Patient Experience Research Articles

How to return? experiences of patients in working age after first Ischaemic stroke: an interpretative phenomenological analysis of patient´s perspective at 12 - 24 months post-stroke.

Limited evidence of young adult patient-reported outcomes and experiences after ischaemic stroke has been conducted. To investigate the meaning of the lived experiences of stroke patients in working age 12-24 months after their first IS. The exploratory qualitative study used an interpretative phenomenological analysis (IPA) design. Nine ischaemic stroke patients (with age ranges from 41 to 50 years) took part in semi-structured qualitative interviews. Even with mild residual neurological deficit, IS negatively impacted the quality of life daily and social life. Six subthemes and three interconnected group experiential themes were generated: (i) From confusion to understanding (ii) Triggers for rebuilding; and (iii) Challenges and benefits. The study highlights the current gaps and limitations in supporting the needs of stroke patients in working age in long-term post-stroke care. The findings are crucial for healthcare professionals to develop improved age- and mild- impairment-appropriate strategies or tailor self-management interventions for stroke patients of working age.ClinicalTrials.gov: NCT04839887.

Patients' Experiences, Satisfaction and Quality of Life With Physiotherapy Follow-Up After Total Knee Arthroplasty: A Phenomenological Qualitative Study Protocol.

Available quantitative studies indicate that patients who have undergone Total Knee Arthroplasty (TKA) experience dissatisfaction. There is a lack of comprehensive information on the experiences, satisfaction, and quality of life of patients after TKA. Hence, there is a need to explore the patients' perspective about the satisfaction and experiences undergoing rehabilitation and to explore the factors influencing quality of life with physiotherapy after 1st and 3rd months of TKA. 35 patients with post TKA, aged from 45years, will participate in semi-structured face-to-face or telephone interviews. The participants will be recruited using criterion-based purposive sampling. The interviews will be audio-recorded and transcribed. NVivo 14V software and Braun and Clarke thematic analysis will be used. Credibility, transferability, dependability, and confirmability will be ensured. The transcribed verbatim transcript will be analysed to generate sub-themes and themes using thematic analysis. Irrespective of the responses received from male or female patients' data would be analysed using inductive qualitative analysis to explore their perspectives. This study is the first qualitative study from lower- and middle-income country that aims to investigate the satisfaction and experiences of patients after undergoing TKA rehabilitation. The efficacy of the data and subsequent suggestions would rely on the insights generated from the qualitative study, which would support the rehabilitation of patients in their later years.

Integrating the Symptom Experience in Patients with Stage I-III Breast Cancer in China: A Qualitative Study

PurposeTo develop an in-depth understanding of the meaning of symptoms in the context of how women with stage I-III breast cancer in China coped with the effects of primary and adjuvant therapies for breast cancer. MethodA qualitative descriptive approach was used. A purposive sample of women diagnosed with stage I-III breast cancer were recruited from the “Be Resilient to Breast Cancer” study between November 2023 and March 2024. Data was collected from in person interviews using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. The framework analysis method was used to generate codes and themes. ResultsA sample of 17 women with breast cancer agreed to participate. The average age was 50.1 years (SD=8.45), and the majority (65%) had stage III. The overarching theme was Confronting Physical and Psychological Symptoms. The four themes explaining the experience were Changed Identity, Uncertainty, Finding Meaning and Seeking Support and Solace. Changed Identity and Uncertainty reflected the challenges of coping with multiple symptoms from the treatment. The themes of Finding Meaning and Seeking Support and Solace captured how women adapted a positive perspective to cope with the experience. ConclusionsThis study contributed to the evidence of the integration of the symptom experience in coping with breast cancer treatment in the context of a collectivist Chinese culture. It enhanced the understanding of the physical and psychological symptom experience of curative intent breast cancer therapy and offered insight into how women from China cope in early survivorship.

Early Hearing Outcomes and Audiological Experiences With a Novel Fully Implanted Cochlear Implant.

