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1.
Braz Oral Res ; 33: e54, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365703

RESUMO

The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.


Assuntos
Resinas Compostas/uso terapêutico , Amálgama Dentário/uso terapêutico , Reparação de Restauração Dentária/estatística & dados numéricos , Pigmentação da Pele , Adulto , Fatores Etários , Brasil , Estética Dentária/estatística & dados numéricos , Feminino , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Distribuição de Poisson , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos , Resultado do Tratamento , Adulto Jovem
2.
Am Surg ; 85(7): 768-771, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405426

RESUMO

Both skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are well accepted in the management of breast cancer. Factors that influence the decision of choosing one of these techniques over the other, however, remain to be well elucidated. From January 2010 to December 2017, 734 patients at our institution underwent one of these two procedures. Factors differentiating these patient cohorts were compared. In this study, 196 (26.7%) underwent NSM and 538 (73.3%) underwent SSM. The median age of patients at the time of surgery was 50 years (range, 22-78 years). On multivariate analysis, younger patient age, insurance type, BRCA+ mutation status, smaller breast size (by weight), and those who did not undergo neoadjuvant chemotherapy were more likely to undergo NSM. Surgeon also was an independent predictor of whether patients had NSM or SSM. There may be many factors that play into the decision to pursue NSM versus SSM, but younger patient age, BRCA mutation status, breast size, and whether the patient had neoadjuvant chemotherapy may be key among them. Insurance status may also be a factor for some patients. Aside from these factors, some surgeons may be more or less inclined to perform NSM.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Mamilos , Tratamentos com Preservação do Órgão/métodos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Satisfação do Paciente , Adulto Jovem
3.
Bone Joint J ; 101-B(8): 941-950, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362549

RESUMO

AIMS: The EuroQol five-dimension (EQ-5D) questionnaire is a widely used multiattribute general health questionnaire where an EQ-5D < 0 defines a state 'worse than death' (WTD). The aim of this study was to determine the proportion of patients awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a health state WTD and to identify associations with this state. Secondary aims were to examine the effect of WTD status on one-year outcomes. PATIENTS AND METHODS: A cross-sectional analysis of 2073 patients undergoing 2073 THAs (mean age 67.4 years (sd 11.6; 14 to 95); mean body mass index (BMI) 28.5 kg/m2 (sd 5.7; 15 to 72); 1253 female (60%)) and 2168 patients undergoing 2168 TKAs (mean age 69.3 years (sd 9.6; 22 to 91); BMI 30.8 kg/m2 (sd 5.8; 13 to 57); 1244 female (57%)) were recorded. Univariate analysis was used to identify variables associated with an EQ-5D score < 0: age, BMI, sex, deprivation quintile, comorbidities, and joint-specific function measured using the Oxford Hip Score (OHS) or Oxford Knee Score (OKS). Multivariate logistic regression was performed. EQ-5D and OHS/OKS were repeated one year following surgery in 1555 THAs and 1700 TKAs. RESULTS: Preoperatively, 391 THA patients (19%) and 263 TKA patients (12%) were WTD. Multivariate analysis identified preoperative OHS, deprivation, and chronic obstructive pulmonary disease in THA, and OKS, peripheral arterial disease, and inflammatory arthropathy in TKA as independently associated with WTD status (p < 0.05). One year following arthroplasty EQ-5D scores improved significantly (p < 0.001) and WTD rates reduced to 35 (2%) following THA and 53 (3%) following TKA. Patients who were WTD preoperatively achieved significantly (p < 0.001) worse joint-specific Oxford scores and satisfaction rates one year following joint arthroplasty, compared with those not WTD preoperatively. CONCLUSION: In total, 19% of patients awaiting THA and 12% awaiting TKA for degenerative joint disease are in a health state WTD. Although specific comorbidities contribute to this, hip- or knee-specific function, mainly pain, appear key determinants and can be reliably reversed with an arthroplasty. Cite this article: Bone Joint J 2019;101-B:941-950.


