Degree Of Patient Satisfaction Research Articles

The role of perceived telemedicine quality in enhancing patient satisfaction during the COVID-19 pandemic: The mediation of telemedicine satisfaction

Adopting telemedicine helped countries manage COVID-19, but it comes with several concerns including how to analyze the degree of patient satisfaction. This research explores the use of healthcare technologies to improve patient satisfaction in the Democratic Republic of Congo (DRC) during the COVID-19 pandemic. This study aims to examine the effect of perceived telemedicine quality on patient satisfaction mediated by telemedicine satisfaction. Data was drawn from 384 responses. Data analysis was conducted utilizing PLS-SEM. The results indicate that perceived telemedicine quality has a direct effect on patient satisfaction and telemedicine satisfaction. Telemedicine satisfaction has a direct effect on patient satisfaction. Also, telemedicine satisfaction was found to have a significant mediation effect between perceived telemedicine quality and patient satisfaction. Overall, using healthcare technologies improved patient satisfaction in the DRC. Implementing educational initiatives to improve patients' and healthcare providers' digital literacy is recommended, particularly in underprivileged and rural regions. This will enable individuals to use healthcare technology, understand its benefits, and navigate the platforms. Additionally, continuous education will ensure that healthcare providers stay informed of the most recent developments and are skilled in applying them for patient care.

Advancing Reduction Mammaplasty Surgery: Advancements and Outcomes with Tumescent Local Anaesthesia.

Tumescent local anaesthesia (TLA) is a method of anaesthesia used for surgical procedures that involves the infusion of a saline solution containing lidocaine, sodium bicarbonate, and epinephrine. This anaesthetic technique is designed to achieve both vasoconstriction and anaesthesia. In this article, we present a modified TLA protocol specifically adapted for reduction mammaplasty, based on an analysis of clinical case histories collected over the past few years. During the period from 2012 to 2022, we performed a reduction mammaplasty procedure in 120 patients employing tumescent local anaesthesia (TLA). The composition of the tumescent solution included 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. The solution was injected diffusely throughout the mammary gland. The average volume of tumescent solution infiltrated during TLA was 350mL per breast. There were no cases of adrenaline or lidocaine toxicity, and no patients required conversion to general anaesthesia. No patient received sedation. Patients reported no pain or discomfort during pre-operative infiltration or during surgery. No reinterventions were necessary because of short-term complications. Among the complications, there were 4 cases of hematoma (3,3%), 3 cases of seroma (2,55%), 10 cases of wound dehiscence (8,3%), 5 cases of asymmetry (4,1%), 9 cases of T-junction breakdown (7,5%), 2 cases of (partial) nipple necrosis (1,6%), and 3 cases of liponecrosis (2,5%). No cases of infection or total nipple-areola loss were reported. The follow-up period was between 30 days and 1year. Reduction mammaplasty is a viable surgical option for women with macromastia seeking to enhance their physiognomy. It is imperative that patients fully understand the potential benefits and risks associated with the procedure and consult with healthcare professionals specialising in this field. The use of tumescent local anaesthesia (TLA) has been confirmed as a safe and effective methodology to perform reduction mammaplasty, ensuring adequate pain control with minimal post-operative complications and resulting in a high degree of patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nonsurgical Rhinoplasty after Rhinoplasty: A Systematic Review of the Technique, Results, and Complications.

Introduction: Surgical rhinoplasty is a complex procedure with a high revision rate. Nonsurgical rhinoplasty (NSR) could avoid secondary rhinoplasty allowing the correction of postsurgical defects. A systematic review has been performed among adult patients who had previously undergone surgical rhinoplasty and now presenting for NSR with filler, demonstrated most common indications, fillers, and complications in this technique. Materials and Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) system guidelines. Primary outcomes included indications for NSR in patients with prior rhinoplasty and complication rate. Secondary outcomes included filler material and degree of patient satisfaction. Results: Twenty articles met the inclusion criteria, obtaining 2,048 patients analyzed in the review. Hyaluronic acid was the most used filler, found in 67% of patients. Indications were highly variable, considering deformities of the middle third of the nose the most remarkable. A high degree of satisfaction was found in the analyzed studies and the rate of major complications was low. Discussion and Conclusions: NSR in patients with prior rhinoplasty is a useful option for correcting a range from subtle aesthetic defects to severe nasal deformities. However, this technique is not exempt from complications, since an increased risk of skin necrosis has been observed.

