish-speaking communities. Fifty-one patients who wanted to undergo primary rhinoplasty and were literate in Turkish were included in the study. The control group consisted of 81 healthy volunteers who did not require rhinoplasty. A Turkish version of the EARS (EARS-T) was created. The participants completed the EARS-T questionnaire twice, 4-week apart. The internal consistency of the scale (Cronbach's α), the test-retest reliability (intraclass correlation coefficient [ICC]), and differences between the patient and control groups (Pearson's chi-square test) were analyzed. A statistically significant difference was found between the age and gender of the patient and control groups (p = 0.001 and 0.001, respectively). Univariate analysis showed that this significant difference did not affect the study results (age: p = 0.2; gender: p = 0.12). In addition, a statistically significant difference was found between the scale scores of the control and rhinoplasty groups (all p < 0.05). The EARS-T had good internal consistency, with high Cronbach's α scores ranging between 0.74 and 0.87. Test-retest reliability was demonstrated by high ICC scores ranging from 0.71 to 0.87. Our study revealed that the EARS-T has good internal consistency, reliability, and validity. Therefore, it can be used to assess the expectations of aesthetic rhinoplasty patients in preoperative consultation practice and in clinical studies related to rhinoplasty.

Internet-Delivered Pain Resilience Therapy: A Multi-Subject Case Series

ObjectivePain is a multifaceted phenomenon; therefore, innovative, multisystem approaches are recommended as a path to pain recovery. Pain Resilience Therapy (PRT) was developed as a novel, resilience-focused approach to pain management. MethodsThree people with chronic pain received tele-physical therapy using PRT. The primary aim of PRT was to facilitate the development of pain resilience. Addressing vulnerability was a secondary aim. Treatment results were assessed using validated self-report measures for pain intensity, resilience, vulnerability, interference, patient outcome expectations, expectancies, and perspectives. ResultsAll patients demonstrated a reduction in pain intensity and pain interference (PROMIS®) with associated improvements in activity, sleep, mood, and stress measured by the Defense and Veterans Pain Rating Scale (DVPRS 2.0). Resilience (positive affect/coping) and self-efficacy increased, as measured by the Pain Self-Efficacy Questionnaire (PSEQ), Self-Efficacy for Rehabilitation (SER), Chronic Pain Acceptance Questionnaire (CPAQ), and the Pain Resilience Scale (PRS). Certain measures related to vulnerability (negative mood and fear avoidance) also improved. The PRT intervention was safely delivered and patients reported their health as very much improved measured by the Patient Global Impression of Change (PGIC) survey. ConclusionThis case series supports the application of PRT’s resilience-focused approach to attenuate pain and vulnerability while improving physical and psychological well-being. Although there is a need for research elucidating change mechanisms, assisting patients/clients in accessing resources that facilitate resilience is a valid pathway to pain recovery. This case series is a step toward integrating an understanding of resilience within the broader context of pain and disability.

Inspanningverbintenis Versus Resultaatsverbintenis: Therapeutic Transactions in Medical Services in Indonesia

The patient's expectations for a cure from their disease takes great demands on the doctor's profession, where patients and families often demand certain positive results for the health services provided, while the therapeutic agreement between the doctor and the patient in health services is inspanningverbintenis where the agreement agreed is the best effort made by doctors regarding therapeutic management without promising definite final results. This concept is supported by amenable laws in Indonesia as stated in the Health Law and the Civil Law. However, the gap in understanding of this concept creates gaps that can give rise to demands. Understanding this concept requires good and intense communication to straighten out differences in the doctor's and patient's perceptions regarding the ongoing therapeutic contract where the doctor adheres to the inspanningverbintenis concept and the patient with their expectations adheres to the concept of resultaatsverbintenis so that confusion of expectations can be minimized.

Shoulder Pain, Kinesiophobia, Emotional State and Muscle Strength in Breast Cancer Surgery Patients: A Cross-Sectional Study