To review audiological experiences and early hearing outcomes from the early feasibility study of a fully implanted cochlear implant. Prospective cohort. Tertiary academic medical center. Three adults (two-male, one female) with bilateral sensorineural hearing loss. Implantation with a fully implanted cochlear implant as part of an early feasibility study. Postoperative unaided and aided pure-tone audiometry, tympanometry, mapping parameters, speech perception, battery life, and quality-of-life assessment. All patients in the early feasibility study of this fully implanted cochlear implant now use their devices regularly. Preoperative and postoperative audiometric measurements showed that their residual hearing in the implanted ear decreased slightly after surgery but was preserved. All patients had type A tympanograms after their transient middle ear effusion resolved. Electrical stimulation levels were comparable to those routinely used in traditional cochlear implants. Two of the three patients use a hearing aid in the implanted ear for additional gain and show significant improvement in speech perception since implantation. Average battery life before recharging is 4 days. All patients are regular users with two showing improvement in quality-of-life metrics after receiving the fully implanted cochlear implant. The patient experience and hearing outcomes from the early feasibility study of a novel fully implanted cochlear implant are detailed in this study and demonstrate ease of operation and daily use by all participants. All patients obtained hearing, but two of three use a hearing aid with their device to overcome unanticipated implant circuitry noise and achieve improved speech perception scores. Current work is focused on reducing this system noise to allow for the device to be used as intended, without a hearing aid.

"Jumping on the Blood Pressure Bandwagon": Nurse, GP, and Patient Perspectives of a General Practice Nurse-Led Hypertension Management Intervention.

To explore the perceptions and experiences of general practice nurses, general practitioners, and patients who participated in a nurse-led intervention to improve blood pressure control. Given the impact of hypertension on rates of premature death and disability, it is important that interventions be evaluated to reduce blood pressure. A key component of such evaluation is understanding the experiences of participants and clinicians. Understanding these experiences can provide insight into acceptability and feasibility that informs future research and implementation. Qualitative descriptive study within a mixed methods project. Semi-structured interviews were conducted post-intervention with six patients, five nurses, and three general practitioners. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. The COREQ checklist guided reporting. Three themes around the need for change, navigating change, and sustaining change were revealed. In highlighting the need for change, participants recognized that it was time to actively work toward improved blood pressure control. In navigating change, general practice nurses were perceived as ideally placed to communicate risks around uncontrolled blood pressure and support lifestyle change. The final theme, sustaining change revealed the feasibility of the intervention in practice, however, clinician participants identified that appropriate funding is required to ensure sustainability. Nurse-led intervention to improve blood pressure control in general practice is feasible in practice and acceptable to patients. This highlights an opportunity for nurses to play a more proactive role in hypertension management within general practice. To ensure sustainability, however, issues such as funding, teamwork, and collaboration need to be addressed. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12618000169246.

A qualitative study on the experiences of autologous haematopoietic stem cell transplant for Multiple Sclerosis

AimAutologous haematopoietic stem cell transplant (HSCT) is an effective treatment for people with highly-active relapsing multiple sclerosis (MS), who are not adequately responding to disease-modifying therapies. To date, research has predominantly focused on disease-specific outcome measures. There is a lack of research exploring patient experiences of this complex treatment. The study aims to explore the experience of considering and receiving HSCT treatment for MS. MethodsSemi-structured interviews were conducted online with 12 adults with MS who had undergone HSCT treatment. Interview topics covered the experience of deciding on the treatment, the HSCT process itself, and the patient-reported outcomes following HSCT. Interviews were audio-recorded and transcribed verbatim. A thematic analysis approach was employed. ResultsThree main themes were identified: (1) Balancing hope and fear explores the decision-making experience when considering HSCT as a treatment; (2) Distinct emotional experience, highlights the unique challenges faced on all stages of the treatment journey; and (3) Adjusting to outcomes, explores how participants make sense of the aftermath of the treatment, including managing the ongoing uncertainty of MS and complications arising from HSCT. DiscussionHSCT is a complex treatment, both physically and psychologically for pwMS. A comprehensive and holistic care pathway is required to support people with MS at all stages of the treatment process, to ensure patient-centred planning and care.

