Subjective Patient Perception Research Articles

In-depth analysis of pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery.

Surgical treatment for airway stenosis necessitates personalized techniques based on the stenosis location and length, leading to favourable surgical outcomes. However, there is limited literature on functional outcomes following laryngotracheal surgery with an adequate number of patients. We conducted a retrospective analysis of patients who underwent laryngotracheal surgery at the Department of Thoracic Surgery, Medical University of Vienna, from January 2017 to June 2021. The study included standardized functional assessments before and after surgery, encompassing spirometry, voice measurements, swallowing evaluation and subjective patient perception. The study comprised 45 patients with an average age of 51.9 ± 15.9 years, of whom 89% were female, with idiopathic being the most common aetiology (67%). Procedures included standard cricotracheal resection in 11%, cricotracheal resection with dorsal mucosal flap in 49%, cricotracheal resection with dorsal mucosal flap and lateral cricoplasty in 24% and single-stage laryngotracheal reconstruction in 16%. There were no in-hospital mortalities or restenosis cases during the mean follow-up period of 20.8 ± 13.2 months. Swallowing function remained intact in all patients. Voice evaluations showed a decrease in fundamental vocal pitch [203 (81-290) Hz vs 150 (73-364) Hz, P < 0.001] and dynamic voice range (23.5 ± 5.8 semitones vs 17.8 ± 6.7 semitones, P < 0.001). However, no differences in voice volume were observed (60.0 ± 4.1 dB vs 60.2 ± 4.8 dB, P = 0.788). The overall predicted voice profile changed from R0B0H0 to R1B0H1. Laryngotracheal surgery proves effective in fully restoring breathing capacity while preserving vocal function. Even in cases of high-grade and complex airway stenosis necessitating laryngotracheal reconstruction, favourable functional outcomes can be achieved.

Remote Communications between Patients and General Practitioners: Do Patients Choose the Most Effective Communication Routes?

The use of remote communication between patients and general practitioners has greatly increased worldwide, especially following the COVID-19 outbreak. Yet, it is important to evaluate the impact of this shift on healthcare quality. This study aimed at evaluating remote healthcare quality by comparing four remote patient-to-physician communication modes used in Israel. The research methodology entailed criteria-based analysis conducted by healthcare quality experts and a subjective patient-perception questionnaire regarding the healthcare quality attributed to each mode and the extent to which each mode was used. Our findings indicate that the extent to which each mode is used was found to be inversely related to its rated quality. As such, the common assumption whereby patients tend to choose the mode of communication that will most likely ensure high service quality is refuted. Our findings also indicate that remote services often hinder the physician's understanding of the patient's clinical issues, as patients encounter difficulties in correctly articulating and conveying them; such services also hinder the patient's understanding of the recommended course of treatment. These findings should be addressed by policymakers for improving remote communication services to ensure optimal healthcare service quality.

What is the Effect of CPAP Treatment With Humidifier on Vocal Quality?

Evaluate vocal quality in patients with OSA before and after continuous use of CPAP with a humidifier using subjective patient perception and clinical assessment. The hypothesis was that CPAP treatment with a humidifier would benefit voice quality. Randomized, sham-controlled, blinded clinical trial. Forty-three natal males with obstructive sleep apnea for whom CPAP treatment was recommended following polysomnography were randomized into two therapy groups: CPAP and Sham-CPAP. Participants completed questionnaires on voice use, a voice self-assessment with the ten-item vocal handicap index (VHI-10), and complementary questionnaires: the Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), reflux symptoms index (LPRSI) and oral dryness visual analog scale (DRY). Their voices were recorded at three different times: before CPAP therapy, and after 3 and 6 months of continuous CPAP use. The acoustic voice quality index (AVQI), and an auditory-perceptual judgment (APJ) were also applied before and after the CPAP and Sham treatments. After 6 months of treatment, the CPAP group presented improvements in their sleep patterns; however, no statistically significant differences were observed between the groups in respect of the results of the voice-related questionnaires, the AVQI values, and the APJ of the voice quality. All of the participants had some degree of vocal deviation at baseline. CPAP therapy with a humidifier did not improve vocal quality as evaluated by the clinician or patient self-assessment. However, it did not have any significant negative effects on voice quality, so can be considered safe to use in male OSA patients.

Kindness: Definitions and a pilot study for the development of a kindness scale in healthcare.

