Positive Patient Satisfaction Research Articles

Immediate Single-Stage Reconstruction of the Breast Utilizing FlexHD and Implant following Skin-Sparing Mastectomy

Introduction: Primary reconstruction of the breast is the standard of care for patients undergoing a mastectomy for breast cancer. Surgical techniques involving immediate implant reconstruction following skin-sparing mastectomy can offer improved patient self-image and enhanced aesthetic outcomes compared with other techniques. The use of an acellular dermal matrix (ADM) as a supporting material has been shown to further improve cosmetic results. Here, we describe a technique that allows for primary reconstruction of the breast mound with implant after a skin-sparing mastectomy in a single procedure using a new form of ADM known as FlexHD. Materials and Methods: A total of 50 patients (85 breast reconstructions) over a period of 20 months underwent immediate reconstruction with this method using a silicone gel mammary implant. The surgical approach and complications for each patient were documented. In some patients, biopsies were obtained 2 and 6 months after initial placement of FlexHD (at the time of expander replacement) for pathologic and histologic evaluations. Results: All reconstructions were completed in a single-stage procedure. The technique resulted in positive aesthetic outcomes and patient satisfaction with few complications and low postoperative pain. Infections were more frequently observed following bilateral mastectomy and in patients who had previous radiation therapy or were smokers. Fibroblast migration and neovascularization of the ADM were observed at 2 months with full incorporation into native tissue at 6 months. Conclusions: Our experience suggests that single-stage breast reconstruction with FlexHD is a preferred approach to the primary reconstruction of the breast after mastectomy.

Self-Care Strategies to Enhance Caring

An increasing amount of information suggests there are positive financial, productivity, patient, and staff satisfaction outcomes associated with creating cultures of effective caring. These data cannot be ignored and form a call to action. For example, a critical topic that has emerged is compassion fatigue (CF). What can be done to avoid experiencing the negative impacts of workaholism, compassion fatigue, stress, and lack of energy and innovation in the workplace? Peter Drucker said it best: “Your foremost job as a leader is to raise your own energy level and then help orchestrate the energies of those around you.” An increasing amount of information suggests there are positive financial, productivity, patient, and staff satisfaction outcomes associated with creating cultures of effective caring. These data cannot be ignored and form a call to action. For example, a critical topic that has emerged is compassion fatigue (CF). What can be done to avoid experiencing the negative impacts of workaholism, compassion fatigue, stress, and lack of energy and innovation in the workplace? Peter Drucker said it best: “Your foremost job as a leader is to raise your own energy level and then help orchestrate the energies of those around you.”

Point-of-Care Testing for Hb A1c in the Management of Diabetes: A Systematic Review and Metaanalysis

The measurement of hemoglobin A(1c) (Hb A(1c)) is employed in monitoring of patients with diabetes. Use of point-of-care testing (POCT) for Hb A(1c) results at the time of the patient consultation potentially provides an opportunity for greater interaction between patient and caregiver, and more effective care. To perform a systematic review of current trials to determine whether POCT for Hb A(1c), compared with conventional laboratory testing, improves outcomes for patients with diabetes. Searches were undertaken on 4 electronic databases and bibliographies from, and hand searches of, relevant journal papers. Only randomized controlled trials were included. The primary outcome measures were change in Hb A(1c) and treatment intensification. Metaanalyses were performed on the data obtained. Seven trials were found. There was a nonsignificant reduction of 0.09% (95% CI -0.21 to 0.02) in the Hb A(1c) in the POCT compared to the standard group. Although data were collected on the change in proportion of patients reaching a target Hb A(1c) of <7.0%, treatment intensification and heterogeneity in the populations studied and how measures were reported precluded pooling of data and metaanalysis. Positive patient satisfaction was also reported in the studies, as well as limited assessments of costs. There is an absence of evidence in clinical trial data to date for the effectiveness of POCT for Hb A(1c) in the management of diabetes. In future studies attention to trial design is needed to ensure appropriate selection and stratification of patients, collection of outcome measures, and action taken upon Hb A(1c) results when produced.

