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1.
J Healthc Manag ; 66(4): 258-270, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34228685

RESUMEN

EXECUTIVE SUMMARY: Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.


Asunto(s)
COVID-19 , Enfermería de Cuidados Críticos/economía , Enfermería de Cuidados Críticos/normas , Disparidades en Atención de Salud/normas , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/normas , Calidad de la Atención de Salud/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Satisfacción del Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/estadística & datos numéricos , SARS-CoV-2 , Estados Unidos
2.
Bone Joint J ; 103-B(7 Supple B): 129-134, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34192904

RESUMEN

AIMS: Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. METHODS: A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed. RESULTS: At mean 12.2 years (2 to 24) follow-up, HHS improved from mean 34.2 (20.8 to 60.5) to 75 (53.6 to 94.0; p < 0.001). Mean postoperative ROM was flexion 77° (50° to 95°), abduction 30° (10° to 40°), adduction 20° (5° to 25°), internal rotation 18° (2° to 30°), and external rotation 17° (5° to 30°). LLD improved from mean -3.36 cm (0 to 8) to postoperative mean -1.14 cm (0 to 4; p < 0.001). Postoperatively, 26 patients (68.4%) required the use of a walking aid. Complications included one (2.5%) dislocation, two (5.1%) partial sciatic nerve injuries, one (2.5%) deep periprosthetic joint infection, two instances of (5.1%) acetabular component aseptic loosening, two (5.1%) periprosthetic fractures, and ten instances of HO (40%), of which three (7.7%) were functionally limiting and required excision. Kaplan-Meier Survival was 97.1% (95% confidence interval (CI) 91.4% to 100%) at ten years and 88.2% (95% CI 70.96 to 100) at 15 years with implant revision for aseptic loosening as endpoint and 81.7% (95% CI 70.9% to 98.0%) at ten years and 74.2% (95% CI 55.6 to 92.8) at 15 years follow-up with implant revision for all cause failure as endpoint. CONCLUSION: The use of an optimal and consistent surgical technique and cementless implants can result in significant functional improvement, low complication rates, long-term implant survival, and high patient satisfaction following conversion of hip fusion to THA. The possibility of requiring a walking aid should be discussed with the patient before surgery. Cite this article: Bone Joint J 2021;103-B(7 Supple B):129-134.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Complicaciones Posoperatorias/epidemiología , Recuperación de la Función , Adolescente , Adulto , Anciano , Niño , Preescolar , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Diferencia de Longitud de las Piernas/epidemiología , Masculino , Persona de Mediana Edad , Osificación Heterotópica/epidemiología , Satisfacción del Paciente , Falla de Prótesis , Rango del Movimiento Articular , Estudios Retrospectivos , Análisis de Supervivencia
3.
Acta Biomed ; 92(3): e2021228, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34212931

RESUMEN

Background The aim of this retrospective study is to evaluate the patient-reported outcome after immediate ADM-assisted implant- based breast reconstruction. Material and Methods Patients underwent breast reconstruction from 2015 to 2019 have been retrospectively divided into group A (partial subpectoral implant and ADM and group B (expander/implant). For each patient we evaluated retrospectively postoperative complications and patients' satisfaction. Results 26 patients from the case group and 40 from the control group completed the BREAST-Q. The incidence of complications in the cases was 18.4%, while in the control group was 20.4%.  We found no statistical difference in most of the domains and in the mean score of the questionnaire (mean score cases=69.0±14.4 vs controls=68.4±15.7; p=0.888). A significant difference results only in the domains Q2a and Q2b, sensation of rippling. Conclusions. The use of ADM in one-stage reconstruction allows to perform breast reconstruction in only one surgery, with similar complication rates and patient satisfaction.


