Participation of pharmacists and patients in web-based pharmaceutical care consultation based on MEDICODE.

BACKGROUND: The participation of providers and patients in medical communication is the core element of shared decision making. Furthermore, web-based pharmaceutical care consultation is increasingly necessary, welcomed and popular. OBJECTIVE: This study aimed to analyze the participation of pharmacists and patients in web-based pharmaceutical care consultation, so as to form the promotion strategy for both parties' participation. METHODS: Data of pharmacist-patient encounters was obtained from the online platform 'Good Doctor Website' from March 31, 2012 to June 22, 2019. MEDICODE was employed to analyze the participation of pharmacists and patients in web-based pharmaceutical care consultation using dialogue ratio, the preponderance of initiative, and dialogical roles (information provider, listener, instigator and participant). RESULTS: This study included 121 pharmacist-patient encounters which discussed 382 specifically named medications. On average, 3.75 specific themes were discussed per medication. Among the 29 specific themes observed, 16 were initiated primarily by patients and 13 by pharmacists, 22 were primarily monologue, 6 were primarily dialogue, and 1 was a combination of the two. Pharmacists and patients were information providers or listeners in most content theme categories, such as possible main effect, possible adverse effect, instructions, warnings, adherence, designation, and observed adverse effect. CONCLUSIONS: Pharmacists and patients exchanged less drug-related information in web-based pharmaceutical care consultation. The exchange had more patient-dominated behaviors and more of a monologue. Furthermore, pharmacists and patients were mainly information providers or listeners in communication. The participation of both parties was insufficient.

Enhanced recovery after surgery pathway reduces the length of hospital stay without additional complications in lumbar disc herniation treated by percutaneous endoscopic transforaminal discectomy.

BACKGROUND: Enhanced recovery after surgery (ERAS) pathway in spine surgery is increasingly popular which can reduce the length of hospital stay (LOS). However, there are few studies on the safety and effectiveness of ERAS pathway in the treatment of single-level lumbar disc herniation (LDH) by percutaneous endoscopic transforaminal discectomy (PETD). The aim of this study was to investigate whether ERAS can reduce LOS of patients with single segment LDH treated by PETD. METHODS: We reviewed the outcomes of all LDH patients (L4/5) who had been treated with PETD at our institution. Quasi-experimental study was adopted between patients treated in an ERAS after PETD with those rehabilitated on a traditional pathway. The two groups were analyzed for LOS, operation time, complications, visual analog scale (VAS), Oswestry Dysfunction Index (ODI), hospitalization expenses (HE), and improved MacNab efficacy assessment criteria (MacNab). RESULTS: A total of 120 single segment LDH patients (ERAS pathway 60 cases, traditional care pathway 60 cases) who were selected from January 2019 to January 2021 met the inclusion criteria. There was a significant difference in mean LOS postoperative VAS scores and ODI on the 3rd day after surgery between the two groups (P < 0.05). The incidence of complications and HE were similar in the two groups (P > 0.05). The mean LOS decreased from 3.47 ± 1.14 days to 5.65 ± 1.39 days after application of ERAS pathway (P < 0.05). CONCLUSIONS: The ERAS pathway reduced LOS without resulting in additional complications after PETD. These findings support the application of the perioperative ERAS pathway in the treatment of single-level LDH with PETD. LEVEL OF EVIDENCE: Level IV, therapeutic.

Granular cell tumor of the trunk of the facial nerve: A case report.

RATIONALE: Granular cell tumor (GCT) is a relatively uncommon, usually benign lesion that often presents as a solitary, painless cutaneous or submucosal nodule. GCTs of the head and neck are not uncommon; however, involvement of the trunk of the facial nerve is rare. PATIENT CONCERNS: A 55-year-old woman presented a lesion at the posterior border of the left parotid gland. Doppler ultrasound revealed a hypoechoic mass and magnetic resonance imaging disclosed an irregularly shaped lesion with unsharp borders in the posterior aspect of the left parotid gland that was hyperintense on T2-weighted images and enhancing with contrast on T1-weighted images. The remainder of the parotid gland was normal. DIAGNOSIS: Following excision of the mass, diagnosis of a GCT was established and confirmed by immunohistochemistry. INTERVENTIONS: The patient underwent surgical excision of the lesion. OUTCOMES: The patient is currently asymptomatic and without recurrence after 10 months follow-up. LESSONS: GCT involvement of the trunk of the facial nerve is rare. Immunohistochemical staining is helpful for its diagnosis.