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1.
Medicine (Baltimore) ; 99(35): e22035, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871960

RESUMO

Imbalances in the gut microbiota mediate the progression of neurodegenerative diseases such as Parkinson's disease (PD). Fecal microbiota transplantation (FMT) is currently being explored as a potential therapy for PD. The objective of this study was to assess the efficacy and safety of FMT on PD. Fifteen PD patients were included, 10 of them received FMT via colonoscopy (colonic FMT group) and 5 received FMT via nasal-jejunal tube (nasointestinal FMT group). The score of PSQI, HAMD, HAMA, PDQ-39, NMSQ and UPDRS-III significantly decreased after FMT treatment (all P < .05). Colonic FMT group showed significant improvement and longer maintenance of efficacy compared with nasointestinal FMT (P = .002). Two patients achieved self-satisfying outcomes that last for more than 24 months. However, nasointestinal FMT group had no significant therapeutic effect, although UPDRS-III score slightly reduced. There were no patients were satisfied with nasointestinal FMT for more than 3 months. Among 15 PD patients, there were 5 cases had adverse events (AEs), including diarrhea (2 cases), abdominal pain (2 cases) and flatulence (1 case). These AEs were mild and self-limiting. We conclude that FMT can relieve the motor and non-motor symptoms with acceptable safety in PD. Compared with nasointestinal FMT, colonic FMT seems better and preferable.


Assuntos
Transplante de Microbiota Fecal/estatística & dados numéricos , Doença de Parkinson/terapia , Idoso , Colonoscopia , Transplante de Microbiota Fecal/efeitos adversos , Transplante de Microbiota Fecal/métodos , Feminino , Humanos , Intubação Gastrointestinal , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Projetos Piloto , Adulto Jovem
2.
Arthroscopy ; 36(9): 2464-2465, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891247

RESUMO

Despite its overall good results, meniscal allograft transplantation is considered a salvage procedure, and abstention from sport practice is considered a valid solution to preserve the transplanted meniscus as long as possible. However, many patients want to return to sport, and this is often beneficial for them. Therefore, we should know how meniscal allograft transplantation performs in terms of return to sport to better counsel our patients. It is thus of primary importance to discuss general and sport-related expectations with each patient, whom should be informed of the potential short- and long-term risks of strenuous or light sport activities. In particular, the high risk of reoperation, the long recovery time, and the potentially deleterious effect of sporting activity on graft survival should be quite clear to both surgeons and patients because, when it comes to return-to-sport decisions, "It takes two to tango"!


Assuntos
Menisco , Volta ao Esporte , Aloenxertos , Humanos , Meniscos Tibiais , Satisfação do Paciente
3.
Soins ; 65(845): 20-22, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32862958

RESUMO

Over 40 patients benefited from remote iconographic follow-up of wounds in an oncology centre. This system is piloted by three expert nurses. They carry out an initial analysis of the photographs received, seek medical expertise if necessary and liaise with the city's professionals. This system makes it possible to expertly accompany professionals and patients while avoiding unnecessary travel. The satisfaction survey conducted in 2018 established full satisfaction of patients and professionals (> 95%) and a guarantee in terms of the safety and quality of care of the wounds.


Assuntos
Assistência ao Convalescente/métodos , Institutos de Câncer , Satisfação do Paciente/estatística & dados numéricos , Consulta Remota/métodos , Ferimentos e Lesões/terapia , Pesquisas sobre Serviços de Saúde , Humanos , Enfermagem Oncológica , Fotografação , Projetos Piloto
4.
Arthroscopy ; 36(8): 2202-2203, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747063

RESUMO

Resilience is a psychological factor that has been shown to affect outcomes after stressful events. Recent work has detected a correlation between patient resilience and surgical outcome. Issues of postoperative pain response, patient-reported outcomes, and ultimate outcomes may all be affected by resilience, and thus research into these relationships and how to optimize psychologic fitness as part of a perioperative plan are of interest.