Empathy and compassion currently receive the most attention in healthcare with respect to the medical humanities and while these skills are important for any clinician to learn, they are complex and can be daunting to healthcare trainees when first encountered. Kindness is a simple, time-sensitive behavior not yet well characterized in the healthcare setting. With this study, we aim to clearly define it as well as investigate a few common examples of kindness that might be used to create a scale for use in the healthcare setting. A literature search was performed to rigorously define kindness. A kindness scale based on this definition was then compiled and administered to 45 patients across three outpatient clinical settings to evaluate the association between several actions and the patient's perception of kindness. Kind actions are small, take little effort, and are short in duration to their intended effect. We define kindness as an action that benefits another, as perceived by the recipient of the kind action. The results from our clinical study indicate several actions such as greeting the patient with a smile, asking questions about the patient's daily life, listening carefully, and appearing interested in the patient have a moderate strength correlation to a perception of kindness. The physician being perceived as kind also had a weak-moderate strength correlation to the patient subjectively reporting improvement after their visit. Definitions in the medical humanities are important as they guide the scales used to measure them. This article defines kindness and describes some examples of its manifestation in the healthcare setting. Our study indicates that performing kind actions may improve a patient's subjective perception of their care, however, future studies are needed to evaluate whether this benefit extends to health outcomes as has been demonstrated for skills such as empathy and good communication. "Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate." ~Albert Schweitzer.

Comparison of Antiemetics in the Management of Pediatric Cannabinoid Hyperemesis Syndrome.

As a result of recent legislative changes allowing for increased access to marijuana products, there have been increasing rates of cannabis abuse among adolescents and subsequent diagnoses of cannabinoid hyperemesis syndrome (CHS). Most available literature on this syndrome exists within the adult population and describes benzodiazepines, haloperidol, and topical capsaicin as potentially efficacious in the management of CHS. The objectives of this study were to identify antiemetics and compare their efficacy and safety in the management of pediatric CHS. A retrospective review of Penn State Children's Hospital electronic health record was performed to identify patients 18 years or younger who had an emergency department or inpatient encounter, a cannabis hyperemesis-related diagnosis code, and met diagnostic criteria for CHS. Antiemetic efficacy was determined using subjective patient perception of nausea and objective documentation of vomiting. Benzodiazepines, haloperidol, and topical capsaicin were classified as nontraditional antiemetics, whereas all other antiemetics were classified as traditional. Nontraditional antiemetic medications appeared to be more effective in resolving patient symptoms compared with traditional antiemetics. Analysis of all ordered antiemetics demonstrated a gap in partial or full symptom resolution between nontraditional and traditional agents. Reported adverse effects were minimal. Cannabinoid hyperemesis syndrome is an underrecognized and underdiagnosed condition characterized by cyclic vomiting related to chronic cannabis use. Abstinence from cannabis remains the most effective approach to mitigating morbidity associated with CHS. Medications such as lorazepam or droperidol may have benefit in managing toxidrome symptoms. Traditional antiemetic prescribing remains a key barrier to effective management of pediatric CHS.

Bulleyaconitine A reduces fracture-induced pain and promotes fracture healing in mice.

A fracture is a severe trauma that causes dramatic pain. Appropriate fracture pain management not only improves the patient's subjective perception, but also increases compliance with rehabilitation training. However, current analgesics for fracture pain are unsatisfactory because of their negative effects on fracture healing or addiction problems. Bulleyaconitine A (BLA), a non-addictive analgesic medicine, is used for the treatment of chronic pain of musculoskeletal disorders in clinical practice, whereas the effects of BLA on fracture pain is undefined. To evaluate the analgesic effects of BLA on fracture, we generated tibial fracture mice here. It is found that oral administration of BLA to mice alleviates fracture-induced mechanical and thermal hyperalgesia. Interestingly, BLA significantly increases locomotor activity levels and reduces anxiety-like behaviors in fractured mice, as determined by open-field test. Notably, BLA treatment promotes bone mineralization and therefore fracture healing in mice, which may be attributed to the increase in mechanical stimulation caused by exercise. Our study suggests that BLA can be used as a promising analgesic agent for the treatment of fracture pain.