Pilot Feasibility Study of an Individualized Cognitive Rehabilitation Program in Mexican Adults with Mild Dementia

Introduction. Dementia is a global public health problem, for which there is currently no cure. The increasing number of non-pharmacological interventions for the management of dementia challenges us to provide evidence-based care. Objective. To evaluate the feasibility of an individualized, cognitive rehabilitation program based on the French ETNA3 trial in Mexican subjects over fifty-five with mild Alzheimer's dementia and their caregivers who live in the community. Method. Non-randomized feasibility study. The intervention consisted of a twelve-month cognitive rehabilitation program, divided into eighteen ninety-minute sessions, administered by trained psychologists, and standardized according to the French ETNA3 program. To assess its feasibility, we determined the percentage of eligibility, acceptability, retention, and compliance and evaluated the adverse effects and degree of satisfaction in patients and their caregivers. Results. Thirty-two people with dementia and their caregivers agreed to participate. The mean age of the participants was 80 ± 8 years, the majority (72%) were women, and 78% had had five or more years of schooling. At twelve months, twenty-eight subjects (87%) completed the program with 100% compliance with the scheduled sessions. Discussion. This study shows the feasibility of an individualized cognitive rehabilitation program based on ETNA3 for Mexican subjects with mild dementia and their caregivers. Conclusion. More studies are required to evaluate the importance of trained therapists and caregiver support in achieving significant cognitive and functional changes in patients.

In-House Virtual Planning and 3D Printed Surgical Guides for Reconstructive Rhinoplasty.

Performing rhinoplasty in patients with craniofacial malformations remains a challenge, even for experienced surgeons. Advances in 3D technology and its application in surgical planning and printing of cutting guides and splints have become important tools to improve aesthetic and functional results. To describe an in-house workflow for surgical planning and printing of cutting guides and splints for complex rhinoplasty cases. This article describes an in-house workflow for complex rhinoplasty, as used in the maxillofacial department of a children's hospital specialized in the treatment of cleft and craniofacial malformations. Customized surgical guides help the surgeon to harvest and mold potential septal and costochondral grafts more accurately, to reduce surgical time and to verify the dimensions of the sculpted nasal shape following surgical planning templates. Patient satisfaction degree according to Rhinoplasty Outcome Evaluation questionnaire was 18/24. The presented workflow represents a potential asset in obtaining more accurate and satisfactory results in complex rhinoplasties.

Comparing the efficacy and safety of microneedling and its combination with other treatments in patients with acne scars: a network meta-analysis of randomized controlled trials.

This study aimed to analyze the efficacy and safety of microneedling (MN), both alone and in combination with other treatments, to refine the approach for treating acne scars using MN. We systematically searched Pubmed, Cochrane Library, Embase, and Web of Science for randomized controlled trials examining MN or its combinations in patients with acne scars. All statistical analyses were performed using Stata 18 software. A total of 24 studies involving 1546 participants were included. The analysis revealed that MN combined with chemical peels (CP) exhibited the best results in terms of degree of improvement, patient satisfaction, and treatment efficacy compared to other treatments examined, including MN alone, MN with hyaluronic acid (HA), MN with botulinum toxin‑A (TA), MN with platelet-rich plasma (PRP), PRP alone, CP, and laser therapy. The results for MN combined with additional treatments were obviously better than for MN alone. Side effects such as erythema, pain, and post-inflammatory hyperpigmentation showed no significant differences across all treatments assessed.