Assuntos
Artroscopia , Manejo da Dor , Humanos , Articulação do Joelho , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente
5.
Front Health Serv Manage ; 37(1): 10-13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842083

RESUMO

The question of how to engender patient trust in a pandemic is not easy to answer, and yet it is a critical question that requires a convincing response. On March 14, 2020, the surgeon general of the United States called for a stop to elective procedures. Ultimately, that led us at Scripps Health to close some clinics to protect personal protective equipment supplies and then furlough staff because of the decrease in patient visits. It soon became evident, however, that patients needed our care more than ever, and we had to pivot to provide the services they needed-but in a very different way. Our team rose to the challenge and quickly redesigned the entire organizational approach to accelerate telehealth services for the convenience of our patients. In the process, we also targeted a patient outreach program to our high-risk patients, which turned out to be an important aspect of our COVID-19 patient care initiative.


Assuntos
Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Pandemias , Participação do Paciente/psicologia , Satisfação do Paciente , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Telemedicina/organização & administração , Confiança , Betacoronavirus , California , Humanos , Relações Enfermeiro-Paciente , Relações Médico-Paciente
6.
JMIR Mhealth Uhealth ; 8(8): e19433, 2020 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795985

RESUMO

BACKGROUND: Dental visits are unpleasant; sometimes, patients only seek treatment when they are in intolerable pain. Recently, the novel coronavirus (COVID-19) pandemic has highlighted the need for remote communication when patients and dentists cannot meet in person. Gingivitis is very common and characterized by red, swollen, bleeding gums. Gingivitis heals within 10 days of professional care and with daily, thorough oral hygiene practices. If left untreated, however, its progress may lead to teeth becoming mobile or lost. Of the many medical apps currently available, none monitor gingivitis. OBJECTIVE: This study aimed to present a characterization and development model of a mobile health (mHealth) app called iGAM, which focuses on periodontal health and improves the information flow between dentists and patients. METHODS: A focus group discussed the potential of an app to monitor gingivitis, and 3 semistructured in-depth interviews were conducted on the use of apps for monitoring gum infections. We used a qualitative design process based on the Agile approach, which incorporated the following 5 steps: (1) user story, (2) use cases, (3) functional requirements, (4) nonfunctional requirements, and (5) Agile software development cycles. In a pilot study with 18 participants aged 18-45 years and with different levels of health literacy, participants were given a toothbrush, toothpaste, mouthwash, toothpicks, and dental floss. After installing iGAM, they were asked to photograph their gums weekly for 4 weeks. RESULTS: All participants in the focus group believed in the potential of a mobile app to monitor gingivitis and reduce its severity. Concerns about security and privacy issues were discussed. From the interviews, 2 themes were derived: (1) "what's in it for me?" and (2) the need for a take-home message. The 5 cycles of development highlighted the importance of communication between dentists, app developers, and the pilot group. Qualitative analysis of the data from the pilot study showed difficulty with: (1) the camera, which was alleviated with the provision of mouth openers, and (2) the operation of the phone, which was alleviated by changing the app to be fully automated, with a weekly reminder and an instructions document. Final interviews showed satisfaction. CONCLUSIONS: iGAM is the first mHealth app for monitoring gingivitis using self-photography. iGAM facilitates the information flow between dentists and patients between checkups and may be useful when face-to-face consultations are not possible (such as during the COVID-19 pandemic).