Naturopathic medicine and aboriginal health: an exploratory study at Anishnawbe Health Toronto.

To explore the experiences and perceptions of providing and receiving naturopathic care within the Aboriginal community served by community health centre Anishnawbe Health Toronto. This is an exploratory study using a descriptive qualitative approach to enable better understanding of the care provided to Aboriginal patients by naturopathic interns and clinician supervisors at Anishnawbe Health Toronto (AHT). We conducted semi-structured interviews with 3 naturopathic supervisors, 7 naturopathic interns, and 7 Aboriginal patients to gain an in-depth understanding of participants' experiences and perceptions of naturopathic medicine at AHT. We also conducted 3 confirmatory interviews with Naturopathic Doctors practicing in other Aboriginal communities. Naturopathic medicine is perceived to fit with health care philosophies in Aboriginal communities, as it emphasizes spiritual, mental and emotional aspects of health. Specifically, strengths of naturopathic medicine within the Aboriginal community relate to the philosophical suitability of naturopathic medicine, the ability to meet a wide range of health needs, the lack of power imbalance in the patient-practitioner relationship, and the cultural sensitivity of the practitioners. While AHT is highly regarded by patients and practitioners, certain limitations at the local setting regarding privacy and inter-professional communication were evident. Further, to facilitate trust, naturopathic interns require enhanced training in specific health issues that face the Aboriginal population to allow them to better engage with the culture and practices of the Aboriginal community. The naturopathic clinic at AHT contributes to positive patient outcomes and satisfaction and helps address unmet health needs in this population. Naturopathic medicine may be well suited to address Aboriginal health care needs through its holistic and respectful approach to care and a foundation of traditional knowledge and research evidence for treatment of a person's mind, body and spirit.

Naturopathic Medicine and Aboriginal Health: An Exploratory Study at Anishnawbe Health Toronto

Objective: To explore the experiences and perceptions of providing and receiving naturopathic care within the Aboriginal community served by community health centre Anishnawbe Health Toronto. Methods: This is an exploratory study using a descriptive qualitative approach to enable better understanding of the care provided to Aboriginal patients by naturopathic interns and clinician supervisors at Anishnawbe Health Toronto (AHT). We conducted semi-structured interviews with 3 naturopathic supervisors, 7 naturopathic interns, and 7 Aboriginal patients to gain an in-depth understanding of participants’ experiences and perceptions of naturopathic medicine at AHT. We also conducted 3 confirmatory interviews with Naturopathic Doctors practicing in other Aboriginal communities. Results: Naturopathic medicine is perceived to fit with health care philosophies in Aboriginal communities, as it emphasizes spiritual, mental and emotional aspects of health. Specifically, strengths of naturopathic medicine within the Aboriginal community relate to the philosophical suitability of naturopathic medicine, the ability to meet a wide range of health needs, the lack of power imbalance in the patient–practitioner relationship, and the cultural sensitivity of the practitioners. While AHT is highly regarded by patients and practitioners, certain limitations at the local setting regarding privacy and inter-professional communication were evident. Further, to facilitate trust, naturopathic interns require enhanced training in specific health issues that face the Aboriginal population to allow them to better engage with the culture and practices of the Aboriginal community. Conclusion: The naturopathic clinic at AHT contributes to positive patient outcomes and satisfaction and helps address unmet health needs in this population. Naturopathic medicine may be well suited to address Aboriginal health care needs through its holistic and respectful approach to care and a foundation of traditional knowledge and research evidence for treatment of a person’s mind, body and spirit. Key words: Naturopathy; Aboriginal health; First Nations health; community health centres; indigenous health services; complementary and alternative medicine

Team climate and quality of care in primary health care: a review of studies using the Team Climate Inventory in the United Kingdom

