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1.
Plast Reconstr Surg ; 145(2): 360e-367e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985640

RESUMO

BACKGROUND: Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release. METHODS: This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed. RESULTS: Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Aspirina/efeitos adversos , Síndrome do Túnel Carpal/cirurgia , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Hemorragia Pós-Operatória/prevenção & controle , Pontuação de Propensão , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco
2.
Hu Li Za Zhi ; 67(1): 81-88, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960399

RESUMO

BACKGROUND & PROBLEMS: Early rehabilitation after stroke is important for the recovery of bodily functions in stroke patients. However, the percentage of completion of early limb rehabilitation among stroke patients is only 16%. PURPOSE: Raise the early rehabilitation intervention rate to 88% for patients with stroke within 24 hours of hospitalization. RESOLUTION: We developed an education course on post-stroke rehabilitation and a related e-Learning course as well as organized an 'alliance for recovery' team. In addition, we established a standard for post-stroke relay rehabilitation and designed rehabilitation relay cards, Xbox rehabilitation games, and nine squares challenge for brain stroke care. RESULTS: The accuracy of the knowledge of nursing staff related to physical rehabilitation improved from 72.4% to 100%; the accuracy of their perceptions regarding early limb rehabilitation increased from 16% to 100%; and patient satisfaction increased from 68% to 98%. CONCLUSIONS: We deployed diverse and innovative strategies to assist limb rehabilitation in patients with stroke. Patients and caregivers should be encouraged to participate in early rehabilitation and related programs and should apply the skills and rehabilitation activities learned to daily life.


Assuntos
Extremidades/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/fisiopatologia , Difusão de Inovações , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação do Paciente/estatística & dados numéricos , Desenvolvimento de Programas
3.
J Surg Res ; 245: 510-515, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446193

RESUMO

BACKGROUND: The increasing use of review websites by consumers has become a crucial first step in choosing a physician with more than half of Americans consulting review sites before physician selection. We sought to identify whether differences exist in the quality and content of online reviews for men versus women surgeons. METHODS: Using a deliberate sampling algorithm of the two most populated physician review websites, RateMDs.com and Yelp.com, we purposefully sampled reviews for the top 20 surgeons per tercile from the four most populated urban areas in the United States: New York, Houston, Los Angeles, and Chicago. A grounded theory qualitative assessment was performed of major and minor thematic elements including global rating, communication, technical skills, and comments on ancillary elements. RESULTS: Four-hundred and thirty-one online patient reviews of 238 surgeons were identified from RateMDs.com (51%) and Yelp.com (49%) with available information on gender for analysis. Seventy-six percent of reviews were of male surgeons. Reviewers were more likely to mention a global rating and technical skill for men compared with women surgeons. Most reviews were positive with no difference in global rating by gender (83.7% positive for men and 74.3% positive for women, P = 0.08). Women surgeons were more likely to have positive comments on social interactions as compared with men (94.7% versus 88.0%, P = 0.03); whereas men surgeons were more likely to have a positive rating on technical skill compared with women (88.2% versus 76.2%, P = 0.04). CONCLUSIONS: The content and quality of online surgeon reviews differ by gender. There is no difference in global rating between men and women. Women are rated higher for social interaction domains and men are rated higher on technical skill domains.


Assuntos
Competência Clínica/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Cirurgiões/estatística & dados numéricos , Comunicação , Feminino , Humanos , Internet/estatística & dados numéricos , Masculino , Pesquisa Qualitativa , Fatores Sexuais , Estados Unidos
4.
Rev. bras. cir. plást ; 34(4): 477-484, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047906