Asunto(s)
Dermis Acelular , Implantación de Mama , Implantes de Mama , Neoplasias de la Mama , Mamoplastia , Femenino , Humanos , Mastectomía , Satisfacción del Paciente , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos
4.
Biol Pharm Bull ; 44(7): 1019-1023, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1292126

RESUMEN

To prevent cognitive decline, non-pharmacological therapies such as reminiscence for mild cognitive impairment (MCI) are required, however, the use of nursing homes was limited due to coronavirus disease 2019 (COVID-19). Therefore, the demand for remote-care is increasing. We hypothesized that immersive virtual reality (iVR) could be used more effectively than conventional reminiscence for anxiety. We first examined the effectiveness and safety of reminiscence using iVR (iVR reminiscence session) in patients with MCI. After COVID-19 imposed restriction on visiting nursing homes, we conducted online iVR reminiscence session (remote iVR reminiscence session) and compared its effectiveness with that of interpersonal iVR reminiscence session (face-to-face iVR reminiscence session). The results of two elderly with MCI suggested that iVR reminiscence could reduce anxiety and the burden of care without serious side effects. The effects of remote iVR reminiscence might be almost as effective as those of face-to-face one.


Asunto(s)
Ansiedad/terapia , Disfunción Cognitiva/terapia , Imágenes en Psicoterapia/métodos , Telemedicina/métodos , Realidad Virtual , Anciano de 80 o más Años , Ansiedad/diagnóstico , Ansiedad/psicología , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/psicología , Femenino , Humanos , Masculino , Aplicaciones Móviles , Casas de Salud , Satisfacción del Paciente , Telemedicina/instrumentación , Resultado del Tratamiento
5.
Bone Joint J ; 103-B(7): 1254-1260, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34192925

RESUMEN

AIMS: The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. METHODS: A study of 2,393 TKAs was performed in 2,393 patients. Patient demographics, comorbidities, OKS, EuroQol five-dimension score (EQ-5D), and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and compared with those without. RESULTS: A total of 37 patients (1.5%) suffered a VTE and were significantly more likely to have associated comorbidities of stroke (p = 0.026), vascular disease (p = 0.026), and kidney disease (p = 0.026), but less likely to have diabetes (p = 0.046). In an unadjusted analysis, patients suffering a VTE had a significantly worse postoperative OKS (difference in mean (DIM) 4.8 (95% confidence interval (CI) 1.6 to 8.0); p = 0.004) and EQ-5D (DIM 0.146 (95% CI 0.059 to 0.233); p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent predictor associated with a worse postoperative OKS (DIM -5.4 (95% CI -8.4 to -2.4); p < 0.001), and EQ-5D score (DIM-0.169 (95% CI -0.251 to -0.087); p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89 (95% CI 0.35 to 2.07); p = 0.717). CONCLUSION: Patients who had a VTE within six months of their TKA had clinically significantly worse knee-specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):1254-1260.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Complicaciones Posoperatorias/epidemiología , Recuperación de la Función , Tromboembolia Venosa/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Calidad de Vida , Estudios Retrospectivos , Factores de Riesgo
6.
Bone Joint J ; 103-B(7): 1284-1291, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34192926