Breast cancer is the most common type of cancer in women. The life expectancy of patients is increasing with advances in treatment. However, lymphovascular, musculoskeletal, and psychogenic complications are reported to be expected in the follow-up period after breast cancer surgery. Kinesiophobia is the behavior of avoiding movement for fear of increased pain. Research on the frequency and interrelationships of kinesiophobia and other complications in the follow-up period is limited. Aim: We aim to evaluate shoulder pain, kinesiophobia, emotional state and muscle strength in female patients who have undergone breast cancer surgery and are in the follow-up period and to examine the relationship between these factors. Materials and Methods: A total of 50 female patients who underwent unilateral breast cancer surgery and were using aromatase inhibitors were included in this cross-sectional descriptive study. Demographic data, details of the surgical procedure and medical treatment information were recorded from the patient files. Hand grip muscle strength was measured by hand dynamometer, the Beck Depression Scale assessed emotional state, and the Tampa Kinesiophobia Scale assessed fear of movement. A Beck Depression Scale score of 10 and above and a Tampa Kinesiophobia Scale of 37 and above were considered significant. Results: The mean age of 50 female patients was 59.31 ± 11.19 years. Sixty percent of the patients had undergone surgery on the right breast and 40% on the left breast. Shoulder pain (n:31) was present in 62%. There were statistically significant correlations between pain and the Tampa kinesiophobia scale and the Beck depression scale (p:0.042, p:0.038). Kinesiophobia was present in 74% of the patients, and 64% had moderate to severe depression. The mean of the Tampa Kinesiophobia scale was 42.86±8.81, and the mean of the Beck depression scale was 15.19±10.98. When the relationship between kinesiophobia and depression was evaluated, a statistically positive significant relationship was found between them (p=0.005, r=0.410). The hand grip strength was 22.16±5.00 kg on the right and 18.22±5.10 kg on the left in patients who underwent left-sided breast cancer surgery. A significant difference was found in the left- and right-hand grip strength of those who underwent left-sided surgery for breast cancer (p

Factors Influencing Outcome After Shoulder Arthroplasty (FINOSA Study): Protocol of a Prospective Longitudinal Study With Randomized Group Allocation.

There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction. This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery. To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner. Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed. Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty. ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267. DERR1-10.2196/56522.

Efficacy and Safety of Fixed-Dose Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% Gel in Participants with Moderate-to-Severe Acne: The Patient Journey

Introduction: The main goal of acne treatment is to clear lesions quickly to manage and/or mitigate sequelae. Topical clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel is the only fixed-dose, triple-combination approved for acne. In three published clinical studies of participants with moderate to severe acne, CAB gel demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability. Herein are presented detailed efficacy and safety data from 5 clinical study patients to document their CAB treatment journey. Methods: In two phase 3 (NCT04214652, NCT04214639), double-blind, 12-week studies, participants aged ≥9 years with moderate-to-severe acne were randomized to once-daily CAB or vehicle gel. Endpoints included percentage of participants achieving treatment success (≥2-grade reduction from baseline in Evaluator’s Global Severity Score and clear/almost clear skin) and percent change from baseline in inflammatory/ noninflammatory lesion counts. Dosing compliance, treatment-emergent adverse events (TEAEs) and cutaneous safety/tolerability were also assessed. Descriptive data from 5 selected cases who completed 12 weeks of CAB treatment are summarized. Results: Participants (n=5) ranged from 13-32 years. At week 12, 3 achieved treatment success, 1 achieved a 2-grade reduction from severe to mild, and 1 achieved a 1-grade reduction from moderate to mild. Reductions from baseline to week 12 in inflammatory/ noninflammatory lesion counts ranged from 74.7-100%. No participants reported TEAEs/serious AEs. Some cutaneous safety/tolerability scores increased at weeks 2, 4, or 8, but generally decreased back to/below baselines levels by week 12, similar to the overall study populations. Most scores at week 12 were 0 (none) or 1 (mild), with only one participant reporting scores of 2 (moderate) for itching, burning, and stinging. Conclusions: In the overall phase 3 clinical trials, fixed-dose, triple-combination CAB gel has demonstrated good efficacy, safety, and tolerability. All 5 cases presented here achieved substantial (&gt;70%) acne lesion reductions, with 4/5 cases achieving treatment success or a 2-grade EGSS reduction by week 12. While patterns in cutaneous safety/tolerability were variable across cases, transient increases with CAB generally resolved to baseline values within two months of treatment. These clinical study cases reinforce the importance of patient education regarding efficacy and safety of acne treatment, including the importance of treatment adherence, managing patient expectations, and the potential for cutaneous effects, which are often transient. Support: Ortho Dermatologics