BackgroundAttributes of teams could affect the quality of care delivered in primary care. The aim of this study was to systematically review studies conducted within the UK NHS primary care that have measured team climate using the Team Climate Inventory (TCI), and to describe, if reported, the relationship between the TCI and measures of quality of care.FindingsThe databases MEDLINE, EMBASE, and CINAHL were searched. The reference lists of included article were checked and one relevant journal was hand-searched. Eight papers were included. Three studies used a random sample; the remaining five used convenience or purposive samples. Six studies were cross sectional surveys, whilst two were before and after studies. Four studies examined the relationship between team climate and quality of care. Only one study found a positive association between team climate and higher quality care in patients with diabetes, positive patient satisfaction and self-reported effectiveness.ConclusionWhile the TCI has been used to measure team attributes in primary care settings in the UK it is difficult to generalise from these data. A small number of studies reported higher TCI scores being associated with only certain aspects of quality of care; reasons for the pattern of association are unclear. There are a number of methodological challenges to conducting such studies in routine service settings. Further research is needed in order to understand how to measure team functioning in relation to quality of care.

Infertility coverage is good business

Tens of thousands of people struggling with infertility and lacking applicable insurance coverage continue to find needed care beyond their affordable reach. Recent survey research findings demonstrate that employers now providing infertility benefits experience improved retention and recruitment of valued employees, higher staff morale, and reasonable related costs. With health benefit reform at the center of public policy debates and an effective business message to convey, infertility specialists and patients can together be powerful advocates to make the case to employers and public policy makers for expanded coverage and access to assisted reproductive services.

A Consultant Pharmacist's Role on a Geriatric Assessment Service

This paper describes the role of a consultant pharmacist on a geriatric assessment service team. The Geriatric Assessment Service (GAS) is part of an Independent Practice Association (IPA) in Rochester, New York. The consultant pharmacist is responsible for the promotion of appropriate, cost-effective prescribing of drug therapy in physician offices affiliated with the IPA. A team included a consultant pharmacist, social worker, and registered nurse with the objective of providing support to community physicians in the care of at-risk, frail, medically complex, community-dwelling adults 75 years of age or older. Assessments completed varied according to patient needs. Recommendations were made to the primary care provider based on the results of each patient assessment. Caregiver Strain Index, Drug Appropriateness Measure, Patient satisfaction, Physician satisfaction. Enrollment rate in the program rose from 19% in the first quarter to 63% in the fourth quarter. The Drug Appropriateness Measure on average improved to greater than 60% for patients enrolled. Member satisfaction averaged 90%. The Caregiver Strain Index showed an improvement of 28%. An observational comparison of GAS-enrolled patients to noninterventional patients showed a lower per-member, per-month cost change from 2005 to 2006. The GAS program provided assistance to primary care providers caring for community-dwelling, at-risk seniors, resulting in improved pharmaceutical care, reduction in caregiver strain, and positive patient satisfaction.

Anterior acromioplasty for the shoulder impingement syndrome: Long-term outcome

This study reanalyzes a group of patients who had anterior acromioplasty between 1975 and 1979, whose results were reported in 1990 at a mean 8-year follow-up, to identify any continuing problems or new complications, to assess the frequency of further surgery, and to define long-term outcome. Thirty-two patients were included. The mean follow-up was 25 years (range, 21 to 27 years). All had the impingement syndrome. At surgery, there was tendon and bursal inflammation with fibrosis in 28 shoulders and a small rotator cuff tear in 4. Five shoulders have required additional surgery: distal clavicle excision in one, revision anterior acromioplasty in one, and repair of a new rotator cuff tear in three. Of the shoulders, 23 (72%) were reported as having no or slight pain. Positive patient satisfaction was expressed in 28 (88%). Comparisons were made to the opposite shoulder in this older patient group. The mean within-patient difference between the operative shoulder and the opposite shoulder on the Simple Shoulder Test was 0.4, with scores of 8.9 for the operative side and 9.3 for the opposite side (P = .47). The mean difference in the American Shoulder and Elbow Surgeon's score was 8.6 points, with scores of 75 for the operative side and 83 for the opposite side (P = .02). The results of open acromioplasty for the impingement syndrome are usually maintained over time. Acromioplasty does not always prevent the need for subsequent rotator cuff surgery, but the rate of reoperation has remained relatively low in the long follow-up period.