Assuntos
Assistência Odontológica/métodos , Gengivite/prevenção & controle , Aplicativos Móveis , Fotografação , Telemedicina , Adolescente , Adulto , Infecções por Coronavirus/epidemiologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Satisfação do Paciente/estatística & dados numéricos , Projetos Piloto , Pneumonia Viral/epidemiologia , Pesquisa Qualitativa , Interface Usuário-Computador , Adulto Jovem
7.
BMJ Open ; 10(8): e039646, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32792455

RESUMO

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic poses immense challenges for national and international healthcare systems. Especially in times of social isolation and governmental restrictions, mental health should not be neglected. Innovative approaches are required to support psychologically burdened people. The e-mental health intervention 'CoPE It' has been developed to offer manualised and evidence-based psychotherapeutic support adapted to COVID-19-related issues in order to overcome psychological distress. In our study, we aim to assess the efficacy of the e-mental health intervention 'CoPE It' in terms of reducing distress (primary outcome), depression and anxiety symptoms as well as improving self-efficacy, quality of life and mindfulness (secondary outcomes). Furthermore, we want to evaluate the programme's usability, feasibility and participants' satisfaction with 'CoPE It' (tertiary outcome). METHODS AND ANALYSIS: The e-mental health intervention 'CoPE It' consists of four 30 min modules, conducted every other day, involving psychotherapeutic techniques of mindfulness-based stress reduction and cognitive-behavioural therapy. The widely applied and previously established content has been adapted to the context of the COVID-19 pandemic by experts in psychosomatic medicine and stress prevention. In our longitudinal study, adult participants-with adequate German language and computer skills, and who have provided informed consent-will be recruited via emergency support hotlines in Germany. Flyers will be distributed, and online channels will be used. Participants will complete a baseline assessment (T0), a postintervention assessment (T1) and assessments 1 and 3 months later (T2 and T3, respectively). We will perform repeated measures analysis of covariance, mixed linear models, standard analyses of variance and regression, and correlation coefficients. In case of binary outcome variables, either mixed logistic regression or χ² tests will be used. ETHICS AND DISSEMINATION: The Ethics Committees of the University of Duisburg-Essen (20-9243-BO) and University of Tübingen (469/2020BO) approved the study. Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: DRKS00021301.


Assuntos
Adaptação Psicológica , Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/psicologia , Aconselhamento à Distância/métodos , Atenção Plena/métodos , Pneumonia Viral/psicologia , Estresse Psicológico/terapia , Ansiedade/prevenção & controle , Ansiedade/terapia , Betacoronavirus , Depressão/prevenção & controle , Depressão/terapia , Humanos , Pandemias , Satisfação do Paciente , Qualidade de Vida , Autoeficácia , Estresse Psicológico/prevenção & controle
8.
Plast Reconstr Surg ; 146(2): 147e-155e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740576

RESUMO

BACKGROUND: As one of the most commonly used soft-tissue fillers, hyaluronic acid is generally considered safe and efficacious. However, evident bone resorption in mentum was observed. In this study, the authors analyzed the impact of hyaluronic acid on bone resorption in mentum and the influencing factors. METHODS: The authors retrospectively compared the computed tomographic scans of patients with or without mentum augmentation using hyaluronic acid. The body mass index- and sex-matched control group was selected randomly. Semimandibular bone resorption index was calculated as the ratio of bone thickness in the incisive fossa to that in the mandibular symphysis. Injection volume, injection interval, the number of injections, product, complication were also recorded. RESULTS: From January of 2014 to June of 2019, 80 patients (160 cases) and 80 controls were recruited. The bone resorption index in the hyaluronic acid injection cohort was significantly lower than in the controls (75.25 ± 10.02 versus 82.86 ± 6.38; p = 0.000). Patients injected with greater than or equal to 1 ml per time were more susceptible to bone erosion compared with patients injected with less (68.89 ± 10.84 versus 76.49 ± 9.42; p = 0.000). There was no significant difference between one- versus multiple-injection groups and short-injection-interval versus long-injection-interval (≥6 months) groups. Furthermore, no reduced aesthetics were realized. CONCLUSIONS: Hyaluronic acid injection could induce bone resorption in the mentum; nevertheless, the aesthetics were not impaired. The severity of the bone loss was positively correlated with the injection volume per time; therefore, large-volume injection of hyaluronic acid should be performed with caution. The patients should be fully informed about this complication preoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Reabsorção Óssea/induzido quimicamente , Queixo/diagnóstico por imagem , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Ácido Hialurônico/efeitos adversos , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/terapia , Reabsorção Óssea/diagnóstico , Reabsorção Óssea/epidemiologia , Reabsorção Óssea/cirurgia , Preenchedores Dérmicos/administração & dosagem , Estética , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Incidência , Masculino , Satisfação do Paciente , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Plast Reconstr Surg ; 146(2): 284-293, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740577

