Patient Perspectives in the Diagnosis and Treatment of Gallstone Disease: A Qualitative Analysis.

INTRODUCTION: Gallstone disease is one of the most common surgical diagnoses in the United States. Notably absent from the literature is the patient's perspective on priorities in management. Understanding patient values will assist surgeons and systems in achieving high-quality, patient-focused care for biliary disease. METHODS: Patients who underwent elective or urgent cholecystectomy were invited to participate in a semistructured interview to assess their experience. Interviews were performed over the phone or in person and recordings were transcribed. Each transcription was analyzed independently by two authors using the MAXQDA software, and a mixed deductive-inductive approach was used to develop themes. Anonymized quotes were used to illustrate themes and subthemes regarding the patient's experiences and priorities surrounding gallstone disease. RESULTS: A total of 29 interviews were completed. Most participants were female, but represented a diverse racial and educational group. The most common diagnosis was acute cholecystitis (48%), and 76% of patients underwent an emergency operation. Patients indicated that their main priority regarding treatment was prompt pain control with definitive management so they could return to their previous quality of life. Most patients wanted face-to-face communication with the surgical team both pre and postoperatively. Patients wished they had more information about postoperative care and expectations in the preoperative setting. CONCLUSIONS: Patients' priorities in their care for gallstone disease are centered around definitive management and quality of life. Improvements in communication were identified regarding meeting the surgeon, and postoperative communication. These results can inform surgeons how to prioritize patient perspectives in an acute care surgical system that was not designed with patient input.

Differences in intestinal bacteria in traumatic injury survivors with and without probable posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a common consequence of traumatic injury, yet certain biological factors contributing to PTSD are poorly understood. The gut microbiome may influence mental health outcomes, but its role in heterogeneous PTSD presentations requires elucidation. METHODS: Bacterial composition was examined in adults 2-4 years post-trauma with probable PTSD (n = 24) versus trauma-exposed controls without probable PTSD (n = 24). 16S rRNA sequencing and bioinformatic tools assessed microbial diversity and abundance. Relationships between taxa and PTSD symptom clusters were evaluated. RESULTS: No differences were found in overall microbial community structure between groups. The probable PTSD group exhibited significantly reduced Actinobacteriota and increased Verrucomicrobiota phylum abundance compared to controls. Specific taxa showed notable inverse associations with negative mood/cognition versus hyperarousal symptoms. Prevotella and Ruminococcaceae were negatively associated with negative mood but positively associated with hyperarousal. CONCLUSIONS: Results demonstrate microbial signatures of probable PTSD subtypes, highlighting the microbiome as a potential mediator of heterogeneous trauma psychopathology. Definition of PTSD microbial correlates provides a foundation for personalized psychobiotic interventions targeting predominant symptom profiles.