Telehealth visit type and patient-reported outcomes among patients with cancer

BackgroundRelaxed licensing restrictions on telehealth use during the COVID-19 pandemic allowed broad use irrespective of visit type. As these telehealth waivers expire, optimal uses of telehealth must be assessed to inform policy and clinical care. We evaluated patient experience associated with telehealth and in-person new or established visits. MethodsPatients seen in-person and via telehealth for urologic cancer care from August 2019 to June 2022 received a survey on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed. We assessed survey responses with descriptive statistics. ResultsSurveys were completed for 1,031 patient visits (N = 494 new visits, N = 537 established visits). Satisfaction rates were high for all visit modalities among new and established patients (mean score range 59.9–60.7 [maximum 63], P > 0.05). Patient-rated quality of the encounter did not differ by visit type and modality (P > 0.05, for nearly all comparisons). New in-person patient visits were associated with significantly higher travel costs (mean $496.10, SD $1021) compared with new telehealth visits (mean $26.60, SD $141; P < 0.001); 27% of new in-person patients required plane travel and 41% required a hotel stay (P < 0.001 vs. 0.8% and 3.2% of new telehealth patients, respectively). ConclusionsSatisfaction outcomes among patients with urologic cancer receiving new patient telehealth care equaled those of new patients cared for in-person while costs were significantly lower. Offering telehealth exemption beyond COVID-19 licensing waivers to include new patient visits would allow for ongoing delivery of high-quality urologic cancer care irrespective of geographic location.

The Impact of Language-Discordant Care Upon the Patient Family Experience in Pediatric Plastic Surgery

Background: Patient satisfaction surveys usually overlook differences in patient family experience (PFE) for families whose spoken language is different from that of the treating physician. This study examines the relationship between language-discordant care and patient experience. Methods: A retrospective review of deidentified pediatric plastic surgery PFE survey responses from 2018 to 2021 was performed with permission from Lurie Children’s Hospital’s PFE Team. Results: A total of 443 pediatric plastic surgery patients were included. The race breakdown was White (49%), Other (23.9%), Black (8.8%), and Asian (5.9%). Ethnic distribution included “Not Hispanic/Latino” (58.2%) and “Hispanic/Latino” (31.4%). Languages spoken were English (80.4%), Spanish (18.1%), and Other (2.3%). Eighty-seven (19.64%) patients were language-discordant with their providers; out of this group, 68 (78.2%) preferred interpreter services. Methods of interpreter services included in-person (54.4%), over-the-phone (27.9%), video (1.5%), and no services (16.2%). The language-discordant group was less likely to give the highest ranking to “provider courtesy and respect” [odds ratio (OR)=0.200, P&lt;0.001], “provider listened carefully” (OR=0.202, P&lt;0.001), and “knowing what to do with subsequent questions following visit” (OR=0.435, P&lt;0.01). No differences in PFE ratings existed for: “enough information provided,” overall provider rating, and whether they would recommend the facility. There were no significant differences in provider ratings by interpreter service method. Conclusions: Patient/provider language discordance results in significantly lower PFE ratings in areas involving patient teaching and perceptions of provider respect, courtesy, and careful listening. This underscores the importance of providers better accommodating families with limited English proficiency.