Pain experience with outpatient hysteroscopy: A prospective cohort study

BackgroundAbnormal uterine bleeding (AUB) affects women of all ages and is one of the most common reasons for referral to a gynaecological clinic. Operative hysteroscopic procedures allow for a see-and-treat approach to AUB, and these techniques have been shown to be feasible and acceptable in the outpatient setting. ObjectiveTo assess if there is an increase in pain scores for women who are undergoing an operative hysteroscopic procedure with Myosure LITE® (Hologic; mechanical hysteroscopic tissue removal system) compared to outpatient diagnostic hysteroscopy alone. Study designA prospective cohort study was performed. All participants attending the outpatient hysteroscopy clinic at Mercy Hospital for Women completed a pre-and post-procedure questionnaire. This included a visual analogue scale (VAS) for any pre-existing pain, anticipated pain, and actual pain experienced during procedure. Factors influencing overall satisfaction and willingness to attend again were also assessed. Data was entered into RedCap® for analysis. A difference in VAS of 10 mm or more was considered clinically significant. An alpha of p < 0.05 was assigned for statistical significance. ResultsBetween February 2020 and November 2022, 208 women underwent outpatient diagnostic hysteroscopy followed by an operative hysteroscopy with MyoSure®. To allow for standardisation of analgesia, only participants who had a cervical block before their Myosure® procedure were included for analysis (n = 111). There was statistical evidence (t(111) = 2.36, p = 0.02) of a lower mean VAS pain score for operative Myosure (36.5 mm, 95 % CI: 31.1–41.8 mm) compared to outpatient diagnostic hysteroscopy (44.1 mm, 95 % CI: 39.0–49.2 mm). The mean difference in VAS pain score was estimated as 7.7 mm (95 % CI: 1.2–14.1 mm) lower for Myosure compared to hysteroscopy. Given the threshold for clinical significance was considered as 10 mm difference in VAS, the variance in pain scores is under the likely clinically significant range. There was no significant difference in pain scores for diagnostic hysteroscopy with or without paracervical block (mean difference = 1.42; 95 % CI: −6.35 to 9.20). There was no association between pre-existing pain, and actual pain for hysteroscopy, or Myosure (p = 0.997 and p = 0.065 respectively). The anticipated pain score was weakly associated with actual pain during the operative Myosure procedure (p = 0.02), and with outpatient diagnostic hysteroscopy (p = 0.019). ConclusionOutpatient hysteroscopy procedures are generally well tolerated. The pain experience with operative Myosure was less than that reported during the diagnostic hysteroscopy by the same patient although this is unlikely of clinical significance. Importantly, Myosure was not more painful than the initial diagnostic procedure, and most patients were satisfied with the outcome and would choose to have the procedure again in an outpatient setting. This is in keeping with other studies which have shown a high degree of patient tolerance and satisfaction with this approach.

Explantation with Lateral Pedicle Mastopexy.

While breast explantation combined with mastopexy is an increasingly common procedure, it does present certain technical difficulties. We present a technique of explantation mastopexy with the use of an extended lateral pedicle for auto-augmentation. A consecutive series of 40 cases was retrospectively reviewed, with patient reported outcome questionnaire and photography at 3 and 12 months. The mean age was 57 years (range 40 - 70 years), and mean duration of implantation was 20.4 years (range 7 - 42 years). 12 women had undergone previous mastopexy (30%). Minor wound complications requiring simple dressings were seen in 7 cases (17.5%). Major infected wound problems occurred in 1 case, who was a smoker and had other co-morbidities. All except 1 case reported being satisfied or very satisfied with the outcome, with a mean patient reported satisfaction score of 4.9/5. When the photographs were independently assessed by a cosmetic practitioner, all cases were rated as average, good or very good, with a mean score of 4.1/5. The procedure is associated with low risk of post-operative complications, good cosmetic outcomes, and a high degree of patient satisfaction. We feel this technique provides a logical, reproducible method for combined explantation and mastopexy.

Comparative Study of 1444 nm Laser Monotherapy versus Integrated Liposuction in the Treatment of Axillary Osmidrosis.

Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates.

Ambulatory models for autologous stem-cell transplantation: a systematic review of the health impact.