RESUMO

BACKGROUND: Gluteal prominence is a unique characteristic that is widely acknowledged in female contouring but ignored in the male population. This study focuses on male gluteal aesthetics based on a muscular anatomical approach. METHODS: A retrospective review of gluteal contouring in men from January of 2012 to September of 2019 was conducted. Male body sculpting surgery in the gluteal area was performed in most cases. Patients were included according to preoperative assessment and the American Heart Association risk analysis. The gluteal area was divided into four main anatomical contouring zones and classified according to the procedure type. The follow-up period of 3 months to 6 years was included with photographs and medical assessment data. A nonstandardized satisfaction survey was performed postoperatively. RESULTS: The analysis included data from 374 consecutive gluteal dynamic definition liposculptures performed in men (mean age, 38.2 years; range, 20 to 66 years). Patients were treated according to the authors' new classification of deformities. Fat extraction, liposhifting, and fat grafting were performed on a regular basis to enhance and define the gluteal area. A satisfaction index of 92.5 percent was reported. Minor complications were reported: seroma, 0.2 percent; prolonged bruising, 1.3 percent; and swelling, 1.8 percent. No necrosis, burns, or infections were reported. CONCLUSIONS: Men have been increasingly requesting improvement and definition of the buttocks, and our novel algorithm allows for a reliable method in this regard. The high satisfaction index supports the natural and athletic results accomplished with our new approach.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/métodos , Nádegas/anatomia & histologia , Estética , Lipectomia/métodos , Adulto , Idoso , Contorno Corporal/efeitos adversos , Nádegas/diagnóstico por imagem , Seguimentos , Humanos , Lipectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Adulto Jovem
10.
BMJ Health Care Inform ; 27(3)2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32796085

RESUMO

BACKGROUND: The COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services. OBJECTIVE: To describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform 'Attend Anywhere' in Moorfields Eye Hospital's accident and emergency (A&E) department (London, UK). METHOD: Patient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service. RESULTS: In the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5-31 min) and the wait time was 6 min (range 0-37 min). CONCLUSION: Video consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/organização & administração , Oftalmopatias , Oftalmologia , Encaminhamento e Consulta/estatística & dados numéricos , Telemedicina/organização & administração , Infecções por Coronavirus , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/tendências , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Feminino , Humanos , Londres , Masculino , Pandemias , Satisfação do Paciente , Pneumonia Viral
11.
Medicine (Baltimore) ; 99(34): e21947, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846864

RESUMO

An intermittent closure with silk suture is routinely used for closing different surgical wounds. However, subcuticular closure with absorbable sutures has gained considerable attention due to convenience and better cosmetic appearance.To compare the clinical outcomes and risk of surgical-site infection of subcuticular and intermittent closure after total-knee arthroplasty (TKA), 106 patients that underwent TKA between January 2017 to June 2019 at the Department of Orthopedics in Xiangya Hospital of Centre South University were retrospectively assessed. Forty-three had received running subcuticular closure (group A) and 58 underwent intermittent closure (group B). The Knee Society score was measured before and 6 months after operation. Inflammation markers including the serum levels of procalcitonin, interleukin-6, and C-reactive protein, and the erythrocyte sedimentation rate were evaluated before operation, 1 day after and 1 month after operation. Patient satisfaction with the closure was evaluated using the Likert scale at the last follow-up.No significant difference was seen in the 6-month postoperative Knee Society score, or in the 1-day and 6-month postoperative inflammation marker levels between both groups (P > .05). Likert scores were higher in group A compared to group B (4.0 ±â€Š1.0 vs 3.6 ±â€Š1.2, P < .05).Running subcuticular closure after TKA results in a better appearance compared to intermittent closure, although neither method has an advantage in terms of efficacy and risk of infection.