Bimekizumab Safe and Effective Self-administration Using 2 mL Devices by Patients with Moderate to Severe Plaque Psoriasis: Results from Two Multicenter, Randomized, Open-label Studies

Introduction: Safe and effective self-injection of subcutaneous bimekizumab (BKZ) in patients with moderate to severe plaque psoriasis using a 1­ mL safety syringe (sy) or auto-injector (AI) has previously been associated with an overall positive patient experience.1 Here, the ability of patients to safely and effectively self-administer subcutaneous BKZ using a 2 mL sy or AI is reported. Methods: DV0002 (North America) and DV0006 (Germany, Hungary and Poland) were sub-studies of the phase 3 open-label extension (OLE) study, BE BRIGHT.1,2 Included patients received BKZ 320 mg every 4 weeks (Q4W) or Q8W based on treatment regimen and Psoriasis Area Severity Index (PASI) response at BE BRIGHT entry. Patients were randomized 1:1 to BKZ-sy-2 mL or BKZ-AI-2 mL, and performed self-injections (after training in the self-injection technique) at baseline and Wk8. Safe and effective self-injection defined as complete dose delivery of BKZ and absence of adverse events related to the device which led to study withdrawal. Primary and secondary objectives were to assess patients’ ability to safely and effectively self-administer BKZ at Wk8 and baseline, respectively. Other objectives included to evaluate patient experience of self-injection, using the injection site pain visual analog scale (VAS; 0 [no pain]–100 [worst possible pain]) and the Self-Injection Assessment Questionnaire (SIAQ; subscale scores ranged 0-10 [higher scores better]), and the post-use structural and mechanical integrity of each device. Data analyzed using two full analysis sets (BKZ-sy-2 mL and BKZ-AI-2 mL) and reported for the combined BKZ dose groups (BKZ Total) using observed cases. Results: In DV0002, 19 patients each were randomized to use BKZ-sy-2 mL and BKZ-AI-2 mL. All patients using BKZ-sy-2 mL (n=19) self-injected BKZ safely and effectively at baseline and Wk8. All (n=19) and 94.7% (n=18/19) of patients using BKZ-AI-2 mL self-injected BKZ safely and effectively at baseline and Wk8, respectively. In DV0006, 44 and 45 patients were randomized to use BKZ-sy-2 mL and BKZ-AI-2 mL, respectively. All patients using BKZ-sy-2 mL (n=44) and BKZ-AI-2 mL (n=45) safely and effectively self-injected BKZ at baseline and Wk8. In DV0002/6, median pre-injection and post-injection SIAQ scores were ≥7.5 across both devices, and &gt;9.0 for feelings about injections, self-image, and injection-site reactions subscales. In DV0002/6, low median VAS scores across both devices indicate variable but generally low pain. All devices maintained their structural and functional integrity post-use. One device deficiency complaint was received. Conclusions: A positive self-administration experience was associated with the 2 mL devices, as reported with 1 mL devices,1 providing patients with an option to self-administer a single injection of BKZ.

Lived experiences of lymphoma patients with sexual dysfunction and related sexual distress during cancer treatment

Lived experiences of lymphoma patients with sexual dysfunction and related sexual distress during cancer treatment

A radiation therapy platform to enable upright cone beam computed tomography and future upright treatment on existing photon therapy machines