Autologous stem-cell transplantation (ASCT) is the standard of care for the management of multiple myeloma and has a well-established role in the treatment of some types of lymphoma. Over the last decades, the number of ASCT performed has increased significantly, leading to elevated pressure and cost for healthcare services. Conventional model of ASCT includes the admission of patients to a specialized Transplant Unit at any stage of the procedure. To optimize healthcare provision, ambulatory (outpatient/at-home) setting should be the focus moving forward. Thus, ambulatory ASCT model permits reducing average hospital stays and pressures on healthcare services, with significant cost-saving benefits and high degree of patient and caregiver satisfaction. In addition, it facilitates the bed resource for other complex procedures such as allografts or CAR-T cell therapy. The aim of this systematic review is to document the health impact, feasibility and safety of the outpatient/at-home ASCT models, which are increasingly being applied around the world.

Comparative analysis of the degree of patient satisfaction after breast-conserving surgery with or without oncoplastic surgery: systematic review and meta-analysis.

Conservative surgery is the gold standard for the treatment of single and small tumors and, combined with the concept of oncoplastic tumors, brings good aesthetic results while maintaining cancer safety. The objective was to comparatively analyze the degree of satisfaction of patients undergoing breast conserving surgery (BCS), with and without oncoplastic surgery (OPS) using level II OPS techniques. Review with a search in the databases MEDLINE (by PubMed), EMBASE, Clinical Trials, Scopus, Web of Science, BVS and Oppen gray. The meta-analysis of random effects was performed using the Der Simonian-Laird method considering the odds ratio (OR) with a 95% confidence interval (95% CI). There was no statistically significant difference in the aesthetic outcome between women who underwent OPS and BCS (OR 0.90; 95% CI 0.62-1.30). The staging (OR 1.93; 95% CI 0.97-3.84; I 2 = 15.83%); tumor location [central (OR 1.28; 95% CI 0.06-27.49; I 2 = 17.63%); lower (OR 0.75; 95% CI 0.21-2.65; I 2 = 2.21%); superior (OR 0.67; 95% CI 0.26-1.74; I 2 = 0.00%] and tumor size (OR 8.73; 95% CI -11.82-29.28; I 2 = 93.18%) showed no association with the type of BCS performed, with or without OPS. The degree of satisfaction remains even in cases of extreme oncoplasty. The level of patient satisfaction in relation to BCS was similar to that of the group undergoing OPS, highlighting that OPS allows the patient's satisfaction rate to be maintained even in the case of large or multicentric tumors.

Establishment and analysis of quality index system for pediatric tumor nursing.

Nursing management considers nursing quality management at its core. Evaluation indexes of nursing quality not only control nursing quality, measure work enthusiasm, and judge the difference in nursing levels but also help nurses accurately understand the satisfaction degree of patients. To analyze pediatric tumor nursing quality evaluation indexes and establish a scientific and rigorous index system of children's nursing quality. Based on the "structure-process-result" in this study, the Delphi method was used to carry out questionnaire investigations and opinion collection for domestic experts in pediatrics, pediatric oncology internal medicine, and pediatric oncology surgical care and clinical aspects two times. In addition, the Kendall coordination coefficient and analytic hierarchy process were used to determine the content of indicators at all levels, set the weight, and finally establish the quality index system of pediatric tumor nursing. The response rate of 27 experts in the first round of the questionnaire was 100%, Ca0.77, Cs,0.73, Cr0.75, and the W value of the expert coordination coefficient was 0.315. In the second round of 27 expert consultations, the reply rate was 96%, Ca0.81, Cs0.80, Cr0.805, and the specialist coordination coefficient W value was 0.369. After two rounds of consultation, the importance evaluation scores of each indicator ranged from 3.31 to 4.88 and 3.29 to 5.00, respectively, and more than 94.7% of the indicators' importance evaluation scores were higher than 3.50. Finally, 3 Level-1 indicators, 12 Level-2 indicators, and 54 Level-3 indicators are established. This study has established a simple, comprehensive, and scientific quality index system for pediatric tumor nursing, highlighted the characteristics of pediatric tumor nursing, and provided an evaluation system for specialized nursing of pediatric tumors to more standardized pediatric tumor nursing and contribute to the sustainable and scientific development of pediatric tumor nursing.