RESUMO

Introdução: Sabe-se que o câncer de mama é hoje a segunda neoplasia mais frequente entre as mulheres, as quais são submetidas desde a tratamentos clínicos até cirúrgicos mutilantes da mama. Ter mamas bonitas e harmoniosas é um direito legítimo, sendo assim o conceito de reconstrução mamária e do complexo areolo papilar se torna importante na reinserção social feminina. Este estudo visa apresentar uma técnica eficaz de reconstrução areolar, utilizando enxerto cutâneo livre palpebral bilateral, demonstrando sua eficácia através de resultados fotográficos, comparação com outras técnicas já descritas e questionários de satisfação dos pacientes. Resultados: Foram avaliados, retrospectivamente, 50 pacientes operados de reconstrução areolar com enxerto de pele palpebral e outras técnicas já descritas, operados por um único cirurgião sênior. O grupo de pacientes operados com pele palpebral não obtiveram diferenças significativas dentro da análise de resultados, comparados com outras técnicas de reconstrução. Houve boa satisfação por parte dos pacientes, quanto ao resultado das cirurgias das aréolas. Conclusão: O estudo obteve baixos índices de complicações, apresentando-se como boa opção terapêutica, dentro do arsenal cirúrgico de reconstrução areolar.


Introduction: Breast cancer is currently the second most common neoplasm among women who undergo clinical treatments and breast-mutilating surgeries. Having beautiful and harmonious breasts is a legitimate right, so the concept of reconstructing the breast and nipple-areolar complex becomes important in female social reinsertion. This study aimed to present an effective technique of areolar reconstruction using free bilateral eyelid skin grafts and demonstrate its effectiveness through photographic results, comparison with previously described techniques, and patient satisfaction questionnaires. Results: The authors retrospectively evaluated 50 patients who underwent areolar reconstruction with eyelid skin grafts and other techniques performed by a single senior surgeon. Patients who underwent eyelid skin graft surgery did not achieve significantly different results from those who underwent other reconstruction techniques. Patients who underwent areola surgeries reported good satisfaction. Conclusion: The study revealed low complication rates and demonstrated that the use of eyelid skin is a good therapeutic option for areolar reconstruction.


Assuntos
Humanos , Feminino , História do Século XXI , Pacientes , Pele , Transplante , Mama , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos , Estética , Pálpebras , Mamilos , Transplante/métodos , Transplante/estatística & dados numéricos , Mama/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pálpebras/cirurgia , Mamilos/cirurgia
7.
Anticancer Res ; 39(11): 6339-6346, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704865

RESUMO

BACKGROUND/AIM: To evaluate the chronological changes in health-related quality of life and treatment satisfaction after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: A total of 196 patients were included, and treatment satisfaction was evaluated using the Expanded Prostate Cancer Index Composite (EPIC) score before and at 1, 3, 6, and 12 months after RARP. RESULTS: At 12 months after RARP, 64.8% of patients were satisfied. On the contrary, 4.6% of patients were dissatisfied at 12 months after RARP. In a multivariate analysis, only urinary bother of EPIC was significantly associated with satisfaction at 12 months after RARP (p=0.025, odds ratio=1.029). CONCLUSION: Treatment satisfaction with RARP was generally acceptable from 1 to 12 months after surgery and did not change over time. Urinary bother was associated with satisfaction at 12 months after RARP. Compared with the objective 24-hour pad test, questionnaires answered subjectively were more associated with satisfaction.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Prostatectomia/psicologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/psicologia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Terapia de Salvação/métodos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia
8.
Medicine (Baltimore) ; 98(44): e17714, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689807