Assuntos
Artroplastia de Quadril/psicologia , Artroplastia do Joelho/psicologia , Indicadores Básicos de Saúde , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/psicologia , Qualidade de Vida/psicologia , Listas de Espera , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
4.
Bone Joint J ; 101-B(8): 984-994, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362557

RESUMO

AIMS: The aim of the Scaphoid Magnetic Resonance Imaging in Trauma (SMaRT) trial was to evaluate the clinical and cost implications of using immediate MRI in the acute management of patients with a suspected fracture of the scaphoid with negative radiographs. PATIENTS AND METHODS: Patients who presented to the emergency department (ED) with a suspected fracture of the scaphoid and negative radiographs were randomized to a control group, who did not undergo further imaging in the ED, or an intervention group, who had an MRI of the wrist as an additional test during the initial ED attendance. Most participants were male (52% control, 61% intervention), with a mean age of 36.2 years (18 to 73) in the control group and 38.2 years (20 to 71) in the intervention group. The primary outcome was total cost impact at three months post-recruitment. Secondary outcomes included total costs at six months, the assessment of clinical findings, diagnostic accuracy, and the participants' self-reported level of satisfaction. Differences in cost were estimated using generalized linear models with gamma errors. RESULTS: The mean cost up to three months post-recruitment per participant was £542.40 (sd £855.20, n = 65) for the control group and £368.40 (sd £338.60, n = 67) for the intervention group, leading to an estimated cost difference of £174 (95% confidence interval (CI) -£30 to £378; p = 0.094). The cost difference per participant increased to £266 (95% CI £3.30 to £528; p = 0.047) at six months. Overall, 6.2% of participants (4/65, control group) and 10.4% of participants (7/67, intervention group) had sustained a fracture of the scaphoid (p = 0.37). In addition, 7.7% of participants (5/65, control group) and 22.4% of participants (15/67, intervention group) had other fractures diagnosed (p = 0.019). The use of MRI was associated with higher diagnostic accuracy both in the diagnosis of a fracture of the scaphoid (100.0% vs 93.8%) and of any other fracture (98.5% vs 84.6%). CONCLUSION: The use of immediate MRI in the management of participants with a suspected fracture of the scaphoid and negative radiographs led to cost savings while improving the pathway's diagnostic accuracy and patient satisfaction. Cite this article: Bone Joint J 2019;101-B:984-994.


Assuntos
Análise Custo-Benefício , Fraturas Ósseas/diagnóstico por imagem , Custos de Cuidados de Saúde/estatística & dados numéricos , Imagem por Ressonância Magnética/economia , Osso Escafoide/lesões , Traumatismos do Punho/diagnóstico por imagem , Adolescente , Adulto , Idoso , Redução de Custos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Fraturas Ósseas/economia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Radiografia , Osso Escafoide/diagnóstico por imagem , Reino Unido , Traumatismos do Punho/economia , Adulto Jovem
5.
Pan Afr Med J ; 33: 29, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31384344

RESUMO

Introduction: In February 2011, the Togolese Government established a compulsory health insurance for public officials and assimilated employees. Four years later, this study investigated the satisfaction of beneficiaries of this insurance plan in Lomé. Methods: The survey was conducted among a sample of beneficiaries using an anonymous face to face questionnaire outside eight health care facilities. The analysis of survey responses allowed measuring the degree of satisfaction. Quantitative data were described using median and extended interquartile range (IQR) and qualitative data were transcribed verbatim. Results: Out of 288 subjects invited to participate, 279 agreed to participate of whom 58% were women and 88% were officials in active employment. The average age of the participants was 38 years (IQR: 30-47). A very large majority of respondents (93.5%) considered this health insurance "satisfactory". The mean overall satisfaction score was 6/10 (min: 5, max: 9). The main elements of dissatisfaction involved the refusal of care to those people with long-term illnesses (84% dissatisfied), the complexity of administrative formalities (84% dissatisfied) and care delays (67% dissatisfied). Conclusion: The very high level of satisfaction promotes the maintenance and the development of this health insurance in Togo. However, the elements of dissatisfaction should receive prompt attention and genuine efforts should be made to correct them.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Seguro Saúde/normas , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Togo
6.
BMC Ophthalmol ; 19(1): 187, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426775