AbstractBackgroundThe conventional lying down position for radiation therapy can be challenging for patients due to pain, swallowing or breathing issues. To provide an alternative upright treatment position for these patients, we have developed a portable rotating radiation therapy platform which integrates with conventional photon treatment machines. The device enables cone‐beam computed tomography (CBCT) imaging of patients in an upright position, and the future delivery of therapeutic radiation.PurposeTo design, manufacture, and test a device for upright radiation therapy. A collaborative partnership between physicists, engineers, radiation therapists, radiation oncologists, implementation researchers and consumers was established, to create a device that meets both the clinical and technical requirements of upright radiation therapy. The device is central to a clinical trial (ACTRN12623000498695) which will evaluate upright image quality in the context of future image guided radiation therapy for patients with lung cancer or head and neck cancer.MethodsThe weight and physical constraints of the device were assessed with respect to the American civilian population. The final design was evaluated with a series of tests to characterize the angular accuracy of the platform rotation and the reproducibility of the platform setup position in a radiation treatment room. To acquire an upright CBCT, the platform movement system was synchronized to the kilo‐voltage fluoroscopic imaging on an existing treatment machine. The accuracy of the synchronization was evaluated by assessing the positional reproducibility of upright CBCT imaging of a chest phantom.ResultsThe platform has a weight limit of up to 125 kg which is suitable for approximately 90% of males and 95% of females. The platform has physical constraints that accommodate approximately 95.6% of males and 99.6% of females: a maximum seated height of 97.5 cm, a maximum hip breadth of 63.0 cm, and maximum elbow to knuckle length of 46.5 cm. The angular accuracy of the motion system is within ±0.15° over a full rotation, which is within the guidelines for machine movement accuracy in radiation therapy (1 mm/1°). The platform is a portable device and can be reproducibly positioned in a radiation therapy treatment room with a translational range within ±0.04 mm and a rotational range within ±0.025°. The CBCT imaging can reproducibly detect the position of a chest phantom with a translational uncertainty of ±0.07 mm and a rotational uncertainly of ±0.22°, when imaging is acquired following a strict procedure.ConclusionThe upright radiation therapy platform is suitable for the evaluation of CBCT imaging in the context of image guided radiation therapy. The platform will allow the investigation of open questions in upright radiation therapy in the areas of patient experience, positional stability, anatomical changes, and treatment delivery. Improvements to the materials in the radiation beam line, synchronization with the existing treatment machine, and increasing the device weight limit are suggested prior to delivery of future upright treatments.

Five-year retrospective analysis of Bakri balloon tamponade for obstetric haemorrhage and patient survey at a single tertiary centre.

Intrauterine balloon tamponade (IUBT), specifically the usage of Bakri balloon tamponade (BBT), is an effective conservative management technique for postpartum haemorrhage (PPH). The primary objective was to evaluate local guidelines and contribute to evidence regarding ideal duration for BBT. The secondary objectives were to consider impacts on maternal-foetal wellbeing, and optimise healthcare efficiency by reducing length of ICU admissions. This five-year retrospective case series analysed 132 cases of obstetric ICU admissions requiring Bakri balloon insertion for PPH within our centre. Additionally, a prospective patient experience survey was conducted over six-month period, involving 22 obstetric patients who required unplanned ICU admissions. Bakri balloon insertion was successful in 95%, whilst 5% experienced failure, necessitating further interventions (uterine artery embolisation) or return to theatre (hysterectomy). The success group demonstrated significant reductions in median blood loss (1.8 L vs. 2.5 L, p = 0.016) and difference in median duration of BBT (18.3 vs. 3.92 hours, p = 0.001). The prospective patient survey revealed a high level of satisfaction of care. Approximately 50% breastfed prior to discharge, on average commencing 23.4 hours post-delivery. This study demonstrates a high success rate of BBT, with failures typically occurring within median duration 3.9 hours. Considering the separation of mother from baby during the Bakri balloon's presence in ICU, we propose timely removal at around six hours, as failures are unlikely post this timeframe, or nursing these women in a neonatal care setting to facilitate earlier mother-baby bonding.

Is it Time to Adopt a New Nomenclature and Classification for White Dot Syndromes Using Multimodal Imaging Techniques? Report 1 from Multimodal Imaging in Uveitis (MUV) Task Force