RESUMEN

AIMS: Acute distal biceps tendon repair reduces fatigue-related pain and minimizes loss of supination of the forearm and strength of flexion of the elbow. We report the short- and long-term outcome following repair using fixation with a cortical button techqniue. METHODS: Between October 2010 and July 2018, 102 patients with a mean age of 43 years (19 to 67), including 101 males, underwent distal biceps tendon repair less than six weeks after the injury, using cortical button fixation. The primary short-term outcome measure was the rate of complications. The primary long-term outcome measure was the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes included the Oxford Elbow Score (OES), EuroQol five-dimension three-level score (EQ-5D-3L), satisfaction, and return to function. RESULTS: Eight patients (7.8%) had a major complication and 34 (33.3%) had a minor complication. Major complications included re-rupture (n = 3; 2.9%), unrecovered nerve injury (n = 4; 3.9%), and surgery for heterotopic ossification (n = 1; 1.0%). Three patients (2.9%) overall required further surgery for a complication. Minor complications included neurapraxia (n = 27; 26.5%) and superficial infection (n = 7; 6.9%). A total of 33 nerve injuries occurred in 31 patients (30.4%). At a mean follow-up of five years (1 to 9.8) outcomes were available for 86 patients (84.3%). The median QuickDASH, OES, EQ-5D-3L, and satisfaction scores were 1.2 (IQR 0 to 5.1), 48 (IQR 46 to 48), 0.80 (IQR 0.72 to 1.0), and 100/100 (IQR 90 to 100), respectively. Most patients were able to return to work (81/83, 97.6%) and sport (51/62,82.3%). Unrecovered nerve injury was associated with an inferior outcome according to the QuickDASH (p = 0.005), OES (p = 0.004), EQ-5D-3L (p = 0.010), and satisfaction (p = 0.024). Multiple linear regression analysis identified an unrecovered nerve injury to be strongly associated with an inferior outcome according to the QuickDASH score (p < 0.001), along with infection (p < 0.001), although re-rupture (p = 0.440) and further surgery (p = 0.652) were not. CONCLUSION: Acute distal biceps tendon repair using cortical button fixation was found to result in excellent patient-reported outcomes and health-related quality of life. Although rare, unrecovered nerve injury adversely affects outcome. Cite this article: Bone Joint J 2021;103-B(7):1284-1291.


Asunto(s)
Traumatismos del Brazo/cirugía , Anclas para Sutura , Traumatismos de los Tendones/cirugía , Adulto , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Recuperación de la Función , Estudios Retrospectivos
7.
Reprod Health ; 18(1): 146, 2021 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-34229710

RESUMEN

BACKGROUND: Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births. METHODS/DESIGN: The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members. RESULTS: The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique. CONCLUSION: Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.


Asunto(s)
Parto Obstétrico/psicología , Parto/psicología , Aceptación de la Atención de Salud/psicología , Satisfacción del Paciente , Mujeres/psicología , Estudios Transversales , Parto Obstétrico/métodos , Femenino , Humanos , Recién Nacido , Irán , Parto/etnología , Embarazo , Relaciones Profesional-Paciente , Investigación Cualitativa , Calidad de la Atención de Salud , Confianza
8.
Artículo en Inglés | MEDLINE | ID: mdl-34200305

RESUMEN

Public-private partnerships (PPP) represent an alternative model of health management focused on improving the quality of health services, particularly in emerging countries. To date, a systematic method to improve the perceived quality of health services by healthcare users in Peru has not been established. The purpose of this study was to evaluate the quality of health services in two PPP hospitals in Peru using the Kano model. A prospective cross-sectional descriptive observational study was carried out through a health service satisfaction survey using the Kano model methodology, measuring six categories of attributes. A total of 250 users of the health services were surveyed in the two PPP hospitals, located in Lima and Callao, using non-probability convenience sampling. Of the 31 attributes evaluated by the patients, 27 (81%) were classified as having a one-dimensional-type attribute, 3 (10%) were reported as mandatory, and 1 (3%) was considered as inverse. These results suggest that the presence of most of the attributes evaluated was relevant to maintaining the level of user satisfaction and that the absence of these attributes generated dissatisfaction in the users. The results showed that the users' evaluation of health services was multidimensional-namely, their evaluation was focused not only on the interaction space between the patient and medical personnel but also addressed other interaction services.


Asunto(s)
Servicios de Salud , Satisfacción del Paciente , Estudios Transversales , Humanos , Nigeria , Perú , Estudios Prospectivos , Calidad de la Atención de Salud
9.
Health Qual Life Outcomes ; 19(1): 174, 2021 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-34217326