Assuntos
Artroplastia do Joelho/métodos , Pele/patologia , Suturas/tendências , Técnicas de Fechamento de Ferimentos/tendências , Idoso , Sedimentação Sanguínea , Proteína C-Reativa/análise , China/epidemiologia , Feminino , Humanos , Inflamação/metabolismo , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Pró-Calcitonina/sangue , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
12.
J Neural Transm (Vienna) ; 127(9): 1271-1274, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32734554

RESUMO

The SARS-CoV-2 virus pandemic has provoked drastic countermeasures including shutdowns of public services. We wanted to describe the effects of a 6 week shutdown of a large German botulinum toxin (BT) outpatient clinics on patients and their well-being. 45 patients (age 61.9 ± 9.8 years, 29 females, 16 males) receiving BT therapy (319.3 ± 201.9MU-equivalent, treatment duration 8.3 ± 5.5 years) were surveyed with a standardised questionnaire. The shutdown delayed BT therapy by 6.6 ± 2.3 weeks. 93% of the patients noticed increased muscle cramps and 82% increased pain reducing their quality of life by 40.2 ± 19.5%. For 23 patients with cervical dystonia this reduction was 41.1 ± 18.3%, for 3 patients with blepharospasm 33.3 ± 15.3%, for 9 patients with spasticity 37.8 ± 15.6%, for 4 patients with pain conditions 37.4 ± 35.7% and for 3 patients with hemifacial spasm 27.5 ± 17.1%. After the shutdown 66% of patients perceived BT therapy as more important than before, 32% perceived it as unchanged. For all patients long-term availability of BT therapy was very important or important. 98% of the patients perceived the shutdown as inadequate and felt their patient rights not respected. The shutdown confirmed the considerable burden of disease caused by dystonia, spasticity, hemifacial spasm and various pain conditions and the importance of BT therapy to treat them. Any shutdown severely affects these patients and needs to be avoided.


Assuntos
Instituições de Assistência Ambulatorial/tendências , Betacoronavirus , Toxinas Botulínicas Tipo A/administração & dosagem , Infecções por Coronavirus/epidemiologia , Pandemias , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Idoso , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neuromusculares/tratamento farmacológico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/psicologia , Pandemias/prevenção & controle , Inquéritos e Questionários
13.
J Nurs Adm ; 50(9): 474-480, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826517

RESUMO

OBJECTIVE: The aim of this study was to connect patients' perceptions of nurses' daily care actions with patients' overall ratings of their hospital experience and hospitals' human caring culture. BACKGROUND: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey measuring patients' hospital experience. Current literature lacks the connections between patients' perceptions of nurses' daily care actions and their overall hospital experience measured by the HCAHPS survey. METHODS: This is a correlational study based on the HCAHPS surveys from patients discharged from a hospital in the United States. Correlations were conducted between patients' perceptions of nurses' daily care actions and overall hospital experience. RESULTS: A total of 3,258 (16.6%) patients returned the HCAHPS survey between January and May 2019. Significant relationships were found among patients' perceptions of nurses' daily care actions, hospitals' caring culture, and overall experience. CONCLUSION: Nurses' daily care actions significantly contribute to favorable patients' overall hospital ratings on HCAHPS.