RESUMO

BACKGROUND: To evaluate the clinical outcomes of extended depth of focus (EDOF) and monofocal intraocular lenses (IOLs) that share identical aspheric platform and compare their visual acuity tolerance to postoperative refractive errors. METHODS: This non-randomized, prospective comparative study included 120 eyes undergoing cataract surgery with implantation of either Tecnis ZCB00 IOL (Abbott Medical Optics Inc., Santa Ana, CA) (monofocal group: 60 eyes of 30 patients) or Tecnis Symfony IOL (Abbott Medical Optics, Inc.) (EDOF group: 60 eyes of 30 patients). Monocular and binocular visual outcomes, changes in refraction, defocus curve, contrast sensitivity, and perception of photic phenomena (Halo & Glare Simulator; Eyeland Design Network, Vreden, Germany) were evaluated 3 months postoperatively. To compare the refractive tolerance, each group was divided into three subgroups according to the postoperative uncorrected distance visual acuity (UDVA) and postoperative spherical equivalent (SE). RESULTS: In the EDOF group, the mean 3-months postoperative monocular UDVA, intermediate (UIVA), and near (UNVA) visual acuities were 0.03 ± 0.07, 0.09 ± 0.15, and 0.24 ± 0.16 logMAR, respectively. A total of 100, 96.55, and 68.97% of eyes in the EDOF group achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. In respect to refractive tolerance, the EDOF group showed higher SE values and statistically significantly better mean UDVA than the monofocal group in all subgroups, with UDVA of - 0.013 and 0.028 logMAR for EDOF and monofocal groups (p = 0.037), respectively, in the subgroup where SE was within ±0.50 D, UDVA of 0.004 and 0.048 logMAR for EDOF and monofocal groups (p = 0.046), respectively, in the subgroup where SE was within - 1.00 D, and UDVA of 0.020 and 0.083 logMAR for EDOF and monofocal groups (p = 0.026), respectively, in the subgroup where SE was more than - 1.00 D. The mean patient satisfaction scores for spectacle-free distance, intermediate, and near visual acuities were 86.0, 85.0, and 66.0, respectively. CONCLUSIONS: The EDOF IOL provided excellent postoperative visual outcomes in far and intermediate distances, with high patient satisfaction rate. Regarding the postoperative refractive tolerance to SE, the Tecnis Symfony IOL showed better tolerance to residual postoperative refractive error than the monofocal IOL with the same material and optical platform.


Assuntos
Percepção de Profundidade/fisiologia , Lentes Intraoculares , Óptica e Fotônica , Refração Ocular/fisiologia , Erros de Refração/fisiopatologia , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Facoemulsificação , Período Pós-Operatório , Estudos Prospectivos , Erros de Refração/epidemiologia , República da Coreia/epidemiologia
7.
Medicine (Baltimore) ; 98(31): e16469, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374008

RESUMO

Despite higher health care needs, older adults often have limited and fixed income. Approximately a quarter of them report not filling or delaying prescription medications due to cost (cost-related prescription delay, CRPD). To ascertain the association between CRPD and satisfaction with health care, secondary analysis of the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Advantage Survey was performed.Regression models quantified the association between CRPD and rating of personal doctor, specialist, and overall health care. Models were adjusted for demographic, health-related, and socioeconomic characteristics. 274,996 Medicare Advantage enrollees were mailed the CAHPS survey, of which 101,910 (36.8%) returned a survey that had responses to all the items we analyzed. CRPD was assessed by self-report of delay in filling prescriptions due to cost. Health care ratings were on a 0-10 scale. A score ≤ 5 was considered a poor rating of care.In unadjusted models, CRPD more than doubled the relative risk (RR) for poor ratings of personal doctor (RR 2.34), specialist (RR 2.14), and overall health care (RR 2.40). Adjusting for demographics and health status slightly reduced the RRs to 1.9, but adjusting for low-income subsidy and lack of insurance for medications did not make a difference.CRPD is independently associated with poor ratings of medical care, regardless of health, financial or insurance status. Providers might reduce patients' financial stress and improve patient satisfaction by explicitly discussing prescription cost and incorporating patient priorities when recommending treatments.