RESUMEN

BACKGROUND: The main aim of post-mastectomy breast reconstruction is to improve the patient's quality of life, which makes high-quality and validated patient-reported outcome measurements essential. None of the established instruments include evaluation of donor-site morbidity, such as impact on upper extremity and back function, when a latissimus dorsi (LD) muscle is used; and BREAST-Q LD questionnaire was therefore recently developed for this purpose. The aim of this study was to translate into Swedish and culturally adapt the BREAST-Q LD questionnaire's two subscales, appearance and function, and perform a psychometric evaluation of the subscales in a Swedish population of patients. METHODS: This was a cross-sectional study. The questionnaire was translated according to established guidelines. The questionnaires were sent to all patients operated using an LD flap between 2007 and 2017. Internal consistency was assessed using Cronbach's α. Inter-item correlations and corrected item-total correlations were calculated using the Pearson's correlation coefficient. Convergent validity was evaluated by comparing the BREAST-Q LD questionnaire to the Western Ontario Osteoarthritis of the Shoulder Index, using the Spearman correlation coefficient. Test-retest reliability was tested with intraclass correlation coefficients (ICCs), and the coefficient of variation and Bland-Altman plots were drawn. Floor and ceiling effects were calculated. Known-group validation was tested by comparing scores from the patients and from normal controls using the Mann-Whitney U-test and by calculating eta squared effect size. RESULTS: The questionnaires were sent to 176 eligible patients and 125 responded (71%). The patients had been operated a mean of 6.6 years ago, and most (92%) had previous radiation. Internal consistency was satisfactory for both subscales. The correlation coefficients between questions were r > 0.30 for all items of both scales. The corrected item-total correlation coefficient ranged from 0.62 to 0.90. As hypothesised, the function scale was correlated with the WOOS "Physical symptoms" subscale. Reliability was adequate according to the ICCs. The ceiling effect threshold for the appearance scale was reached and that for the back scale was almost reached. There were significant differences between patients and controls, in the hypothesised direction. CONCLUSIONS: The results of this study support a good internal consistency, convergent validity, test-retest reliability and known-group validation for the Swedish BREAST-Q LD questionnaire. However, it may be difficult to discriminate between patients with very mild and those with no symptoms using the appearance scale. TRIAL REGISTRATION: ClinicalTrials.Gov identifier NCT04526561.


Asunto(s)
Neoplasias de la Mama/cirugía , Mamoplastia , Mastectomía , Satisfacción del Paciente , Psicometría , Músculos Superficiales de la Espalda/trasplante , Colgajos Quirúrgicos , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Mastectomía/métodos , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Psicometría/métodos , Calidad de Vida , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Suecia , Traducciones
10.
N Z Med J ; 134(1538): 77-88, 2021 07 09.
Artículo en Inglés | MEDLINE | ID: mdl-34239147

RESUMEN

AIMS: Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal guideline-directed medical therapy (GDMT) is challenging. COVID-19 created a need to explore new ways to deliver care. METHODS: Fifty consecutive patients were taught to identify fluid congestion and monitor their vital signs using BP monitors and electronic scales with NP-led telephone support. Quantitative data were collected and a patient experience interview was performed. RESULTS: The majority (76%) of the cohort (male, 76%; Maori/Pacific, 58%) had a new diagnosis of HFrEF, with 90% having severe left ventricular (LV) dysfunction. There were 216 contacts (129 (60%) by telephone), which eliminated travelling, (time saved, 2.12 hours per patient), petrol costs ($58.17 per patient), traffic pollution (607 Kg of CO2) and time off work. Most (75%) received contact within two weeks and 75% were optimally titrated within two months. Improvements in systolic BP (SBP) (124mmHg to 116mmHg), pulse (78 bpm to 70 bpm) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (292 to 65) were identified. Of the 43 patients who had a follow-up transthoracic echocardiogram (TTE), 33 (77%) showed important improvement in left ventricular ejection fraction (LVEF). CONCLUSIONS: Patients found the process acceptable and experienced rapid titration with less need for clinic review with titration rates comparable with most real-world reports.