RESUMO

This study aimed to compare clinical results, symptom relief, quality of life and patient satisfaction after the 2 most common procedures for achalasia treatment: laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (EBD).Patients treated at University Hospital of Heidelberg with LHM or EBD were included. A retrospective chart review of perioperative data and a prospective follow-up of therapeutic efficiency, Gastrointestinal Quality of Life Index (GIQLI) and patient satisfaction was conducted.Follow-up data (mean follow-up: 75.1 ±â€Š53.9 months for LHM group and 78.9 ±â€Š45.6 months for EBD) were obtained from 36 patients (19 LHM; 17 EBD). Eckardt score (median (q1,q3): 2 (1,4) in both groups, P = .91, GIQLI (LHM: 117 (91.5, 126) vs EBD: 120 (116, 128), P = .495) and patient satisfaction (3 (2,3) vs 3 (2,4), P = .883) did not differ between groups. Fifteen patients (78.9%) in LHM group and 11 (64.7%) in EBD group (P = .562) stated they would undergo the intervention again. All patients with EBD had at least 2 dilatations (100%), whilst only 2 patients (10.5%) had dilatation after LHM (P < .001). There were no complications after EBD, but 2 after LHM (10.5%, P = .517).Both LHM and EBD are able to control symptoms and provide similar quality of life and patient satisfaction. However, reintervention rate was higher following EBD, hence LHM provided a more sustained treatment than EBD.


Assuntos
Dilatação/estatística & dados numéricos , Acalasia Esofágica/cirurgia , Esofagoscopia/estatística & dados numéricos , Miotomia de Heller/estatística & dados numéricos , Dilatação/instrumentação , Dilatação/métodos , Esofagoscopia/métodos , Feminino , Seguimentos , Miotomia de Heller/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
9.
BMC Health Serv Res ; 19(1): 782, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675973

RESUMO

BACKGROUND: In China, a long waiting time for registration is a common occurrence in many tertiary hospitals. This study aimed to analyze the effects of a comprehensive reservation service for non-emergency registration on appointment registration rate, patient waiting time, patient satisfaction and outpatient volume at the Guangzhou Women and Children's Medical Center. METHODS: This was a cross-sectional study. This study investigated the effects of a comprehensive reservation service for non-emergency registration in Guangzhou Women and Children's Medical Center in China starting in October 2015. In total, 2194 patients completed a satisfaction survey administered by the Guangdong Situation Research Center. The content of the questionnaire consisted of six aspects: general impression, service attitude, service quality, hospital environment, price perception and medical ethics. A Likert 5-point rating scale was used in the questionnaire; answers were classified as "very satisfied", "relatively satisfied", "neutral", "unsatisfied" and "very unsatisfied". The method of application was paper-based. T-tests were used to compare the sample means, and chi-square tests were used to compare the rates. A multiple-test procedure was performed to evaluate the differences in the reservation rates during a 12-month period. RESULTS: After the implementation of the comprehensive reservation service for non-emergency registration in our hospital, which has an annual outpatient volume of approximately 4 million, the monthly appointment registration rate increased from (34.95 ± 2.91)% to(89.13 ± 3.12)%,P < 0.01. The patient waiting time was significantly reduced (P < 0.01), and the proportion of patients who believed that the waiting time required improvement was decreased significantly (P < 0.01). Moreover, the third-party evaluation result of outpatient satisfaction significantly improved (P < 0.01). The total hospital outpatient volume decreased(P < 0.01). The outpatient volume of the Department of General Pediatrics decreased. CONCLUSION: The implementation of the comprehensive reservation service for non-emergency registration in the hospital shortened patient waiting time and improved patient satisfaction, and the outpatient volume was effectively controlled. These results indicated that this program obtained the desired results in a Grade 3A hospital in China.


Assuntos
Agendamento de Consultas , Pacientes Ambulatoriais/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Listas de Espera , China , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Inquéritos e Questionários , Fatores de Tempo
10.
Bull Cancer ; 106(12): 1104-1114, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31615646