Same-day Discharge Following Vaginal Hysterectomy and Native-tissue Apical Repair for Uterovaginal Prolapse: A Prospective Cohort Study.

The safety and feasibility of same-day discharge (SDD) has been consistently reported across the benign and gynecologic oncology literature. However, outcomes of SDD in the urogynecology population are sparse. The objectives of this study were to describe the success of SDD following vaginal hysterectomy and native-tissue colpopexy, and to compare the incidence of postoperative adverse events in patients discharged same-day versus postoperative day 1 (POD1). Further objectives were to compare pain, quality of recovery (QoR), and satisfaction between the groups. This was a single-center, prospective cohort study of patients with planned SDD. A standardized ERAS protocol was utilized. The QoR-40 questionnaire was administered at baseline, POD2, and the 6-week postoperative visit. Pain scores were captured similarly, and a satisfaction survey was administered at 6 weeks. The primary outcome was composite adverse events defined as any postoperative adverse event and/or health care utilization, excluding telephone calls, and urinary tract infection. A total of 101 patients were enrolled in the study; the primary outcome was available for 99. SDD was achieved for 76 patients (77.0%); 23 patients stayed overnight (23.2%). The overall incidence of composite adverse events was 20.2% (95% CI, 13.5-29.2), and was not different between the groups (26.1% vs 18.4%, p = 0.42). Additionally, there were no differences in the QoR-40 or pain scores on POD2 and at 6 weeks. Patient satisfaction was high and similar between the groups. Successful SDD was achieved in 77.0% of the patients. SDD following vaginal hysterectomy and native-tissue colpopexy appears to be safe, feasible, and associated with good QoR and a high degree of patient satisfaction.

Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial.

To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. The survival rate was 98.5%. The average MBLM was 0.24mm (± 0.53) and the MBLD was 0.27mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.

Retrospective evaluation of the Complementary Health and Wellbeing (CHW) service delivered at the Christie NHS trust UK.

IntroductionThe Complementary Health and Wellbeing service has been offering integrative therapies to cancer patients at The Christie Hospital NHS Trust since 1997 and has not undergone an external service evaluation in that time. It is considered a pioneering service. MethodAn external academic was invited to undertake a service evaluation based on information and experiences since the implementation of services changes as the result of the COVID 19 pandemic. Service users and therapists were interviewed along with review of quality control data and documentation. ResultsEighteen staff and eight patients were interviewed showing a high functioning and valuable service, offering a range of services to meet the needs of both inoutpatient and outpatient services. All staff are qualified and passionate, with a significant number of research outputs. However, the service is at capacity, and must rethink some delivery to ensure long term sustainability. Services offered include acupuncture, aromatherapy, massage, talking therapies and motivational behavioural changes. There is a high degree of patient satisfaction as the therapies help them manage their life affecting side effects, however accessing or being aware of the service before treatment commenced was a concern for patients. DiscussionThe Complementary Health and Wellbeing Service is well resourced, with all staff paid employees of the NHS trust funded via a charitable part of the trust. There is a self-funding education unit to provide staff training with participants coming from around the world. The therapists are expert practitioners who have undergone specialist training to work in this unique environment, however capacity to meet the needs of the service is limited, and there are gaps in the way patient evaluations are collected, which needs to be addressed for long term viability and future benchmarking. The changes to service to adapt to COVID-19 have become embedded within the service.

Radiofrequency and Electrical Muscle Stimulation: A Synergistic Treatment That Achieves Lipolysis and Circumferential Waist Reduction in Noninvasive Body Contouring.