Asunto(s)
COVID-19/prevención & control , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Enfermeras Practicantes , Pautas de la Práctica en Enfermería , Telemedicina , Anciano , Factor Natriurético Atrial/sangre , Presión Sanguínea , Estudios de Factibilidad , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Satisfacción del Paciente , Proyectos Piloto , Guías de Práctica Clínica como Asunto , Precursores de Proteínas/sangre , SARS-CoV-2 , Volumen Sistólico , Telemedicina/economía , Telemedicina/organización & administración , Teléfono , Viaje/economía
11.
BMC Health Serv Res ; 21(1): 696, 2021 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-34266429

RESUMEN

BACKGROUND: Healthcare complaints are grievances that may be indicative of some system failures, individual failings, or a combination of both. Moreover, the experience of making a complaint, including its outcome, often falls short of patient expectations, particularly in relation to the interpersonal conduct of National Health Service (NHS) staff. Over half of unresolved (local) complaints are subsequently upheld by the ombudsman with others potentially resulting in costly litigation. METHOD: A nuanced discourse analytical approach to analysing the language choices within complaint-responses could potentially provide greater insight into why many local complaints continue to remain unresolved. Over a period of 1 month we collated a data corpus of written complaints and their responses (n = 60) from an NHS healthcare area in Scotland, United Kingdom (UK) following anonymisation by NHS complaint handling staff. We took a qualitative approach to analysing the data drawing upon Discourse Analysis with this paper reporting on the complaint-responses only (n = 59). We had undertaken a similar review of the initial written complaints and this is reported elsewhere. In this paper we examine how, and to what extent, the complaint-responses fully addressed the complainants' perceived grievances. RESULTS: The complaint-responses rarely acknowledged the amount of detail or 'work' involved in making the complaint. Complaint-responses constructed complainants' accounts as subjective by using specific discourse strategies. Further, complaint responses used unintentionality or exceptionality to mitigate sub-standard experiences of care. We also observed the 'fauxpology' - a non-apology or false apology (e.g. I am sorry you feel) which imputes the cause of distress to the subjective (and possibly misguided) impressions of the complainant. The complaint-responses thereby evade blame or responsibility for the complainable action by implying that the complainants' feelings do not align with the facts. CONCLUSIONS: Complainants and complaint-responders work to different frames of reference. Complaint responders need to engage and align with complainants from the outset to ensure more appropriate complaint- responses. Complaint resolution as opposed to complaint handling could be enhanced by the approach of linguistic analysis and reference to the consumer literature's justice-based approach to post-complaint behaviour.


Asunto(s)
Satisfacción del Paciente , Medicina Estatal , Humanos , Investigación Cualitativa , Escocia , Reino Unido
12.
J Laryngol Otol ; 135(7): 634-639, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34254581

RESUMEN

OBJECTIVES: Tonsillectomy has generated extensive comment on the internet, but this content has not been examined in a scientific manner. This study aimed to determine what the blogosphere has to say about adult tonsillectomy and to report whether this information can be used to improve post-surgical care. METHODS: The internet was searched to find personal blogs relating to tonsillectomy. A retrospective review of data collected on these blogs was carried out and the blogs were conceptually analysed by the authors. RESULTS: Fifty blogs were included. Seventy per cent of patients had read blogs prior to their procedure. The average pain score where available was 7.2. Complications occurred in 10 per cent of patients. Only 1 patient (2 per cent) regretted having a tonsillectomy. CONCLUSION: It is important for otolaryngologists to stay in tune with the blogosphere as this unregulated and easily accessible source of information is both friend and foe but will ultimately help in pre-operative counselling and post-operative management.