ABSTRACT Purpose The survey aims to explore the use of existing nomenclature and current clinical and multimodal imaging (MMI) approach in diagnosing white dot syndromes (WDS) among uveitis and retina specialists. Methods The members of the International Uveitis Study Group (IUSG) task force MUV (Multimodal imaging in UVeitis) developed a survey. The questionnaire, created using Qualtrics, consisted of 22 questions. The responses were compared against regions, workplace setting, sub-specialty, and experience of the participants. Results A total of 432 participants initiated the background section; 343 initiated the investigation section and 263/343 completed the survey (76.7%). The majority (43.7%) reported a specialty/practice focus mostly on uveitis, 32.2% on uveitis and retina, and 20.1% mostly on retina. Specifically, 55.7% were in practice > 10 years post-fellowship and 65.8% worked in academic settings. The term WDS was not universally used in clinical practice, with no significant differences by region, subspecialty, experience, workplace setting or number of WDS patients managed in the prior year (p > 0.01). Nearly 90% of participants reported using MMI to diagnose WDS. More than 70% advocated redefining the nomenclature and classification of WDS based on the primary anatomical location of disease using MMI without significant regional or professional differences (p > 0.01). Conclusion These results underscore the widespread adoption of MMI among uveitis and retina specialists in the characterization of entities traditionally grouped under the term WDS. Respondents strongly agree that MMI provides a precise distinction between these posterior uveitis, advocating for the overcoming of the clinical term WDS in favor of a patho-anatomic redefinition.

Duration of In-patient Physical Therapy at a Tertiary Hospital: Implications of a Time and Motion Study

Background and Objectives. Inpatient physical therapy (PT) care entails careful provision of service for individuals across a spectrum of disorders needing evidence-based physical rehabilitation during their hospital admission. The main difficulty is identifying adequate time allocation for safe patient service within an eight-hour working time frame. At a selected tertiary teaching government-run hospital, an arbitrary personnel-population ratio method is used for human resource allocation which may lead to issues in service delivery and healthcare workforce wellness. Apart from patient care, physical therapists also assume non-clinical roles revolving on administration, clinical education, and research. This highlights the importance of identifying the duration of tasks to assess work efficiency and manage time constraints posed by the limitations of the work shift. Practice guidelines may help improve staff workload scheduling, however, there is a lack of available guidelines regarding physical therapy practice in the hospital or acute care setting for developing countries. The purpose of this study was to determine the duration of care for inpatients with musculoskeletal and neurological conditions and administrative tasks, and to determine the relationship of duration of care with months of experience. Methods. A continuous observation time motion study of a typical workday of all physical therapists in an in-patient setting of a tertiary teaching hospital was conducted. An external observer will time the tasks done by the PT. The external observer kept distance from the direct patient encounter to minimize interference that may affect timing. Patients with conditions of different etiologies and functional levels were included. Results. Nineteen physical therapists with a mean experience of 54.63 months were observed. There were no adverse events during the implementation of this study. The total mean time in minutes of management of neurological patients is 37:32, and musculoskeletal patients is 28:30. Time for administrative tasks took an average of 20:33 minutes. There was also a low positive correlation on months of experience and treatment duration for patients with neurologic conditions (p=0.0471). Results showed that the allocated treatment duration is determined to be sufficient for performing PT activities. The optimal number of patients to be decked can also be appropriately determined to optimize resource allocation. Conclusion. Our pilot study attempted to quantify the duration of PT care in an inpatient setting that caters to patients with different diagnosis and varying needs for PT management. Although descriptive statistics and a weak to insignificant correlation was seen in most of the variables, there may be some benefit in gathering more duration data across different acute care settings within the country. Our pilot time and motion study can contribute to the limited evidence of duration of inpatient care that may inform human resource allocation, deliverables prioritization, and employee wellness and development. Figures have been presented which could be the basis for future policy research for management science and resource allocation studies.

Patient-related perceptions and experience measures of non-surgical endodontic treatment – A cross-sectional study