CARDIAC REHABILITATION PROGRAM AS AN EFFORT TO IMPROVE THE QUALITY OF LIFE OF PATIENTS WITH CONgenital HEART DISEASE

ABSTRACT Introduction: Congenital Heart Disease (CHD) is the most common congenital disorder found throughout the world, including Indonesia. Currently, the main treatment for CHD patients is open cardiothoracic surgery. However, its implementation in Indonesia still has some obstacles due to several things which cause the life expectancy of CHD patients in Indonesia is estimated to be not as good as the life expectancy of CHD patients in developed countries. Apart from being related to life expectancy, CHD patients will also experience a decrease in their quality of life, especially those who are not treated properly. The cardiac rehabilitation program is one of the programs to overcome this. Discussion: Cardiac rehabilitation program is able to improve physical and psychosocial quality and ensure that CHD patients' cognitive and socioemotional development is maintained. Cardiac rehabilitation includes physical exercise, psychosocial management, education, risk factor modification, and nutritional management. Several studies have shown that cardiac rehabilitation has many benefits and is safe for CHD patients. In its implementation, cardiac rehabilitation faces several challenges, especially in center-based cardiac rehabilitation (CBCR), so it is recommended to increase home-based cardiac rehabilitation (HBCR) while ensuring that information regarding HBCR is delivered completely and well received by the patients. Conclusion: Based on this literature review, the authors suggest an increase in the implementation of cardiac rehabilitation for CHD patients throughout Indonesia, especially HBCR which can be carried out independently or in the community to improve the patient’s quality of life in the long term. Keywords: congenital, cardiac, rehabilitation, quality of life

Expectations of prospective orthodontic patients regarding post-orthodontic retention

Objective: To assess the awareness among patients of prospective orthodontics about post-orthodontic retention. Method: The cross-sectional study was conducted from May 2022 to May 2023 at the Department of Orthodontics, Ziauddin University, Karachi, and comprised patients of either gender enrolled for their first appointment at the outpatient clinic. Each patient received a validated questionnaire which explored their understanding, attitudes and expectations regarding the importance of retention after orthodontic treatment. Data was analysed using SPSS 25. Results: Of the 206 questionnaires distributed, 203(98.5%) were returned duly filled. The overall mean age of the sample was 20.25±5.24 years (range: 8-48 years). There were 131(64.5%) females with mean age 12±3.2 years, and 72(35.5%) males with mean age 16±2.1 years. Majority of the participants 133(64.9%) believed that movement of teeth cannot occur without orthodontic appliances, 115(56.1%) believed that parents and guardians were responsible for the stability of the treatment results, while 88(42.9%) believed that dentists/orthodontists were responsible for the stability of the treatment outcomes. There were 132(64.4%) subjects who found removable retainer as a favourable retention device, while 71(34.6%) favoured fixed retainers. Conclusion: There was a notable gap in patients’ understanding of the retention phase, its importance and treatment durability expectations. Key Words: Orthodontic retainers, Retention, After treatment, Care goals, Awareness.

Evaluation of Satisfaction Levels Following Orthognathic Treatment in Adult Patients: A Systematic Review.

Dentofacial deformities can significantly impact an individual's quality of life, affecting facial aesthetics, self-esteem, and overall well-being. The combined orthognathic surgery-orthodontic treatment is the preferred approach for correcting moderate-to-severe deformities. However, patient satisfaction following orthognathic surgery remains a crucial outcome measure, influenced by various factors, including the type of malocclusion, surgical procedure, and demographic characteristics. This systematic review aimed to synthesize the available evidence regarding patient satisfaction following orthognathic surgery, exploring the effects of the type of malocclusion, surgical procedure, age, and gender on satisfaction rates, addressing a gap left by previous outdated reviews. A comprehensive literature search was conducted across multiple databases, including PubMed®, Scopus®, Web of Science™, and Embase®. Eligibility criteria were defined using the PICOS (population, intervention, comparison, outcomes, and study design) framework. Cochrane's ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions) tool was employed for non-randomized intervention studies within clinical controlled trials to assess the risk of bias. In parallel, a revised version of the Newcastle-Ottawa scale determined the methodological quality of cohort and cross-sectional studies. Sixteen studies were analyzed, revealing satisfaction levels ranging from 83% to 100%. Findings indicate that class III malocclusion patients report higher satisfaction than class II patients and satisfaction varies based on surgical type, with bimaxillary procedures generally yielding better outcomes. While most studies found no significant correlation between satisfaction and demographic factors such as age and gender, some suggested younger patients may express higher satisfaction and that female patients might report lower satisfaction levels. The review highlights the importance of effective patient communication and expectation management in achieving optimal satisfaction outcomes in orthognathic surgery. Limitations such as memory bias and methodological diversity across studies restrict the ability to perform meta-analyses, underscoring the need for further research in this area.

Orthopedic Surgery in Osteogenesis Imperfecta in Adults.