Asunto(s)
Analgésicos/uso terapéutico , Blogging , Dolor Postoperatorio/tratamiento farmacológico , Satisfacción del Paciente , Complicaciones Posoperatorias , Tonsilectomía , Tonsilitis/cirugía , Adulto , Femenino , Humanos , Internet , Masculino , Dimensión del Dolor
13.
J Coll Physicians Surg Pak ; 30(7): 868-870, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34271796

RESUMEN

The origin of the patient-centered interdisciplinary collaborative round, which involves health care members of all levels at a time, is an effective and emerging approach to offer inpatient healthcare. Traditionally, post-partum rounds at teaching hospitals consisted of separate visits from all members of the obstetric team that resulted in patient inconvenience, care insufficiencies, and communication gaps. The main objective of this study was to assess the patient's satisfaction level from the traditional post-partum round versus the patient-centered collaborative care (PCCC) round. This study showed that in the traditional round, the patient's satisfaction with the treatment was 95.1%; whereas, in PCCC rounds it was 96.9%. Patients were more satisfied with the treatment options discussed with them and the results of the medical tests explained to them. In conclusion, the survey showed that the implementation of the PCCC round improved patient satisfaction. Key Words: Interdisciplinary collaborative  round, Traditional postpartum round, Patients satisfaction, Clinical competence.


Asunto(s)
Competencia Clínica , Rondas de Enseñanza , Femenino , Humanos , Grupo de Atención al Paciente , Satisfacción del Paciente , Atención Dirigida al Paciente , Periodo Posparto , Embarazo
14.
Biol Pharm Bull ; 44(7): 1019-1023, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34193684

RESUMEN

To prevent cognitive decline, non-pharmacological therapies such as reminiscence for mild cognitive impairment (MCI) are required, however, the use of nursing homes was limited due to coronavirus disease 2019 (COVID-19). Therefore, the demand for remote-care is increasing. We hypothesized that immersive virtual reality (iVR) could be used more effectively than conventional reminiscence for anxiety. We first examined the effectiveness and safety of reminiscence using iVR (iVR reminiscence session) in patients with MCI. After COVID-19 imposed restriction on visiting nursing homes, we conducted online iVR reminiscence session (remote iVR reminiscence session) and compared its effectiveness with that of interpersonal iVR reminiscence session (face-to-face iVR reminiscence session). The results of two elderly with MCI suggested that iVR reminiscence could reduce anxiety and the burden of care without serious side effects. The effects of remote iVR reminiscence might be almost as effective as those of face-to-face one.


Asunto(s)
Ansiedad/terapia , Disfunción Cognitiva/terapia , Imágenes en Psicoterapia/métodos , Telemedicina/métodos , Realidad Virtual , Anciano de 80 o más Años , Ansiedad/diagnóstico , Ansiedad/psicología , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/psicología , Femenino , Humanos , Masculino , Aplicaciones Móviles , Casas de Salud , Satisfacción del Paciente , Telemedicina/instrumentación , Resultado del Tratamiento
15.
Medicina (Kaunas) ; 57(7)2021 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-34209250

RESUMEN

Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for "Whole Health Veterans Administration," "integrative medicine," "integrative health," "complementary and alternative medicine," and, as they related to the outcomes, of "health outcomes," "cost-effectiveness," "cost reduction," "patient satisfaction," and "physician satisfaction." Additional studies were identified from an initial search and the authors' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.


Asunto(s)
Medicina Integral , Autocuidado , Atención Ambulatoria , Humanos , Satisfacción del Paciente , Atención Primaria de Salud , Estados Unidos
16.
Urologe A ; 60(6): 732-739, 2021 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-34061221

RESUMEN

In implant surgery for erectile dysfunction and urinary incontinence, adequate patient selection is essential for postoperative therapy success. Several scientific studies report patient satisfaction rates for penile implants and artificial urinary sphincter implantation of over 90%. Nevertheless, studies also report, that between 5 and 30% of the patients are not satisfied with the result of their operation. Sufficient patient information and consent prior surgical procedure in urological prosthetics are a key determinant for later patient satisfaction and therapy success. Diligent assessment of realistic expectations, possible complications, and risks must be made. Unrealistic and exaggerated expectations need to be met and discussed with the patient. Therefore adequate physician-patient communication is essential. Especially in the case of surgical revision or for patients with risk factors, the probability of complications is higher and may significantly increase later dissatisfaction. Also, the involvement of the partner plays a major role in later patient satisfaction in urological implant surgery. Finally, there is a group of patients for which the risk of later dissatisfaction is particularly high. These are patients with compulsive/obsessive behavior, unrealistic expectations, patients after revision surgery, self-entitled patients, as well as those patients who deny the extent of their illness, visit multiple surgeons (surgeon hopping) or have psychiatric illnesses. These patients are referred to with the acronym "CURSED" patients.