Assuntos
Adesão à Medicação/psicologia , Medicamentos sob Prescrição/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastos em Saúde/normas , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Medicare/economia , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
8.
Asia Pac J Ophthalmol (Phila) ; 8(4): 285-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397676

RESUMO

PURPOSE: The aim was to study the visual performance of a new refractive extended depth of focus (EDOF) intraocular lens (IOL). DESIGN: Prospective, comparative study. METHODS: Consenting patients with age-related cataract willing for bilateral cataract surgery within 2 weeks were implanted with the Supraphob EDOF IOL and those willing for 1 eye surgery were implanted with a monofocal IOL. The uncorrected and best-corrected distance, intermediate and near visual acuity, and contrast sensitivity were evaluated at 1 and 3 months postoperatively. We also inquired about glare, halos, difficulties in night driving, requirement for spectacles, and overall satisfaction with vision. RESULTS: The Supraphob EDOF group (n = 72 eyes) and the monofocal IOL group (n = 54 eyes) were comparable with respect to all preoperative parameters including biometry, visual acuity, and cataract status. The mean age of participants was 58.4 ±â€Š10.6 years. Both groups had similar distance vision but the EDOF group had significantly better intermediate (0.2 ±â€Š0.2 logMAR vs 0.75 ±â€Š0.19 logMAR, P < 0.001) and near vision (median = N6 vs N12, P < 0.001) compared to the monofocal group at 3 months. The contrast sensitivity was similar in both groups. Patients in the EDOF IOL group had much greater satisfaction for intermediate and near vision. Less than 10% patients reported glare, halos, and difficulty in driving at night in the EDOF group. CONCLUSIONS: The Supraphob EDOF IOL was effective in improving the distance, intermediate and near vision in majority of patients, and retained good contrast sensitivity with most patients reporting excellent satisfaction.


Assuntos
Sensibilidades de Contraste/fisiologia , Percepção de Profundidade/fisiologia , Lentes Intraoculares , Facoemulsificação , Acuidade Visual/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Desenho de Prótese
9.
Asia Pac J Ophthalmol (Phila) ; 8(4): 335-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403494

RESUMO

AcrySof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX) is a 1-piece aspheric hydrophobic presbyopia-correcting intraocular lens (IOL) launched in 2015. Unlike traditional trifocal IOLs that usually have an intermediate focal point of 80 cm, the PanOptix IOL is designed to have an intermediate focal point of 60 cm (arms-length), a more natural and comfortable working distance to perform functional tasks on computers, laptops, mobiles, among others. The non-apodized PanOptix IOL uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology that provides high (88%) utilization of light energy, low dependence on pupil size in all lighting conditions, and a more comfortable near-to-intermediate range of vision than traditional trifocal IOLs. This review provides an overview of the clinical performance of the PanOptix IOL and discusses it in the context of other commercially available trifocal IOLs, FineVision Micro F (PhysIOL, Liege, Belgium), the AT LISA tri 839MP (Carl Zeiss Meditec AG, Jena, Germany) and the extended depth of focus IOL, TECNIS Symfony (Abbott Medical Optics, Santa Ana, CA). A literature search was performed in the PubMed database to identify studies that have assessed the visual and other clinical outcomes with the PanOptix IOL. In total, 12 studies were included in this review article. Overall, the clinical evidence suggests that in general good visual outcomes, along with a high degree of spectacle independence, are achieved in patients implanted with the PanOptix, FineVision, AT LISA and Symfony IOLs. However, every MIOL has its benefits and limitations, which along with patient's needs and clinical conditions are important factors to consider while selecting an IOL to achieve best possible post-operative outcomes.


Assuntos
Lentes Intraoculares , Satisfação do Paciente , Pseudofacia/cirurgia , Refração Ocular/fisiologia , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Humanos , Facoemulsificação , Desenho de Prótese , Pseudofacia/fisiopatologia
10.
Rev. Ciênc. Plur ; 5(1): 89-101, jun. 2019. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1007359

RESUMO

Introdução:A avaliação do sorriso deve abranger diversos aspectos desde a composição facial até características morfológicas dos elementos dentários e, dessa forma, se qualquer um desses aspectos forem afetados, o sorriso se torna esteticamente inadequado.Objetivo:apresentar um caso clínico cujo plano de tratamento foi composto pela confecção de facetas diretas em resina composta dos elementos antero-superiores a fim de devolver a estética adequada para a paciente. Descrição do caso:Paciente, 16 anos, do sexo feminino, apresentava má oclusão (Classe III de Angle) compensada ortodonticamente, agenesia de incisivos laterais e inversão dental dos elementos 23 e 24. A resolução estética deste caso utilizou a técnica direta com resina composta por meio do protocolo correto no quesito proporção áurea e mimetização.Conclusão:As restaurações diretas em resina composta são uma solução simples, efetiva e prática na intervenção de desarmonias de forma e tamanho dental e, portanto, foi possível reanatomizar os dentes anteriores devolvendo estética, função e satisfação ao paciente (AU).