Surgeons and providers in aesthetic medicine seek noninvasive devices that can be utilized for safe, efficient, and effective body contouring. Patient demand has propelled the development of novel devices that can simultaneously improve skin laxity, adipolysis along with stimulation of muscle hypertrophy. To determine the efficacy of body contouring after 3 treatments using the noninvasive Transform (InMode, Lake Forest, CA) device. A prospective, multicenter study was performed. Outcomes evaluated include: standardized caliper and ultrasound measurements of abdominal skin/soft-tissue thickness, waist circumference, histologic evaluation, patient comfort, and satisfaction assessments. Forty-four patients were successfully enrolled in the study and completed the series of 3 treatments which involved combined electrical muscle stimulation (EMS) and noninvasive bipolar radiofrequency (RF). Abdominal ultrasound measurements reveal a decrease in soft-tissue thickness (average 3.1 mm; P = .001), there was a significant decrease in caliper measurements of periumbilical skin thickness (P < .003), and the average reduction of abdominal circumference was 1.9 cm (P < .0001) 3 months after the treatment series. Histology confirmed subcutaneous adipolysis without damaging the dermal layer. Patients reported a high degree of satisfaction with the overall result (P = .003) and that each of the 3 treatments were progressively more comfortable (P < .005). This study demonstrates that a series of simultaneous noninvasive RF with EMS treatments to the abdomen decreases subcutaneous soft-tissue thickness of the treated area. These comfortable treatments ultimately result in a high degree of patient satisfaction at 3 months.

Long-term results of arthroscopic capsulolabral revision repair for failed anterior shoulder instability repair using suture anchors at a minimum of 10 years follow-up.

Arthroscopic revision anterior shoulder instability repair has been proposed, and early clinical results have been promising. However, long-term results after this procedure and the probable risk factors for failure have not been sufficiently discussed in the literature. Thirty-eight patients who were diagnosed with recurrent anteroinferior shoulder instability after failed Bankart repair, treated with ACRR between September 1998 and November 2003 and able to be contacted were included. Of these patients, 2 were excluded from the study due to the use of SureTak anchors for fixation, and 5 other patients refused to participate in the study due to lack of interest (3 patients) or lack of time (2 patients). The remaining shoulders were clinically examined at a minimum of ten years after surgery via the ASES, Constant, AAOS, Rowe, Dawson and VAS scores for pain and stability. Degenerative arthropathy was assessed with the modified Samilson-Prieto score. All 31 remaining shoulders were evaluated at a mean time of 11.86 years (142.4 months) after surgery. Six patients (19.35%) reported redisolcation after the revision procedure, 4 of whom were affected by a new significant shoulder trauma. The ROWE and Constant scores improved significantly. Moderate to severe dislocation arthropathy was observed in 19.4% of patients. Five patients (16.2%) were not satisfied with the procedure. Long-term follow-up after ACRR shows predictable results, with a high degree of patient satisfaction, good to excellent patient-reported outcome scores and minimal radiological degenerative changes. However, with an average recurrence rate of 19.3% after 11.86 years, the redislocation rate appears high. With careful patient selection, recurrence rates can be significantly reduced.

Methods for assessing the quality of medical care in Russia and abroad: formation and modern aspects

The study presents the results of the analysis of available literary sources covering the historical and modern aspects of assessing the quality of medical care in the healthcare systems of the Russian Federation and some foreign countries and shows the relevance and feasibility of improving the methodology for assessing the quality of medical care in the Armed Forces of the Russian Federation. At present, many methods are used for assessing the quality of medical care in the healthcare system of the Russian Federation; however, none of them contains an exhaustive set of criteria that would allow assessing the quality of medical care provided in full. In the Armed Forces of the Russian Federation, the methods used to assess the quality of medical care are also not perfect, which leads to a decrease in the effectiveness of management decisions and thereby a decrease in the effectiveness of military medical organizations and units. To this end, active development of assessment indicators and criteria for the quality of medical care, introduction of new assessment methods, including the use of automated data accounting and analysis tools, and improvement of the procedures and standards of medical care are necessary. The most promising area is the use of comprehensive methods for assessing the effectiveness and quality of medical care, which have recently become widespread. Their application provides comprehensive control over compliance with medical care requirements and allows us to investigate the conditions wherein it is indicated, assess the degree of patient satisfaction, and helps optimize the assessment procedure. In addition, to improve the effectiveness, continuity in the implementation of control measures performed at various levels both within the medical organization and with the participation of departmental and state control bodies must be ensured. To do this, close interaction of all control bodies must be organized, and their activities must be integrated into a single quality management system for medical care. The results of the assessment of the quality of medical care can help determine the main directions of the development of the medical and diagnostic process and optimize the work of medical personnel, which increases the importance of work aimed at improving the assessment methodology. In addition, the quality control of medical care in the Armed Forces of the Russian Federation must be further improved.