Asunto(s)
Disfunción Eréctil , Implantación de Pene , Prótesis de Pene , Urología , Comunicación , Disfunción Eréctil/cirugía , Humanos , Consentimiento Informado , Masculino , Satisfacción del Paciente , Selección de Paciente
17.
Rev Med Suisse ; 17(743): 1177-1181, 2021 Jun 16.
Artículo en Francés | MEDLINE | ID: mdl-34133096

RESUMEN

Breast hypertrophy (macromastia) can cause various symptoms correlated with excessive breast volume and is usually associated with breast ptosis. Symptomatic macromastia can constitute a heavy burden on patient's global health. While conservative therapy does not allow for long term relief, breast reduction mammaplasty is an effective and safe treatment. Multiple techniques have been described, but all rely on common principles. Measures can be taken to lower surgical complications rates and implemented by primary care physicians in collaboration with the plastic surgery approach.


Asunto(s)
Mamoplastia , Satisfacción del Paciente , Mama/cirugía , Tratamiento Conservador , Femenino , Humanos , Hipertrofia/cirugía
18.
BMC Womens Health ; 21(1): 229, 2021 06 03.
Artículo en Inglés | MEDLINE | ID: mdl-34082733

RESUMEN

BACKGROUND: Sleep quality is among the indicators associated with the quality of life of patients with cancer. A multitude of factors may affect patient sleep quality and are considered as associated predictive factors. The aim of this study was to examine the predictors of poor sleep quality in Moroccan women with gynecological cancer after radical surgery. METHODS: A cross-sectional study was carried out at the Oncology Department of the Ibn Rochd University Hospital, Casablanca (Morocco), on women who had undergone radical surgery for gynecological cancer (n = 100; mean age: 50.94 years). To assess sleep quality, symptoms of depression and anxiety, self-esteem and body image, the following translated and validated Arabic versions of the tools were used: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Rosenberg's Self-Esteem Scale and Body Image Scale. To determine predictors of sleep quality, multiple linear and hierarchical regressions were used. RESULTS: 78% of participants were considered poor sleepers, most of them exhibited very poor subjective quality (53%), longer sleep onset latency (55%), short period of sleep (42%) and low rate of usual sleep efficiency (47%). 79% of these patients did not use sleep medication and 28% were in poor shape during the day. Waking up in the middle of the night or early in the morning and getting up to use the bathroom were the main reasons for poor sleep quality. Higher PSQI scores were positively correlated with higher scores of anxiety, depression, body image dissatisfaction and with lower self-esteem (p < 0.001). The medical coverage system, body image dissatisfaction and low self-esteem predicted poor sleep quality. After controlling for the socio-demographic variables (age and medical coverage system), higher body image dissatisfaction and lower self-esteem significantly predicted lower sleep quality. CONCLUSION: Body image dissatisfaction and lower self-esteem were positively linked to sleep disturbance in women with gynecological cancer after undergone radical surgery. These two predictors require systematic evaluation and adequate management to prevent sleep disorders and mental distress as well as improving the quality of life of these patients.