Introduction:Smile evaluation should cover several aspects from facial composition to morphological characteristics of dental elements and, therefore, if any of these aspects are affected, the smile becomes aesthetically inadequate.Objective:to present a clinical case whose treatment plan was composed by the making of dental veneers in composite resins of the upper and lower elements in order to obtain a suitable aesthetic.Case description:A 16-year-old female patient presents malocclusion (Class III of Angle) orthodontically compensated, agenesis of lateral incisors and dental inversion of elements 23 and 24. The aesthetic resolution of this case used the direct technique with composite resin by means of the correct protocol in relation to golden proportion and mimicry.Conclusion:Direct restorations in composite resin are a simple, effective and practical solution in the intervention of disharmonies of form and dental size and, therefore, it was possible to reanatomize the anterior teeth restoring aesthetics, function and patient satisfaction (AU).


Assuntos
Humanos , Feminino , Adolescente , Satisfação do Paciente , Resinas Compostas , Facetas Dentárias , Estética Dentária , Brasil , Reabilitação Bucal
11.
Pan Afr Med J ; 32: 191, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312303

RESUMO

Several surgical procedures, including mosaic arthroplasty, can be used to treat patients with cartilage loss in the femoral condyles. This study aims to assess mid-term clinical and radiological results as well as the main prognostics elements. We conducted a retrospective epidemiological study over a period of 15 years. During the study period we collected data from 35 workable medical records of patients with osteochondritis dissecans of the femoral condyles treated by mosaic arthroplasty, with an average follow-up of 24 months. The level of complaints as well as preoperative knee function were evaluated and compared with the healthy knee according to the International Cartilage Repair Society (ICRS) score, the International Knee Documentation Committee (IKDC) score and visual analogue scale (VAS). It was less than 60% in 27 patients. During the follow-up period, the results were analyzed according to Hughston's functional and radiological criteria. After an average follow-up of 24 months, algoneurodystrophy was reported in 5 cases with a single case of haemarthrosis. A net ICRS score improvement was observed with a mean increasing from 54% to 74% on the follow-up visit. Most of patients were satisfied or very satisfied (82.9%). The elements of good prognosis recognized in our study included: a mean time between symptom onset and surgery of less of 18 months, having deep lesions with a diameter less than 02 cm and having lesions in the internal condyle. The treatment of cartilage loss is necessarily based on the correction of its direct and indirect causes namely the morphotype, the laxity and meniscus capital. No consensus in the decision-making was reached and no one could confirm the superiority of a technique in relation to the other but we can say that cartilage defect which sizes from 2 to 4 cm² may be the best indication for mosaic arthroplasty.


Assuntos
Artroplastia/métodos , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Osteocondrite Dissecante/cirurgia , Adolescente , Adulto , Cartilagem Articular/patologia , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/patologia , Satisfação do Paciente , Prognóstico , Radiografia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Medicine (Baltimore) ; 98(27): e16107, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277111

RESUMO

BACKGROUND: The aim of this study was to compare the clinical effects between traditional surgery and minimally invasive periodontal surgery in the treatment of epulis. METHODS: A total of 33 cases of patients diagnosed with fibrous epulis were randomly divided into traditional surgery group and minimally invasive periodontal surgery group. After the different procedures, several parameters were detected to evaluate the effects of minimally invasive periodontal surgery. RESULTS: Preoperative bleeding index and plaque index, adopt rank, and test showed no significant differences between the 2 groups. After 12 weeks, gingival papilla filling index in experiment group is statistically higher than control group, and shows the statistical differences (P < .05). The width of keratinized gingiva in experiment group grew more than that in control group, and showed the statistical differences (4.68 ±â€Š0.30 vs 3.00 ±â€Š0.28 mm, P < .05). No recurrence of fibrous epulis was found during the subsequent 6 months to 2 years follow-up after the surgeries. CONCLUSION: Minimally invasive periodontal surgery that reserved tumor epithelium could have a better effect than the traditional surgery in the selected patients.