An Evaluation of Patients’ Opinions of Primary Care Physicians: the Use of EUROPEP in Gaza Strip-Palestine

The objective of this paper is to identify the level of patients' satisfaction with primary care physicians. Data were gathered from an exit interview using a standardized questionnaire (EUROPEP) and background variables. A total of 956 patients in fifteen primary health care clinics in Gaza Strip participated. Outcome measures is positive patient satisfaction (good and excellent ratings in the EUROPEP Index). As a results, the mean percentage of positive satisfaction with medical services was poor (41.8%). The poorest performance was recorded for: getting through to the clinic on the phone, being able to speak to physician on the telephone, time spent in waiting rooms and helping the patient deal with emotional problems. The comparison between clinical behaviour dimension and organization of care showed that clinical behaviour was evaluated higher. In conclusion, Palestinian patients expressed overall dissatisfaction with services provided by primary care physicians. These findings present a real challenge for Palestinian authority policy makers and administrators in terms of designing appropriate quality improvement strategies.

Dietary Behaviors, Eating Attitudes and Patient Satisfaction Outcomes of Diettian Intervention

Data were culled retrospectively from the medical records of 81 ambulatory patients, 68 females and 13 males age 52 ± 13.0 years (mean ± SD) who received at least 2 individualized dietitian sessions {medical nutrition therapy (MNT)} for hyperlipidemia 31%, diabetes 27%, glucose intolerance 42%. hypertension 16%, weight reduction 84% and coronary heart disease 10%. Patients received 6 ± 4 sessions (median = 4, range = 2–18) over 10 ± 8 weeks (median = 6, range = 2–30). Time spent was 206 ± 141.5min (median = 150, range = 90–570). A telephone survey was conducted with a previously validated instrument (J Am Diet Assoc. 1994; 94: 437–440). Patients reported: a) dietitian's advice was suited to their special needs 96%, b) knew what to eat after MNT 90%, c) made recommended dietary changes 69%, d) did not have trouble changing diet 86% , e) felt in control of diet 69%. f) MNT helped achieve positive health changes 68%. g) noted positive health changes due to diet modification 68% and h) noted improvement in clinical conditions 69%. Results were similar by gender (p =NS). Patients attributed MNT to an improvement in eating behaviors such as increased consumption of fruits (69%), vegetables (69%), whole grains (61%), high calcium foods (43%) and planning meals and snacks (77%). Patients reported MNT helped to achieve the following positive eating attitudes: not to feel guilty after an occasional splurge (82%), eat healthfully and exercise instead of obsessing about one's weight and diet(81%), eat fat in moderation (81%), eat a balanced diet (63%) and variety, balance and moderation are the keys to a healthful diet (73%). Only 17% stated they had difficulty changing their diet as suggested. Stated barriers to change were preparing meals and snacks (31%), high cost of foods suggested (18%). taste of the foods suggested (20%), finding the foods needed in the store (22%), knowing what to eat (11%) and getting to the store (11%). Only 5% received but 96% wanted coverage of MNT by their health care plans. MNT leads to positive dietary behaviors, eating attitudes and patient satisfaction. This study supports the inclusion of MNT by health care plans as a value added service.

Can laparoscopic cholecystectomy be a same-day procedure?

Gall bladder surgery by video-laparoscopy (VL) can now successfully fulfill the same goals as traditional surgery and is associated with comparable, if not better, results both in terms of positive surgical outcome and patient satisfaction. With public health spending under growing social and administrative pressures, and continuous efforts being focused on enhancing the efficiency of both surgical instruments and operating procedures, it is a most attractive, albeit initially challenging, prospect to regard video-laparoscopic surgery as day-care surgery. In the period January 1994 to December 1996, 1334 patients underwent VL cholecystectomy (898 were women and 436 men). A total of 1034 laparoscopies used gas and 300 were gas-less. Of the 1334 patients, 72 (5.4%) were treated on an outpatient basis. The authors assess this option, in light of recent technical developments and of the relevant major organisational and professional implications, and consider the feasibility of a day-care surgery project which might be implemented.