Cementless Total Hip Arthroplasty With Paavilainen Femoral Shortening Osteotomy Can Provide Good Results at 10 Years in Patients Who Have Crowe IV Developmental Dysplasia of the Hip

BackgroundThe aim of this study was to present the clinical and radiologic results of primary total hip arthroplasty (THA) using the femoral shortening osteotomy technique described by Paavilainen in patients who have Crowe IV developmental dysplasia of the hip. MethodsWe retrospectively analyzed the results of primary THA using the Paavilainen technique in 335 hips. The mean follow-up was 10.2 years. The degree of limp, leg-length discrepancy, and patient satisfaction were assessed. The Oxford Hip Score was used to examine functional outcomes. A number of radiographic parameters were also assessed. ResultsThe most common reason for revision surgery was nonunion of the distally advanced greater trochanter. This complication was observed in 22 hips (6.5%). The 10-year survival for acetabular components, it was 97.3%, and for femoral components was 98.7% with aseptic loosening as the end point, and 85.9% with reoperation for any reason as the end point. Patients demonstrated improved functional outcomes. The mean limb lengthening was 27.8 mm. Nonunion was more common if the contact length of the proximal femoral fragment with the lateral surface of the distal femoral fragment was less than 35 mm. ConclusionsCementless primary THA using the femoral shortening osteotomy technique described by Paavilainen in patients who have Crowe IV dysplasia of the hip demonstrates good clinical and radiologic postoperative results. If the contact between the fragments after osteotomy is less than 35 mm, there is a high risk of nonunion, and supplemental fixation may be warranted.

Gestion de la douleur à domicile après chirurgie de l’avant pied en ambulatoire

Introduction: Healthcare structures must adapt to the shift to ambulatory care. While first ray surgery lends itself well to this organization, it is known to be painful for patients who are often reluctant to undergo this procedure. We studied the evolution of post-operative pain in patients undergoing first ray surgery from D0 to D5. A home nursing protocol was used. Secondary objectives were to assess patient satisfaction and to identify complications.Methods: This is a retrospective, observational, single-center, single-operator study. One hundred and thirty-eight patients undergoing surgery on the first ray of the foot (hallux valgus or rigidus) and eligible for ambulatory care were included between April 2019 and December 2022. The operative technique for the cure of hallux valgus was open surgery by double metatarsal and phalangeal osteotomy; for hallux rigidus, open dorsal plate arthrodesis. Home follow-up was carried out by a healthcare provider. The protocol allowed pain to be managed with an IV nefopam diffuser for a maximum of 5 days, combined with oral analgesics of levels 1 to 3. Pain was recorded at D0, D1, D3 and D5 using a numerical scale from 0 to 10. Patient satisfaction was assessed retrospectively by telephone call.Results: Ten patients were excluded due to incomplete data. The series comprised 102 women and 36 men, with an average age of 59.8 years. There were 116 hallux valgus and 22 hallux rigidus. Thirty-three patients had procedures associated with their 1st ray surgery. Pain analyzed by VAS was 4.21 at D0, 2.96 at D1, 1.90 at D3, 1.33 at D5. The mean duration of nefopam infusions was 4.31 days. Treatment tolerance was satisfactory in 88.4% of cases. Eighty-four percent of patients were very satisfied with their pain management. There were 4 early scar complications that resolved with local care. One infection was noted at a distance from the operation, requiring repeat surgery and re-hospitalization. Four postoperative algoneurodystrophies were identified. Three recurrences of hallux valgus required repeat surgery. The existence of fibromyalgia, algodystrophy, chronic pain on long-term morphine therapy, chronic inflammatory disease, depression or parkinsonian syndrome correlated with higher pain.Conclusion: Pain management after outpatient first ray foot surgery using the injectable nefopam protocol is satisfactory in the majority of cases, with a very high degree of patient satisfaction. This protocol is now routinely offered to our patients undergoing first ray surgery.Level of evidence: IV; cohort study.