Assuntos
Pacientes Internados , Cuidados de Enfermagem/estatística & dados numéricos , Cultura Organizacional , Satisfação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Hospitais , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estados Unidos
14.
Medicine (Baltimore) ; 99(30): e21309, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791717

RESUMO

BACKGROUND: Microscopic bilateral decompression (MBD) has been suggested as an alternative to open laminectomy and fusion. Recently, percutaneous biportal endoscopic decompression (PBED) has begun to attract attention. The purpose of this retrospective study was to evaluate postoperative pain, functional disability, symptom reduction and satisfaction, and specific surgical parameters between the MBD and PBED techniques in patients with lumbar spinal stenosis (LSS). METHODS: A retrospective review of LSS patients performed with MBD or PBED technique between May 2015 and June 2018 was conducted. Institutional review board approval in People's Hospital of Ningxia Hui Nationality Autonomous Region was obtained prior to conducting chart review and analysis. We received informed consent from all patients before surgery. The primary outcomes assessed were the preoperative to postoperative changes in leg/back pain and disability/function, patient satisfaction with the procedure, and postoperative quality of life. The secondary outcomes including duration of postoperative hospital stay, time to mobilization, postoperative analgesic use, complication rates, and baseline patient characteristics were prospectively collected. RESULTS: The hypothesis was that the PBED technique would achieve better clinical outcomes as compared to the MBD technique in LSS.


Assuntos
Descompressão Cirúrgica/tendências , Vértebras Lombares/patologia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Avaliação da Deficiência , Endoscopia/métodos , Humanos , Laminectomia/normas , Tempo de Internação/estatística & dados numéricos , Microscopia/instrumentação , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Qualidade de Vida , Estudos Retrospectivos , Fusão Vertebral/normas , Resultado do Tratamento
15.
Am J Orthod Dentofacial Orthop ; 158(2): 237-246.e4, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32746975

RESUMO

INTRODUCTION: Patients may express views about their orthodontic care by posting publicly available reviews on the Internet. This study analyzed online reviews of orthodontists with an emphasis on the types and frequency of complaints expressed in negative reviews. METHODS: A random sample of 10.6% of the American Association of Orthodontists membership was evaluated to identify members practicing in a North American office that is limited to orthodontics and has an online presence. Information regarding those orthodontists and their offices was collected. For offices with Google and/or Yelp reviews, all negative (1- or 2-star) reviews were saved for content analysis. If an office posted a response to a negative review, those responses were also collected for analysis. RESULTS: Of the 807 eligible orthodontists, 92.4% had reviews on Google and/or Yelp. Average ratings of orthodontists were very positive (ie, 4- and 5-star reviews constituted >97% of Google reviews and >88% of Yelp reviews), yielding an average orthodontist rating of 4.72 on Google and 4.42 on Yelp. However, approximately half of those orthodontists (50.9%) also had at least 1 negative review. The 3 most frequently mentioned categories of complaints were regarding quality of care and/or service, interpersonal interactions, and money and/or financial issues. An analysis of the specific kinds of complaints is described. Orthodontists posting responses to negative reviews had significantly better average ratings than those who did not, but this association does not demonstrate a causal relationship. CONCLUSIONS: Understanding the complaints orthodontic patients express in online reviews may suggest strategies to improve patient satisfaction and an orthodontist's online reputation.


Assuntos
Ortodontia , Ortodontistas , Humanos , Satisfação do Paciente
16.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 678-683, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773800