Electromyographic evaluation of masseter and temporalis muscle activity after periodontal surgery: A prospective clinical trial

ObjectivesFollowing periodontal treatment, tooth supporting structures are restored to functionality and hence improve muscle activity. In this study, we aimed to investigate the influence of periodontal disease on muscle activity by electromyography and the subjective perception of periodontal therapy through the Oral Impact on Daily Performance (OIDP) questionnaire. MethodsSixty subjects with moderate to severe periodontitis were included. Periodontal condition was re-evaluated 4–6 weeks after non-surgical periodontal therapy (NSPT). Subjects with persistent probing pocket depths ≥5 mm were designated for flap surgery. All clinical parameters were recorded at baseline, 3 months and 6 months after surgery. The activities of the masseter and temporalis muscles were measured by electromyography and OIDP scores were recorded at baseline and 3 months. ResultsThe mean plaque index scores, probing pocket depths, and clinical attachment levels were reduced from baseline to 3 months. Mean EMG scores were compared at baseline and 3 months post-surgery. The mean OIDP total score prior to and after periodontal therapy was significantly different. ConclusionThere was a statistically significant correlation between clinical parameters, muscle activity and a patient's subjective perception. Therefore, it can be concluded that successful periodontal flap surgery led to improvements in masticatory efficiency and subjective perception, as determined by the OIDP questionnaire.

Approaches to studying the internal picture of treatment in patients with paranoid schizophrenia

The concept of the internal picture of the disease is widely used in domestic medical, as well as medical and psychological practice; its practical use increases the effectiveness of therapeutic and rehabilitation processes. The development of the concept of the internal picture of the disease is the formation of ideas about the internal picture of treatment and the internal picture of pharmacotherapy. The internal picture of treatment is defined as the patient's subjective perception of the treatment process from going to the doctor to changing the lifestyle in the dynamics of the therapeutic process. In the internal picture of treatment, sensory and intellectual levels are distinguished. The study of the internal picture of the disease in schizophrenia and the dissociation of mental functions with the separation of the associative process and emotional, sensory experience, and the presence of productive symptoms contribute to the formation of an inadequate attitude towards the disease, which enhances the patient's disadaptation.

P 51 Evaluation of a Visual-Analog Scale (VAS) for Remote DBS Programming (The REMOTE-Trial)

Introduction: Deep brain stimulation (DBS) represents the treatment of choice for advanced stages of Parkinson's disease (PD). In addition to careful patient selection and precise lead placement, postoperative programming of DBS devices is considered the most important factor for the individual patient. Despite expert-based recommendations for adjusting neurostimulation parameters, DBS programming remains time- and resource-consuming, thus impacting the postoperative treatment in particular for patients without easy access to specialist care. Currently, adaptive closed-loop stimulation systems that apply disease-specific biomarkers, such as local field potentials (LFPs), are being actively examined to facilitate programming. However, the most suitable feedback signal, still remains largely unknown. We previously tested the usefulness of the patient's subjective rating on a visual analogue scale (VAS) as a potential feedback signal for DBS adjustment and found no significant difference compared to standard programming 1 . Our results thus suggest that DBS patients are well able to adjust their IPG setting by themselves and will support the investigation of the patient's subjective perception as a valid and useful feedback signal for DBS programming. One of the practical advantages of using VAS-based programming strategies – in addition to saving time – is the principal applicability of such an approach to a remote programming setting, although a validation of such an approach is required. Patients & Methods : Within the scope of a prospective, randomized multicenter clinical trial (the REMOTE Trial), we will examine the effectiveness and safety of VAS-based remote DBS programming in PD by using a novel and recently introduced software platform (Abbott Neurosphere TM Virtual Clinic) that allows for the programming through a smartphone-based video connection with the patient. Therefore, n = 50 PD patients undergoing STN-DBS surgery will be randomized and subsequent to surgery will have their IPG settings adjusted either during regular visits at the hospital or alternatively be programmed remotely through a VAS-based approach. Expected Results: Prior to surgery and after a 90 days follow-up period, we will assess specific clinical (MDS-UPDRS, PDQ-39, BDI, MOCA) parameters to determine the effectivity and safety of the two different strategies on the patient outcome and to correlate it with VAS ratings and MRI data (Fig. 1). Conclusion: Our results will support the examination of remote-based DBS programming and evaluate the patient’s subjective judgment as a valid feedback signal.