Objectives: This study assessed the outpatients’ perceptions of non-surgical root canal treatment (RCT) and compared them with their post-treatment experiences. Material and Methods: Eighty participants were selected for this cross-sectional study based on inclusion and exclusion criteria. Two surveys were conducted from October 01, 2023, to November 30, 2023 (Pretreatment survey) – one conducted before the RCT includes a survey about the patient’s past RCT experiences and demographics such as age, sex, and level of educational status. Multiple-choice questions were employed to determine patient concerns related to RCT, while modified visual analog scales (0–100) were used to assess pain and anxiety (Post-treatment survey) – done after the endodontic procedure with a root canal filling material. It outlines the patient’s experience, any discomfort experienced during treatment, the significance of tooth retention, and Re-RCT. Results: No difference was found in the demographic analysis. Out of the 80 participants, 33 participants (41.25%) presented with pretreatment anxiety, and 12 participants (15%) reported post-treatment. In the pretreatment survey, the primary concerns were pain and cost, which were reported at 27.55% and 10%, respectively. The post-treatment survey detailed that the time and the need for Re-RCT were the concerns, with reported rates of 11.25% and 10%, respectively. An absolute difference was found between anticipated and pre-operative pain and between experienced and pre-operative pain. However, no difference was found between anticipated and experienced pain 89% of the patients were willing to go for RCT again if needed. Conclusion: Treatment success is the goal for any dental procedure performed, which might be perceived differently by the patient and dentist. Consideration of patient perceptions and experiences, along with the dentist’s opinions, will help enhance endodontic treatment success.

Facilitating the transition from hospital to home after hip fracture surgery: a qualitative study from the HIP HELPER trial.

People post-hip fracture have reported experiences of fragmented care and poor discharge planning, therefore improvements in patient flow are required. This study reports the challenges people face during the discharge process and offers potential solutions for improving the transition from hospital to home from the perspectives of patients, carers, and health professionals. This was a qualitative study embedded within a multi-centre, feasibility randomised controlled trial (HIP HELPER). We undertook semi-structured interviews with 10 patient-carer dyads (10 people with hip fracture; 10 unpaid carers) and eight health professionals (four physiotherapists, two occupational therapists, one nurse and one physiotherapy researcher) between November 2021 and March 2022. Data were analysed using the principles of Framework Analysis. Participants identified challenges in the transition from hospital to home post-hip fracture surgery: ineffective communication, disjointed systems, untimely services and 'it's more than just the hip'. Possible solutions and insights to facilitate this transition included the need for reassurance, collaborative planning, and individualisation. The transition from hospital to home following hip fracture surgery can be a challenging experience for patients, and for friends and family who support them as carers, making them feel vulnerable, frustrated and uncertain. Enabling a coordinated, collaborative approach to discharge planning and early recovery provision is considered a positive approach to improving NHS care. ISRCTN13270387. Registered 29th October 2020.

Is Vibration Anesthesia Effective and Safe for Pain Reduction in Botulinum Toxin Injection? A Randomized Split-Face Controlled Trial and Cadaver Experiment.

Pain is an important issue in botulinum toxin injection. Vibration anesthesia is a noninvasive way for pain alleviation, but few study reported its use during botulinum toxin injection. To investigate whether vibration anesthesia is effective and safe for pain reduction during botulinum toxin injection for masseter reduction. A randomized split-face controlled trial was performed in patients who required masseter reduction. Vibration anesthesia was randomly administered on either side. Study outcomes were pain scores on a visual analog scale, duration of effect, satisfaction, and complications. Intergroup comparison and linear regression analyses were performed. In a total of 216 patients, the pain score on the vibration side (2.97 ± 1.44) was significantly lower than that on the non-vibration side (4.72 ± 2.13) (p < 0.0001), with a higher proportion of mild pain. Linear regression showed that history of injection, more injection points and doses increased the pain, while 2 ml syringe reduced the pain compared to 1ml syringe. Side effects were found in 19 patients and 21 sides (7%), but were not associated with vibration. High satisfactions were reported. Cadaver experiment confirmed that vibration did not alter the diffusion radius and depth of injection. Vibration anesthesia could significantly relieve the pain during botulinum toxin injection for masseter reduction, while did not affect adverse effect and effect duration. Therefore, we recommended the use of vibration anesthesia, larger syringe size, and less injection points to improve patient experience and satisfaction.

Opportunities to optimize patient experience in the in vitro fertilization (IVF) clinic and the role of genetic counselors.