RESUMO

OBJECTIVE: To evaluate decision regret among patients receiving penile girth enhancement with acellular dermal matrix (PGE with ADM) and to investigate the potential indicators for decisional regret so as to facilitate the decision-making process for this special group. METHODS: In the study, 78 patients receiving PGE with ADM from Jun. 2016 to Jan. 2019 at Peking University People's Hospital and cooperative hospitals were eligible. Penile girth was taken by only one surgeon 1 week before surgery. Hospital anxiety and depression scale (HAD), international index of erectile function (IIEF) and a 10 cm long visual analogue scale named visualized penile image (VPI) were applied to measure psychological burden, erectile function and satisfaction with penile image respectively at the same time. All the patients were followed up for 3 months. Decision regret scale (DRS) was adopted for measuring decisional regret. Multivariate analysis of variance was applied to investigate the potential indicators for regret. Data analysis process was conducted with SPSS (version 24.0; SPSS, Chicago, IL, USA). RESULTS: Mean penile girth recorded before intervention was (8.29±0.30) cm and increased to (9.46±0.29) cm post surgery (t=76.28, P < 0.01). As for both subscales of HAD measuring psychological burden, a signi-ficant reduction in the mean score was seen, that is, 2.8±1.3 (t=19.28, P < 0.05) for anxiety and 3.0±1.2 (t=20.67, P < 0.05) for depression, respectively. The average score of VPI increased by 3.7±1.1 (t=30.63, P < 0.05). There was no significant change in the average score of IIEF measuring erectile satisfaction (t=1.60, P=0.11). Twenty-nine (38.2%) patients expressed regret to some degree, and the mean DRS score was 23.4±14.8. The scores of DRS correlated negatively with scores of visualized penis image (r=-0.348, P < 0.01), and positively with scores of anxiety (r=0.760, P < 0.01) and depression subscale (r=0.471, P < 0.01). The scores of DRS was irrelevant to those of IIEF (r=0.02, P=0.867). The patients with high annual income (> 120 000 yuan) and education level above undergraduate were more prone to experience decision regret after intervention (P < 0.01). CONCLUSION: PGE with ADM did augment penile girth and lower psychological burden, the regret rate of which was acceptably low among the patients. High income and good education might indicate more post-operative regret. Additional decision-making aids should be offered to patients with high income and education level above high school.


Assuntos
Derme Acelular , Emoções , Humanos , Masculino , Satisfação do Paciente , Ereção Peniana , Pênis , Procedimentos Cirúrgicos Reconstrutivos
17.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 762-770, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773816

RESUMO

OBJECTIVE: To compare the clinical efficacy of a kind of complete dentures fabricated using computer aided design/computer aided manufacturing (CAD/CAM) workflow with that of the complete denture fabricated using conventional workflow. METHODS: Twenty edentulous patients were included in this prospective, single-blind, self-controlled clinical trial. Two pairs of complete dentures were fabricated for each participant: one using the functional suitable denture (FSD) system with CAD/CAM, and the other using conventional fabrication workflow. In the final delivery appointment, the conventional dentures worn by the participant for 3 months at first. Then the participant swapped to wear digital denture for another 3 months. The patients' satisfaction and oral health related quality of life (OHRQoL) were measured using the visual analogue scale (VAS) and oral health impact profile (OHIP-20E) at baseline, 2 weeks, 1 month, 2 months, and 3 months following denture delivery. In addition, the masticatory efficiency of each pair of dentures was measured after three months adaptation period for each type of dentures. RESULTS: The VAS scores of the twenty patients in FSD denture group on general satisfaction, ease of cleaning, ability to speak, esthetics, stability and oral health status on these six domains were higher than that of conventional denture group 3 months after delivery. While the VAS cores in FSD denture group on comfort, ability to chew and ability to chew up were the same as those of conventional denture group. But there was no significant difference (P>0.05). The VAS score on each domain in FSD denture group was higher than that of conventional denture group 3 months after delivery, three domains of which reached statistical significance (P < 0.05), involving functional limitation, psychological discomfort and total. The masticatory performance of the FSD denture (1.20±0.54) was slightly higher than that for the conventional denture (1.16±0.53), but the difference did not reach statistical significance (P=0.691). CONCLUSIONS: The clinical efficacy of the FSD complete denture is comparable to that of the conventional complete denture. As for patient satisfaction and oral health related quality of life, FSD dentures received comparable scores as conventional complete dentures did.