Osteogenesis imperfecta is a genetic disorder, mainly characterized by bone fragility. In adult with osteogenesis imperfecta, surgical treatment may be indicated as an emergency procedure in the event of a fracture, or as a scheduled procedure in case of patient functional impairment due to many causes, such as persistent pain, complex bone deformities, and degenerative arthropathies. In all cases, a multidisciplinary approach is recommended. It is essential to consider the patient's characteristics and expectations regarding treatment, as well as the local conditions, which may be complex due to the poor bone quality, bone deformity, and the presence of hardware implanted during childhood. The procedure can be very complex and challenging and each patient is a unique case. An accurate preoperative planning is mandatory to select the appropriate surgical technique, which can be either conservative or prosthetic, and to evaluate its feasibility and the risk-benefit ratio. The aim is to improve the patient's quality of life and autonomy as long as possible.

Meta-analyses of epigenetic age acceleration and GrimAge components of schizophrenia or first-episode psychosis

Schizophrenia is a common chronic psychiatric disorder that causes age-related dysfunction. The life expectancy in patients with schizophrenia is ≥10 years shorter than that in the general population because of the higher risk of other diseases, such as cardiovascular diseases. Aging studies based on DNA methylation status have received considerable attention. Several epigenetic age accelerations and predicted values of aging-related proteins (GrimAge and GrimAge2 components) have been analyzed in multiple diseases. However, no studies have investigated up to GrimAge and GrimAge2 components between patients with schizophrenia and controls. Therefore, we aimed to conduct multiple regression analyses to investigate the association between schizophrenia and epigenetic age accelerations and GrimAge and GrimAge2 components in seven cohorts. Furthermore, we included patients with first-episode psychosis whose illness duration was often shorter than schizophrenia in our analysis. We integrated these results with meta-analyses, noting the acceleration of GrimAge, GrimAge2, and DunedinPACE, and increase in adrenomedullin, beta-2 microglobulin, cystatin C, and plasminogen activation inhibitor-1 levels, in patients with schizophrenia or first-episode psychosis. These results corroborated the finding that patients with schizophrenia had an increased risk of diabetes, cardiovascular disease, and cognitive dysfunction from a biological perspective. Patients with schizophrenia and first-episode psychosis showed differences in the results when compared with controls. Such analyses may lead to the development of novel therapeutic targets to patients with schizophrenia or relevant diseases from the perspective of aging in the future.

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.

Locally advanced/metastatic non-small-cell lung cancer in Lebanon: focus on ALK tyrosine kinase inhibitors.

Treatment of non-small-cell lung cancers (NSCLC) has evolved over the last decade. According to studies, the use of targeted therapies has significantly increased the life expectancy of patients. Moreover, ALK-tyrosine kinase inhibitors (ALK-TKIs) have improved clinical outcomes. In Lebanon, translating recommendations into clinical practice remains challenging. A Lebanese expert panel of oncologists was convened to describe the management paradigm and the clinical evidence supporting the optimal use of next-generation TKIs in patients with ALK-rearranged NSCLC and to provide an expert overview of local challenges and recommendations for optimizing the management of advanced NSCLC in Lebanese patients. The experts agreed that these recommendations should be part of a healthcare strategy to be implemented at the national level.

Exploring the attitudes and experiences of Hungarian primary care physicians on the utilisation of digital health solutions

BackgroundDuring the COVID-19 pandemic, digital health solutions ensured the continuity of care especially in primary healthcare practices. COVID-19 accelerated the adoption of digital health solutions. The aim of this study is to describe the digital health-related attitudes and experiences of Hungarian Primary Care Physicians (PCPs) and also analyse the socio-demographic effects on digital health attitudes among PCPs.MethodsThis study used a quantitative and qualitative mixed methodological approach to examine the digital health-related attitudes and experience of Hungarian PCPs. As part of the "E-physicians and E-patients in Hungary" survey, we conducted an online survey among medical doctors working in Hungary between July 2021 to May 2022. A total of 1,774 questionnaires were received, consisting of 1,576 medical doctors and 198 dentists. Among the medical doctors there were 415 primary care physicians (PCPs). In addition to the online questionnaire survey, qualitative research in the form of semi-structured interviews with doctors was also conducted. These interviews took place between October 2021 and June 2022. A total of 62 interviews were conducted,19 with PCPs.ResultsPrimary care physicians are more open to technologies that facilitate communication and collaboration with patients, while showing less interest in technologies that support clinical work. Of the demographic variables (age, gender, type of settlement), age was found to have the most significant effect on digital health knowledge, use and intended use. Both the interviews and the multivariate analysis indicate that individuals with greater knowledge, expertise, and experience are more likely to perceive the advantages of digital solutions. This highlights the importance of training, especially given the significant aging population among Hungarian primary care physicians, who may not be accustomed to using these tools naturally. The way PCPs perceive patient expectations regarding the use of digital health tools has a significant impact on the PCPs’ use and intended use of digital tools. When looking at perceived patient needs among PCPs the effect of age and municipality type of PCPs is significant. As age increases, the perception of patient needs decreases (from 5.02 to 4.47), and by municipality type, the average number of perceived needs decreases as one moves from larger cities to smaller municipalities (from 4.85 to 4.14).ConclusionsDigital health solutions have the potential to enhance the work of PCPs, but successful implementation requires addressing specific needs, demographic differences, and challenges faced by PCPs. Development of infrastructure, education, and institutional support is necessary to ensure more efficient and higher-quality healthcare delivery through the use of digital technologies.