Assuntos
Doenças da Gengiva/cirurgia , Neoplasias Gengivais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento
13.
Anaesthesia ; 74(9): 1112-1120, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31264207

RESUMO

Patient-centred care and factors associated with patient satisfaction with anaesthesia have been widely studied. However, the most important considerations in the setting of obstetric anaesthesia are uncertain. Identification of, and addressing, factors that contribute to patient dissatisfaction may improve quality of care. We sought to identify factors associated with < 100% satisfaction with obstetric anaesthesia care. At total of 4297 women treated by anaesthetists provided satisfaction data 24 h after vaginal and 48 h after caesarean delivery. As 78% of women were 100% satisfied, we studied factors associated with the dichotomous variable, 100% satisfied vs. < 100% satisfied. We evaluated patient characteristics and peripartum factors using multivariable sequential logistic regression. The following factors were strongly associated with maternal dissatisfaction after vaginal delivery: pain intensity during the first stage of labour; pain intensity during the second stage of labour; postpartum pain intensity; delay > 15 min in providing epidural analgesia and postpartum headache (all p < 0.0001). Pruritus (p = 0.005) also contributed to dissatisfaction after vaginal delivery, whereas non-Hispanic ethnicity was negatively associated with dissatisfaction (p = 0.01). After caesarean delivery, the intensity of postpartum pain (p < 0.0001), headache (p = 0.001) and pruritus (p = 0.001) were linked to dissatisfaction. Hispanic ethnicity also had a negative relationship with dissatisfaction after caesarean delivery (p = 0.005). Thus, inadequate or delayed analgesia and treatment-related side-effects are associated with maternal dissatisfaction with obstetric anaesthesia care. Development of protocols to facilitate identification of ineffective analgesia and provide an appropriate balance between efficacy and side-effects, are important goals to optimise maternal satisfaction.


Assuntos
Anestesia Obstétrica/psicologia , Parto Obstétrico , Dor do Parto/tratamento farmacológico , Dor do Parto/psicologia , Trabalho de Parto , Satisfação do Paciente/estatística & dados numéricos , Adulto , Anestesia Obstétrica/métodos , Feminino , Humanos , Gravidez , Estudos Retrospectivos
14.
Stud Health Technol Inform ; 262: 166-167, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349292

RESUMO

The purpose of the study was to investigate the experiences of discharged patients from Intensive Care Units (ICUs). A study with retrospective data collection (n=112) was conducted via interviews using the Intensive Care Experience Questionnaire. 93% of participants reported positive experiences from the ICU. Frightening experiences were restricted to minimum levels (mean score=9/25), while the feeling of security was prevalent (96.5%) and care satisfaction was high (mean score=18.2/20). Communicating the aforementioned experiences, professionals may better understand patients' needs in order to improve the IT systems and patients' hospitalization.


Assuntos
Enfermagem de Cuidados Críticos , Sistemas de Informação Hospitalar , Unidades de Terapia Intensiva , Cuidados Críticos , Humanos , Informática Médica , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários
15.
Rev Lat Am Enfermagem ; 27: e3143, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340340

RESUMO

OBJECTIVE: to develop, evaluate and correlate the acceptability of an educational mobile application to patients submitted to orthognathic surgery. METHOD: methodological study based on systematic instructional design with contents aimed at patient learning through a mobile application. Usability and user satisfaction were evaluated by 30 patients in the perioperative stage through an electronic questionnaire sent by social networks, e-mail and business card, measured using the System Usability Scale instrument validated in Portuguese and user satisfaction with an instrument based on another study, after its applications. Data were analyzed with descriptive statistics and Spearman correlation. RESULTS: the application named "OrtogApp" features content validated in a previous study included five learning content sessions essential for managing perioperative care, and it is available on IOS and Android platforms. Usability corresponded to 79.8 + 15.4 points and the satisfaction index was 82.9%; correlation of age, schooling and uses of the application with the instruments was not significant. CONCLUSION: OrtogApp is an educational application with content validated by professionals, resulting in high user satisfaction and good usability. Patients may use the application as supportive educational material to supplement guidance provided by perioperative nurses and/or surgeons during perioperative care.