Study of Correlation of Severity and Quality of Life in Patients with Congenital Ichthyosis

Introduction: Congenital ichthyosis is a disorder of cornification of skin with various cutaneous symptoms. Quality of life is a subjective perception of patients regarding their disease status and treatment received. Dermatological disorders have poor quality of life associated with them as any other systemic disease. Objective : The present study was conducted to assess the quality of life among patients of congenital ichthyosis, so that suitable remedial measures may be devised based on the same. Materials and Methods: It was a hospital based cross-sectional study with total 120 patients enrolled for study duration of one year .Children’s Dermatology Quality Life Index (CDLQI) questionnaire was used to assess the quality of life among patients. Global disease severity scale and VAS scale for severity of ichthyosis was used along with recording of socio-demographic details. Results: With a response rate of 87%, the sample size comprised of 104 subjects, aged between 0-15 years. Females outnumbered the sample by more than 2/3rd. ‘Symptoms and feelings’ was the most affected domain in the CDLQI. Itching, female gender and presence of scales were significant predictors of poor quality of life scores. Conclusion: The present study shows the epidemiological correlation of patients with congenital ichthyosis and the predictors of poor quality of life score. Regular subjective assessment of quality of life among patients should be included in routine clinic visits, as counselling plays a very important role in these patients.

Smartphone-based real-life activity data for physical performance outcome in comparison to conventional subjective and objective outcome measures after degenerative lumbar spine surgery

IntroductionOutcome assessments after surgery for degenerative lumbar disorders (DLDs) rely on subjective patient-reported outcomes (PROMs). New objective functional capacity tests, like the smartphone-based 6-min walking test (6WT), have been introduced but presumably also do not reflect the patient's real-life functional performance. Research questionPilot study to analyze changes in smartphone-based real-life activity data for physical performance outcome in patients undergoing surgery for DLD. Material and methodsProspective observational study of DLD patients. Objective functional capacity and subjective outcomes were measured using 6WT and PROMs. Real-life physical performance data were acquired retrospectively using Apple iPhone Health data and compared against objective capacity and subjective outcomes. ResultsEight patients (mean 46 years, 62% male) provided 286.858 smartphone mile counts. PROMs and physical capacity (6WT) significantly improved postoperatively. 6WT results increased from 352m pre-to 555/567m at 6/12 weeks postoperatively (p ​= ​0.03). For physical performance a linear mixed effect models showed an increase in daily distance in the first 4 months after surgery (slope +0.178; p ​< ​0.001). However, those increases reversed from 4 until 12 months postoperatively (negative slope estimate of −0.076; p ​< ​0.001). Smartphone-derived physical performance measures showed a positive correlation with corresponding physical capacity in the 6WT (R ​= ​0.57,p ​= ​0.004) and negative correlations with PROMs (COMI: R ​= ​−0.62p ​= ​0.001; ZCQ-Physical-Function: R ​= ​−0.68,p ​< ​0.001; ZCQ-Symptom-Severity: R ​= ​−0.52,p ​= ​0.009). Discussion and conclusionSmartphone-based real-life activity data allows for longitudinal physical performance assessment. Physical performance correlated with physical capacity and patient's subjective perception of disability. However, physical performance may be more resistant to postoperative longtime change which should consult a more cautious use as objective outcome measure.

Statička i dinamska komponenta opstrukcije kod benigne hiperplazije prostate

Introduction / Goal: Benign prostatic hyperplasia (BPH) is the most common benign neoplasm that occures in male population with an incidence of 45 to 90% between 50 and 80 years of age. BPH can cause an increase in output resistance, or an increase in resistance to urine flow, with its static and dynamic components. In clinical practice, the most common pharmacological treatment of lower urinary tract symptoms (LUTS) in patients with BPH is based on monotherapy with alpha-blockers, 5-alpha-reductase inhibitors or combination therapy. The aim of this review is to determine the main therapeutic and side effects of the most common pharmacological therapy and the recommended approaches of the European Association of Urology (EAU) and the American Urological Association (AUA) in the diagnosis of benign prostate obstruction (BPO). Method: Selective literature search with additional examination of EAU and AUA guidelines and meta-analysis. Results: The treatment of patients with BPH is complex. The factors on the basis of which treatment decisions are made are based on the patient's subjective perception of symptoms and quality of life due to LUTS and in relation to the presence of subvesical obstruction. Urodynamic pressureflow studies are the basis for the definition of BPO due to BPH or other etiology. Non-invasive uroflowmetry, determination of residual urine after urination (PVR) and non-invasive ultrasound tests are of great use in the diagnosis of BPO. Treatment with alpha1 receptor inhibitors (alpha-blockers), or 5-alpha-reductase inhibitors may be considered in patients with predominantly urinary dysfunction. Conclusion: Standard pharmacological medical treatment for BPH / LUTS is still based on alphablockers, 5-alpha-reductase inhibitors or a combination thereof. In the future, BPH / LUTS treatment is expected to become individualized, according to the type of symptoms, the presence of sexual dysfunction and the risk of BPH progression.