Assuntos
Prótese Total , Qualidade de Vida , Humanos , Satisfação do Paciente , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
18.
Med Care ; 58(8): 744-748, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692141

RESUMO

INTRODUCTION: Cancer patients' experience of care is an important component of quality that has not previously been used for comparing performance. We administered a new patient experience survey to cancer patients receiving outpatient chemotherapy treatment. We examined its measures for sensitivity to adjustment for case-mix and response tendency (level of general optimism/pessimism) and reliability for making performance comparisons between practices. METHODS: We surveyed 2304 cancer patients who received chemotherapy at 23 medical oncology practices in Southeastern Pennsylvania, receiving 715 responses (response rate 31%; 14 practices had 10 or more responses). We aggregated patient responses to calculate practice-level scores on 5 predefined composites: Affective Communication, Shared Decision-Making, Patient Self-Management, Exchanging Information, and Access. We then ranked the practices on each composite before and after adjustment for standard case-mix variables and supplemental adjustment for response tendency (measured via the Life Orientation Test-Revised). We calculated the reliability of practice scores on each composite using hierarchical linear models and calculated minimum sample sizes necessary to achieve reliabilities exceeding 0.7. RESULTS: After adjusting responses for case-mix and converting to a 0-100 scale, composite scores ranged from 77 for the Patient Self-Management composite to 92 for the Access composite. Adjustment for response tendency had an impact on practice rankings only for the Shared Decision-Making composite. The number of responses necessary to create reliable practice-level measurements ranged from 17 (Access composite) to 96 (Affective Communication composite). CONCLUSIONS: Patient experiences at oncology practices can be measured reliably using reasonable sample sizes. Standard case-mix adjustment is adequate for making comparisons on most composites.


Assuntos
Institutos de Câncer/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/estatística & dados numéricos , Tomada de Decisão Compartilhada , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Relações Profissional-Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
19.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609440

RESUMO

Efforts to increase patient comfort by minimizing pain and anxiety have been shown to improve clinical outcomes, reduce pain thresholds, decrease analgesic requirements and complication risk, strengthen the physician-patient relationship, and increase overall patient satisfaction. Patients also have a strong preference for patient-centered communication and educational discussion with physicians. In recent years, the increasing emphasis on patient experience scores as a metric for quality care has had significant implications for physician practice and has reinforced attempts to provide more patient-centered care. Though different pharmacologic agents and techniques have been extensively reviewed in the dermatologic literature, there have been few studies of non-pharmacologic strategies for improving patient-centered care. This evidence-based review describes alternative techniques that have been suggested for use in dermatologic surgery. Mechanoanesthesia, cold therapy, verbal and audiovisual distraction, music, optimal needle insertion methods, hypnosis and guided-imagery, perioperative communication, and educational strategies have been reported to improve the patient experience in dermatologic surgery. These interventions are often cost-effective and easy to implement, avoid medication side effects, and serve as adjunct approaches to enhance patient comfort. This review examines the corresponding evidence for these nonpharmacologic strategies to provide a clinical resource for the dermatologic surgeon seeking to optimize the patient experience.


Assuntos
Ansiedade/prevenção & controle , Procedimentos Cirúrgicos Dermatológicos/psicologia , Humanos , Hipnose , Imagens, Psicoterapia , Terapias Mente-Corpo , Filmes Cinematográficos , Música , Dor/prevenção & controle , Educação de Pacientes como Assunto , Satisfação do Paciente
20.
Medicine (Baltimore) ; 99(27): e20967, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629706

RESUMO

BACKGROUND: Hypertension is a silent disease of the masses with an increasing prevalence and poor control rates. This study aims to establish and test the efficacy of a nurse-led hypertension management model in the community. METHODS: A single-blind, randomized controlled trial was performed. 156 hypertensive patients with uncontrolled blood pressure were equally and randomly allocated into 2 groups. Patients in the study group received a 12-week period of hypertension management. Blood pressure, self-care behaviors, self-efficacy, and satisfaction were assessed at the start of recruitment, 12 and 16 weeks thereafter. RESULTS: After the intervention, blood pressure of patients in the study group had greater improvement in self-care behaviors and a higher level of satisfaction with the hypertensive care compared to the control group (both P < .05). CONCLUSIONS: The nurse-led hypertension management model is feasible and effective for patients with uncontrolled blood pressure in the community.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Hipertensão/enfermagem , Padrões de Prática em Enfermagem/normas , Idoso , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Autocuidado , Autoeficácia , Método Simples-Cego
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