Assuntos
Aplicativos Móveis , Cirurgia Ortognática , Período Perioperatório/educação , Cuidados Pós-Operatórios/educação , Adulto , Brasil , Telefone Celular/instrumentação , Comportamento do Consumidor , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Autocuidado/métodos , Inquéritos e Questionários , Telemedicina/métodos , Adulto Jovem
16.
Rev Med Chil ; 147(3): 305-313, 2019 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-31344167

RESUMO

BACKGROUND: The Chilean public health system is based on Primary Health Care (PHC), whose assessment is challenging due to the heterogeneity of services and multi-dimensionality of expected results. The Primary Care Assessment Tool was adapted and validated for Chile. AIM: To analyze, from the provider's perspective, the structure and functioning of the health centers, to determine the achievement of PHC's core functions: access, continuity, coordination, comprehensiveness of care, cultural competence, family centeredness and community orientation. MATERIAL AND METHODS: All professionals working in primary care in a commune of Metropolitan Santiago were invited to answer an online version of the Primary Care Assessment Tool. RESULTS: One hundred and nine professionals (51% of those invited) from four Family Health Centers, two Community Health Centers, and a Community Mental Health Center, answered the online questionnaire. Their distribution by profession and health units does not resemble the whole research population, which should be considered when interpreting the results. Data show a good performance of the system: general and domain specific scores are all near three for a maximum score of four. Family centeredness obtained the highest score, whereas cultural competence had the lowest. CONCLUSIONS: Reinforcing intercultural skills and a wider approach to psycho-social problems is recommended to strengthen the new healthcare model implementation.


Assuntos
Pessoal de Saúde , Acesso aos Serviços de Saúde , Atenção Primária à Saúde , Inquéritos e Questionários , Chile , Competência Cultural , Saúde da Família , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , População Urbana
17.
Medicine (Baltimore) ; 98(28): e16403, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305450

RESUMO

BACKGROUND: Thoracic epidural analgesia is the preferred method for postoperative analgesia following thoracic surgery. However, intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. This study was conducted because few scientific reports exist comparing fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment of postoperative pain after video-assisted thoracic surgery (VATS). METHODS: This prospective, and randomized study included 70 patients randomized into fk-IVPCA and t-PCEA groups. Pain at rest and during movement, successful and unsuccessful triggers after pressing the PCA device button, the need for rescue analgesia, drug-related adverse events, and patient satisfaction were recorded for 48 hours postoperatively. RESULTS: No significant differences in the intensity of pain at rest or during movement were observed between the 2 groups within 48 hours postoperatively. The number of unsuccessful PCA triggers in the t-PCEA group 0 to 4 hours after surgery was significantly higher than that in the fk-IVPCA group. However, the numbers of successful PCA triggers in the fk-IVPCA group at 4 to 12 and 0 to 24 hours after surgery were significantly higher than those in the t-PCEA group. The incidence of analgesic-related side effects and patient satisfaction were similar in both groups. CONCLUSIONS: Compared with t-PCEA, the addition of a subanesthetic dose of ketamine to fentanyl-based IVPCA resulted in similar pain control after VATS with no increase in the incidence of drug-related adverse effects. The results confirm that both multimodal intravenous analgesia and epidural analgesia can provide sufficient pain control and are safe strategies for treating acute post-thoracotomy pain.


Assuntos
Analgesia Epidural , Analgesia Controlada pelo Paciente , Analgésicos/administração & dosagem , Fentanila/administração & dosagem , Ketamina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Administração Intravenosa , Analgesia Epidural/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/métodos , Analgésicos/efeitos adversos , Quimioterapia Combinada/efeitos adversos , Feminino , Fentanila/efeitos adversos , Humanos , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Movimento , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Satisfação do Paciente , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento
18.
Bone Joint J ; 101-B(7): 860-866, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256664