Assessment of the quality of life of patients with cancer: Current state of the problem

The successes of modern medicine in the treatment of malignant neoplasms have led to increased interest in the study of quality of life (QOL), which is considered one of the endpoints of modern clinical research in oncology. This study aimed to identify the main features of the current state and patterns of further development in assessing the QOL of patients with cancer. This study was based on a bibliographic search in PubMed and Google Scholar. A literature search was conducted using pairs of keywords quality of lifeoncology, quality of lifecancer, quality of lifequestionnairesoncology, patient-reported outcome (PRO)oncology, and quality-adjusted life-year (QALY)oncology for articles published from 2017 to 2022 in Russian and English. Further, the articles were identified manually through the article link lists. PROs are currently considered the generally accepted standard for collecting data on the subjective perception of patients with cancer regarding their health status. Numerous questionnaires for assessing QOL are available, but the Functional Assessment of Cancer TherapyGeneral and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire are preferred. The combination of advanced technologies allows the collection of more reliable PRO data. Thus, unified approaches for the application of PRO results in large clinical trials are necessary.

High-Density Autologous Chondrocyte Implantation (HD-ACI) in patients with bilateral knee chondral defects

IntroductionBilateral knee chondral defects can be treated in one or two surgical acts.ObjectivesTo study clinical outcome of patients with bilateral knee chondral defects treated with High-Density Autologous Chondrocyte Implantation (HD-ACI) during the same surgery.MethodsStudy on eight patients (4 women and 4 men) with chondral defects in both knees treated with HD-ACI during the same surgical act. Patients were evaluated 2, 6, 12 and 24 months post-op for treatment safety and efficacy: visual analogic scale (VAS) for pain, International Knee Documentation Committee (IKDC) for subjective patient's perception of both knees and EuroQol five-dimensional five-level questionnaire (EQ-5D-5 L) for quality of life. Integrity of neoformed tissue at 12 and 24-month follow-up was assessed by the magnetic resonance observation of cartilage repair tissue (MOCART) score.ResultsVAS decreased from baseline to 24 months from a median of 8 (6 – 9) to a median of 0 (0 – 5) (P < .001). IKDC increased from a median value of 39.0 (17.2 – 48.3) in the basal visit to a median of 83.7 (24.0 – 98.0) in the 24-month visit (P < .001). EQ-5D-5 L decreased at 2 months post-op and increased throughout the follow-up visits thereafter, needing 24 months after surgery to reach a value higher than the basal one. Median MOCART at 12 months was 80.3 (58.0 – 89.7) and 81.3 (54.0 – 89.9) at 24 months.ConclusionsTreatment of both knees with HD-ACI during the same surgical act in patients with bilateral chondral lesions is a safe procedure, providing good clinical results.

Superior Laryngeal Nerve Block for Treatment of Neurogenic Cough.

This study aimed to add to the body of evidence for efficacy of Superior Laryngeal Nerve (SLN) blocks for treatment of neurogenic cough. Efficacy at short- and long-term intervals are presented as well as relationships with laryngoscopic findings. A retrospective chart review of patients treated with SLN block between 2018 and 2020 was conducted. Patient demographics, videostroboscopic findings, and patient-subjective perception of outcomes were recorded and analyzed. Cough Severity Index (CSI) scores from pre-injection, short-term follow-up, and long-term follow-up were compared. Twenty patients underwent SLN block in the clinic setting. Four patients were excluded for incomplete records. The indication was neurogenic cough refractory to medical management and/or cough suppression therapy. Patients with short-term follow-up (n=13) had statistically significant decrease in CSI scores, with a mean baseline CSI of 24.3 decreasing to 16.15 (P= .006). Patients with evidence of Vocal Fold Motion/Vibratory Abnormalities (VFA) (n=8) showed improvement in short-term CSI scores, with a mean baseline CSI of 24.13 decreasing to 14.5 (P =.004). Those without evidence of VFA did not have statistically significant improvement in short-term CSI scores. At long-term follow-up, patients with VFA had improvements that approached statistical significance with a mean baseline CSI of 22.56 decreasing to 14.56 (P= .057), while patients without VFA showed no improvement. Our results are consistent with previous literature indicating efficacy of SLN block. The presence of VFA may be an indicator of patients who experience increased therapeutic effect. 4 Laryngoscope, 131:E2676-E2680, 2021.