To understand factors influencing patient satisfaction with genetics education and psychosocial support in an IVF clinic without a genetic counselor (GC), and how the role of a GC may fill gaps in care using a mixed-method cross-sectional study. Previous IVF patients (n = 133) completed a survey assessing satisfaction with genetics education and psychosocial support and decisional conflict about genetic testing. Kruskal-Wallis tests were used to compare satisfaction level to demographic and clinical variables. Spearman's correlation was used to analyze decisional conflict. Focus groups with 12 total participants expanded on themes identified in survey responses. Thematic analysis was performed using interpretive description. Participants reported satisfaction with their genetics education experience (78.9% somewhat or extremely satisfied). Satisfaction with genetics education was associated with satisfaction with information received about genetic testing results (H = 21.3, p < 0.01) and confidence using results in future decisions (H = 9.9, p < 0.01). Participants desired thorough pre-test and post-test counseling regarding genetic testing and directive guidance. Decision conflict about genetic testing was low (mean of 22.3, range 0-100). Satisfaction with genetics education was inversely correlated with decisional conflict (rs = - 0.42, p < 0.05). In-person GC visit scored highest among proposed education methods (mean score of 84.1). Patients felt satisfied with genetics education and psychosocial support provided by clinical providers. Gaps in care included misconceptions regarding genetic testing, a desire for more thorough counseling about genetic testing options, more directive guidance, and increased psychosocial support through external sources such as support groups.

Real-world patient experience with medicinal cannabis use for symptom management in an Australian advanced cancer setting: a mixed method, cohort study using the theory of planned behaviour framework.

Patient hesitancy to use MC due to the fear of negative social implications leads to intentional non-adherence and compromises therapeutic outcomes. Hence, we aimed to determine the rate of patient adherence to MC and explore factors influencing patient MC use. Demographic and quantitative data related to MC usage were extracted from medical records for patients prescribed MC at a single cancer centre in metropolitan Sydney. Qualitative data was generated from semi-structured interviews. Interview guides were developed based on the Theory of Planned Behaviour (TBP) domains (i.e. Attitudes, Subjective Norms, Behavioural Intention and Perceived Behavioural Control) to elucidate themes influencing MC use. A mixed method approach involving triangulation of quantitative and qualitative methods was used for data analysis. Twenty patients were included in the study, and the majority of patients showed adherence (n = 14, 70%). The MC formulation used (p = .018), symptom relief (p = .001) and side effects experienced (p = .007) significantly influenced MC adherence. In addition to side effects experienced, findings for barriers to adherence were convergent or complementary for other medication-related factors, including the inconvenience of MC co-administration with food, cost and unpleasant taste. MC adherence is influenced by its effectiveness for symptom relief whereby appropriate MC formulation selection is crucial and should be determined by the indication (or symptom clusters). Social factors such as the views and experiences of close others had little bearing on MC adherence.

The 2023 Gerard W. Ostheimer Lecture. A Contemporary Narrative Review of Maternal Mortality and Morbidity: Opportunities to Improve Peripartum Outcomes.

The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiology. This is a narrative review of 2022 literature pertinent to maternal morbidity and mortality in all income settings globally. Themes associated with worse maternal mortality rate (MMR), challenges health care workers face, public health priority areas, and initiatives to help countries achieve the United Nations Sustainable Development Goal targets for MMR are discussed. MMRs are higher in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Cesarean delivery rates are rising most rapidly in LMICs, warranting urgent maternal health care workforce planning efforts in these settings. Globally racial, ethnic, and geographical disparities in maternal mortality continue to be evident in global health care settings. In the United States, the MMR is rising. The evolving changes in abortion legislation in the United States may further negatively impact maternal morbidity and mortality. The need to implement American Society of Anesthesiologists-recommended obstetric anesthesia quality metrics to facilitate benchmarking and to improve patient experience and outcomes is discussed as well as the need for professional society guidance on minimum staffing levels in American labor and delivery units.