HPB O03 - Snapshot Audit of RELEVANCE: REal worLd outcomEs of adjuVant therapy in pANcreatic CancEr

Abstract Background Evidence-based medicine plays a critical role in shaping clinical practices and setting patient expectations. While randomized controlled trials (RCTs) of adjuvant chemotherapy in pancreatic cancer have demonstrated improved survival rates with newer regimens, their selective inclusion criteria often favor patients with better prognoses. This study aims to compare real-world outcomes with those from RCTs to evaluate the effectiveness of adjuvant therapies in typical clinical settings. Method In this retrospective study, we examined overall survival (OS) among patients who received adjuvant chemotherapy (gemcitabine, gemcitabine-capecitabine, or FOLFIRINOX) following the resection of pancreatic ductal adenocarcinoma. We compared survival curves from RCTs (ESPAC 4, PRODIGE-24) with those from real-world cohorts selected based on RCT criteria. Data were collected retrospectively from medical records and institutional databases, covering OS, disease-free survival (DFS), and adverse events. Results From July 2014 to December 2019, 303 pancreatic ductal adenocarcinoma patients underwent resections, with 209 (69%) receiving adjuvant chemotherapy: 91 (44%) received gemcitabine, 69 (34%) gemcitabine-capecitabine, and 37 (18%) FOLFIRINOX. The median OS for gemcitabine was 21.6 months, close to ESPAC 4’s 25.5 months. Gemcitabine-capecitabine had a median OS of 25.2 months versus ESPAC 4’s 28 months. FOLFIRINOX had a lower median OS in our cohort (19.9 months) compared to PRODIGE 24’s 54.4 months. Additionally, gemcitabine OS in PRODIGE 24 was higher (35 months) than in our data. FOLFIRINOX had a 17% completion rate. Conclusion The real-world outcomes for gemcitabine-based adjuvant therapy align closely with RCT results, while FOLFIRINOX appears less effective in typical clinical settings, possibly due to tolerance issues. These findings highlight the importance of incorporating real-world data in clinical decision-making to better predict patient outcomes and improve treatment strategies for pancreatic cancer. Further research is needed to bridge the gap between RCTs and real-world practices, especially concerning patient selection and treatment tolerability.

Envisioning the sustainable and climate resilient hospital of the future

ObjectivesThis study aims to create a vision of the future hospital to help healthcare leaders understand how changes in society and the healthcare system, compounded by climate change, could affect future hospital estate. Study designThe study is part of a larger project based on participatory backcasting aimed at providing integrated strategies for transitioning to a zero-carbon future and adapting to existing climate change through improved asset management. MethodsThe data presented in this paper were collected during a full-day workshop to construct the vision of the future hospital in 2050. A multidisciplinary team of 19 participants participated in the discussions. A six-phase thematic analysis was applied to the data to develop the narrative vision and graphic recording. ResultsThe healthcare system is undergoing transformative changes due to evolving healthcare delivery, patient expectations, emerging technologies, climate change, and sustainability. However, current hospital strategies often fail to consider the interrelationship between the hospital estate and its socio-environmental context. Policymakers, healthcare system leaders, and hospital leaders need a clear vision of the hospital of the future to implement transformational strategies. ConclusionsHealthcare transformations require shifting from traditional centralised hospitals to a more flexible, distributed model. Healthcare leaders need to proactively assess how hospitals respond to current and future hazards and consider the impacts within the context of integrated and dispersed healthcare delivery. To address this, a systematic approach to modelling hazards and evaluating design or upgrading options is essential to mitigate the transfer of climate-related risks within healthcare systems.