ABSTRACT
BACKGROUND: Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. AIM: To identify barriers and facilitators for applying SDM in cystitis management in general practice. DESIGN & SETTING: Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). METHOD: Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. RESULTS: Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. CONCLUSION: SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management.
ABSTRACT
BACKGROUND: Limited follow-up data on aesthetic outcome and survival after microsurgical reconstruction of complex scalp and forehead defects are available. These data are important to improve reconstruction quality and patient counseling. The purpose of this study was to evaluate surgical, aesthetic, and oncologic outcome of free flap scalp and forehead reconstructions in the patient population of two academic centers. METHODS: Retrospective data analysis of patients with a microsurgical reconstruction of the scalp or forehead between January of 1999 and June of 2008 was performed. Aesthetic outcome was assessed on a five-point Likert scale for flap color match, contour, and overall aesthetic result. RESULTS: The group consisted of 84 patients with a mean follow-up time of 27 months (range, 1 to 95 months). Mean defect size was 134 cm (range, 20 to 340 cm), with 46 percent full-thickness bone defects and 16 percent dura defects. The most commonly used free flaps were latissimus dorsi (n = 34) and anterolateral thigh (n = 24). Total flap failure occurred in five patients (6 percent). Disease-free survival and overall survival rates at 5 years were 57 and 65 percent, respectively. Additional operations for aesthetic reasons were performed in 19 patients (23 percent). Panel scores showed a significant lower satisfaction with reconstruction of defects that were located over the frontal scalp compared with other locations (p = 0.004). CONCLUSIONS: Microsurgical reconstruction in complex scalp and forehead defects is a safe procedure. From the authors' experience, they suggest an algorithm for reconstruction of these complex reconstructive defects that will most likely result in the best aesthetic result.