An Objective Pain Score for Chronic Pain Clinic Patients.

Objectives Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient's behavioral component as observed by the provider in addition to the patient's subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS. Methods In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed. Results Interrater reliability revealed a fair-good agreement between the nurse's and researcher's CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16–0.50) and 0.47 (95% CI 0.31–0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56–0.77) and 0.67 (95% CI 0.55–0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2–6) and 6 (4–8)) and postprocedure (1 (0–2) and 3 (0–5)), p < 0.001. Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.

Improving symptom-related communication skills among cancer patients in an oncology ward: a best practice implementation project.

As a symptom is a subjective perception of patients, good symptom management requires the patients to actively talk to clinicians about their symptom experience and to effectively express concerns about treatment. It has been found that the patients displayed poor communication behaviors and lacked communication knowledge and skills in the oncology ward of a tertiary hospital in PR China, indicating the need for improvement. This project aimed to promote the cancer patients' symptom-related communication with clinicians in this hospital setting. A baseline audit against six evidence-based audit criteria derived from best practice recommendations was conducted, utilizing the JBI Practical Application of Clinical Evidence System tool. Identification of facilitators and barriers to best practice was then carried out and strategies were implemented to overcome identified barriers. A postimplementation audit was undertaken to assess any improvement in practice. The baseline audit showed that the nurses' compliance with best practice recommendations was unsatisfactory, with five out of six criteria recording 0% compliance. Strategies including nurse education, patient symptom assessment, patient education and use of communication tools were implemented. The postimplementation audit showed significantly improved compliance in the nurses' practice with all best practice recommendations, with all audit criteria achieving at least 69% compliance. The project achieved improved practice in patient communication promotion across all six audit criteria. However, further effort is needed to strengthen and maintain best practice. Patient symptom-related communication behavior should be measured in the future.

The Bucket Test Improves Detection of Stroke in Patients With Acute Dizziness.

It is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes. We evaluated the feasibility and utility of the bucket test (BT), which measures the difference between patient's subjective perception of the visual vertical and the true vertical, as a screening tool for stroke in patients presenting to the ED with acute dizziness. In this work, we prospectively enrolled 81 patients that presented to our academic medical center ED with dizziness as their chief complaint. The BT was performed 3 times for every patient. Seventy-one patients met the study criteria and were included in the analysis. Ten patients were excluded because of a history of drug-seeking behavior. There were no reported difficulties performing the BT. Six patients (8%) were diagnosed with ischemic stroke on MRI and 1 additional patient was diagnosed with transient ischemic attack and found to have a stroke on subsequent MRI. All 7 patients with dizziness attributed to cerebrovascular etiology had an abnormal BT, resulting in a sensitivity of 100% (95% confidence interval [CI] 59-100%). The specificity of the BT was 38% (95% CI 24-52%). The positive predictive value of the BT for detecting stroke was 18% (95% CI 15-21%). The BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.

Does prioritizing patient safety during the COVID-19 pandemic come at the expense of patient satisfaction?

Does prioritizing patient safety during the COVID-19 pandemic come at the expense of patient satisfaction?

Analysis of Quality of Life Parameters in a Health-Promoting Program for a Population with Cardiovascular Risk Factors: a Preliminary Study

One of the main risk factors of premature death in non-communicable diseases is physical inactivity, being as significant as hypertension, diabetes mellitus, and even smoking. It has been observed that interventions for carrying out physical activity (PA) in a communal environment have been very effective in terms of participation and adherence. The aim of this study is to prove the changes that occur on a physical level in a group of 46 patients on a regulated promotion plan for PA for health. The study consisted of a total of 15 weeks, during which a series of measurements were taken on the patients prior and post carrying out the program. There were significant changes in the undertaking of body mass index (p = 0.006), systolic and diastolic arterial pressure (p = 0.03 and p = 0.01, respectively), changes in attitude [degree of PA (METs, p ≤= 0.001)], changes in perceived quality of life (EuroQoL-VAS, p ≤= 0.001), as well as in the total number of risk factors (RFT, p = 0.03). These data confirm that a regulated program of PA is effective improving cardiovascular risk factors; improving all parameters of functional fitness studied; increasing the degree of PA; and increasing the subjective perception of patients’ health. Furthermore, it is verified that carrying out these types of programs is awarded a high degree of satisfaction by the participants.