Asunto(s)
Insatisfacción Corporal , Neoplasias , Trastornos del Sueño-Vigilia , Imagen Corporal , Estudios Transversales , Depresión/etiología , Femenino , Humanos , Persona de Mediana Edad , Marruecos , Satisfacción del Paciente , Calidad de Vida , Autoimagen , Sueño , Trastornos del Sueño-Vigilia/etiología , Encuestas y Cuestionarios
19.
J Med Life ; 14(2): 250-256, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34104249

RESUMEN

This was a clinical trial study that aimed to investigate the efficacy of vaginal chlorhexidine gel in the treatment of vulvovaginal candidiasis, bacterial vaginosis, and nonspecific vaginitis. The study population included patients who complained of vaginal discharge and presented to our University Gynecology Clinic. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software. The student t-test and Mann-Whitney U test were used to analyze the quantitative and ordinal data, respectively. In order to analyze the qualitative data, the Chi-square or Fischer's exact tests were used. The mean satisfaction score in the vulvovaginal candidiasis patients who received chlorhexiine vaginal gel was 9.06 and 8.29 in the patients who received clotrimazole vaginal cream. The Mann-Whitney test did not show a statistically significant difference between mean scores of VAS in these two groups with vulvovaginal candidiasis (P=0.027). Among the patients with bacterial vaginosis, the mean satisfaction score was 8.91 in the chlorhexidine vaginal gel group and 8.72 in the metronidazole tablet group (P=0.607). In the nonspecific vaginitis group, the mean satisfaction score was 8.83 in the chlorhexidine vaginal gel group and 9.17 in the combination group (metronidazole + clotrimazole vaginal cream)(P=0.401). The highest mean visual analog scale score (VAS) score was documented in the combination therapy group. We found that chlorhexidine vaginal gel is a more effective method for the treatment and improvement of vaginal infections. The benefits of chlorhexidine gel have a positive therapeutic effect as a single drug in nonspecific vaginitis, rather than simultaneous administration of two agents.


Asunto(s)
Candidiasis Vulvovaginal/tratamiento farmacológico , Clorhexidina/uso terapéutico , Clotrimazol/uso terapéutico , Metronidazol/uso terapéutico , Vaginosis Bacteriana/tratamiento farmacológico , Vulvovaginitis/tratamiento farmacológico , Adulto , Clotrimazol/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Metronidazol/administración & dosificación , Satisfacción del Paciente , Escala Visual Analógica
20.
Medicine (Baltimore) ; 100(24): e26175, 2021 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-34128848

RESUMEN

ABSTRACT: Reconstruction of breast defects of patients who underwent mastectomy can be challenging. This study was designed to review a series of 43 breast cancer patients who underwent immediate breast reconstruction (IBR) using the latissimus dorsi myocutaneous flap with/without implants. The demographic characteristics, clinical application feasibility, and the satisfaction rates of the patients were retrospectively collected and evaluated.A total of 43 breast cancer patients who underwent mastectomy between August 2015 and February 2020 were included in the retrospective study. The included patients were subjected to IBR using latissimus dorsi muscular flap (LDMF) with/without implants. The clinical application feasibility and the satisfaction rates of the patients were evaluated.Among these patients, 35 patients underwent nipple-sparing mastectomy and 8 patients underwent skin-sparing mastectomy. Twenty-nine patients underwent IBR using LDMF with implants, and 14 patients underwent IBR using LDMF without implants. Among these patients, 2 patients had partial LDMF necrosis and atrophy, and showed significant shrink of the reconstructed breast. One patient developed seromas, and seromas were improved by active dressing change and sucking out the fluid via the skin using a syringe. Two patients had local skin flap necrosis on the chest, 1 patient had preserved areola and local necrosis of the nipple, and this was healed after dressing change. Based on the Harris method, 27, 9, 5, and 2 cases were evaluated as "excellent," "good," "fair," and "poor," respectively.In the present study, the reconstructed breast has natural shape, good symmetry, and hidden postoperative scars. The aesthetic effect is relatively good, and the use of LDMF may represent an acceptable and valid option for IBR. The success of this procedure depends on the design of the incision, the skill and proficiency of the operation, as well as the correct treatment after surgery.


Asunto(s)
Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Colgajo Miocutáneo/trasplante , Músculos Superficiales de la Espalda/trasplante , Adulto , Implantes de Mama , China , Estética , Estudios de Factibilidad , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Retrospectivos , Resultado del Tratamiento
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