RESUMO

AIMS: The aim of this study was to investigate the influence of age on the cost-effectiveness of arthroscopic rotator cuff repair. PATIENTS AND METHODS: A total of 112 patients were prospectively monitored for two years after arthroscopic rotator cuff repair using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the Oxford Shoulder Score (OSS), and the EuroQol five-dimension questionnaire (EQ-5D). Complications and use of healthcare resources were recorded. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). Propensity score-matching was used to compare those aged below and above 65 years of age. Satisfaction was determined using the Net Promoter Score (NPS). Linear regression was used to identify variables that influenced the outcome at two years postoperatively. RESULTS: A total of 92 patients (82.1%) completed the follow-up. Their mean age was 59.5 years (sd 9.7, 41 to 78). There were significant improvements in the mean DASH (preoperative 47.6 vs one-year 15.3; p < 0.001) and OSS scores (26.5 vs 40.5; p < 0.001). Functional improvements were maintained with no significant change between one and two years postoperatively. The mean preoperative EQ-5D was 0.54 increasing to 0.81 at one year (p < 0.001) and maintained at 0.86, two years postoperatively. There was no significant difference between those aged below or above 65 years of age with regards to postoperative shoulder function or EQ-5D gains. Smoking was the only characteristic that significantly adversely influenced the EQ-5D at two years postoperatively (p = 0.005). A total of 87 were promoters and five were passive, giving a mean NPS of 95 (87/92). The total mean cost per patient was £3646.94 and the mean EQ-5D difference at one year was 0.2691, giving a mean ICER of £13 552.36/QALY. At two years, this decreased further to £5694.78/QALY. This was comparable for those aged below or above 65 years of age (£5209.91 vs £5525.67). Smokers had an ICER that was four times more expensive. CONCLUSION: Arthroscopic rotator cuff repair results in excellent patient satisfaction and cost-effectiveness, regardless of age. Cite this article: Bone Joint J 2019;101-B:860-866.


Assuntos
Artroscopia/economia , Análise Custo-Benefício , Satisfação do Paciente/estatística & dados numéricos , Lesões do Manguito Rotador/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/economia , Pontuação de Propensão , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Lesões do Manguito Rotador/economia , Resultado do Tratamento , Reino Unido
19.
Niger Postgrad Med J ; 26(2): 129-137, 2019 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187754

RESUMO

Background of the Study: Low adherence is an essential element responsible for impaired effectiveness and efficiency in the pharmacological treatment of hypertension. Patient satisfaction is an important measure of healthcare quality and is a crucial determinant of patients' perspective on behavioural intention. Aims: This study determined the association between medication adherence and treatment satisfaction among hypertensive patients attending hypertension outpatient clinic in Lagos University Teaching Hospital (LUTH), Nigeria. Materials and Methods: Setting - The study setting was LUTH; a descriptive cross-sectional study was conducted. Study design - Hypertensive patients were consecutively recruited from the outpatient clinic. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale and treatment satisfaction was assessed using the 14-item Treatment Satisfaction Questionnaire for Medication. Statistical Analysis: Univariate and linear regression analyses were conducted using STATA software version 14.1 (StataCorp LP, College Station, TX, USA). Statistical significance was set at P ≤ 0.05. Results: A total of 500 respondents with a mean age of 58.9 ± 13.3 years participated in the study. Overall, majority (446 [89.2%]) of the respondents in this study had 'moderate' adherence to antihypertensive medication. However, only five (1.0%) respondents reported 'high' adherence. Mean scores were highest in the moderate adherence category for all satisfaction domains and overall domain. Treatment satisfaction was associated with medication adherence, and was statistically significant (P = 0.000). Conclusion: One in every hundred patients had high adherence to hypertensive medication in this study, and there was a positive association between treatment satisfaction and medication adherence. Continuous patient-specific and tailored adherence education and counselling for hypertensive patients is recommended.


Assuntos
Anti-Hipertensivos/administração & dosagem , Hipertensão/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Hospitais de Ensino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Inquéritos e Questionários
20.
Infect Dis Poverty ; 8(1): 44, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31182164

RESUMO

BACKGROUND: Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Using an insurance-based approach, the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients, particularly among the poor. This study aims to assess the program effects on service use, and its equity impact across different income groups. METHODS: Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts. RESULTS: After program implementation, the hospital admission rate increased more for the extreme poverty group (48.5 to 70.7%) and moderate poverty group (45.0 to 68.1%), compared to the non-poverty group (52.9 to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups. Satisfaction rates were high in all groups. Qualitative feedback from stakeholders also suggested that increased reimbursement rates, easier reimbursement procedures, and allowance improved patients' service utilization. Implementation of case-based payment made service provision more compliant to clinical pathways. CONCLUSION: Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor.


Assuntos
Assistência à Saúde/economia , Acesso aos Serviços de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Tuberculose/economia , Tuberculose/psicologia , Adulto , Idoso , Antituberculosos/economia , Antituberculosos/uso terapêutico , China , Estudos Transversais , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde , Modelos Logísticos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Satisfação do Paciente/economia , Pobreza/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Tuberculose/tratamento farmacológico
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