RESUMO

INTRODUCTION: Since the cancer plan, evaluation of professional practices is essential to ensure the implementation of high-quality health care. Assess patient satisfaction is one of the pillars of high-quality health care. The main objective of the study was to assess the satisfaction of patients with early breast cancer taking a hormonal therapy, the secondary objective was to identify factors associated with their satisfaction. METHODS: The modified EORTC OUT-PATSAT-35 questionnaire was sent to a sample of patients in Franche-Comté in order to evaluate nine dimensions of satisfaction among which interpersonal skills, provided information, and overall satisfaction. For each dimension, a satisfaction score between 0 (no satisfaction) and 100 (highest satisfaction) was measured. Logistic regression analyses were used to study the factors associated with satisfaction. RESULTS: The mean overall satisfaction score for the 280 patients who answered was 73 [0-100]. Practicing an extra-professional activity was associated with higher satisfaction for several dimensions (odds ratio between 2.80 and 4.12, P<0.05) whereas it was decreased in the case of a modified appetite (odds ratio between 0.27 and 0.52, P<0.05). No link has been shown between satisfaction and adherence. DISCUSSION: The patients were satisfied and several factors impacting their satisfaction were identified, based on a questionnaire that must evolve to take into account the ambulatory aspect of their care. During the consultations, particular attention will be paid to these factors.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Qualidade da Assistência à Saúde , Análise de Regressão , Inquéritos e Questionários
11.
J Altern Complement Med ; 25(12): 1206-1214, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31580714

RESUMO

Objective: To quantify differences in patient expectations of healthscape (e.g., interior environment) across Western medicine (WM) and Traditional Chinese Medicine (TCM) paradigms. Data sources/study setting: Primary survey data comprise 469 Taiwanese consumers. National insurance coverage of both TCM and WM is an ideal setting to test for differences in healthscape expectations. Study design: Respondents report their recent experience as either exclusive users of TCM, exclusive WM, neither, or dual usage (both TCM and WM), and are randomly assigned to one of two surveys (identical except one refers to WM contexts, the other TCM) to rate the importance of 28 healthscape factors derived from previous studies. Data collection/extraction methods: Multivariate analysis of variance is used to test the research hypotheses. Principal findings: Dual users accept some differences across paradigms. In contrast, exclusive WM users apply their existing WM expectations to TCM contexts, raising the possibility of dissatisfaction and low adoption. Conclusions: A person's experience with TCM is related to acceptance of healthscape differences. Medical service providers of TCM, and by extension complementary and alternative medicine, should devise strategies to ease initial visitation by exclusive WM users. Healthscape designs need not be modeled closely on a WM standard, as dual users accept differences.


Assuntos
Terapias Complementares/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Assistência à Saúde , Medicina Tradicional Chinesa , Assistência à Saúde/métodos , Assistência à Saúde/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Taiwan , Adulto Jovem
12.
Nurs Outlook ; 67(6): 707-712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607371

RESUMO

BACKGROUND: The research findings about nurse practitioner (NP) patient experiences (satisfaction) are limited to small sample sizes from local community clinics. No national studies with large sample sizes were found. PURPOSE: To analyze responses from the Consumer Assessment of Healthcare Providers and Systems survey and compare the patient experiences from four different provider categories. METHODS: Secondary data analysis was completed on survey responses from 53,885 patients. FINDINGS: In the sample, medical doctor providers were disproportionately represented in greater number than NPs, doctor of osteopathy, or physician assistant. Further analysis comparing patient experiences between providers revealed NP to be rated significantly higher than their colleagues. DISCUSSION: Recognizing the factors associated with patient satisfaction with their providers can lead to improvements in patient-provider interactions that can result in increased quality of care. CONCLUSION: Policy makers should find opportunities to employ NP in primary care settings and achieve greater patient satisfaction that can influence outcomes associated with patient-centered care initiatives.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Relações Enfermeiro-Paciente , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
13.
Br J Anaesth ; 123(6): 887-897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591019

RESUMO

BACKGROUND: An unintended consequence of medical technologies is loss of personal interactions and humanism between patients and their healthcare providers, leading to depersonalisation of medicine. As humanism is not integrated as part of formal postgraduate anaesthesiology education curricula, our goal was to design, introduce, and evaluate a comprehensive humanism curriculum into anaesthesiology training. METHODS: Subject-matter experts developed and delivered the humanism curriculum, which included interactive workshops, simulation sessions, formal feedback, and patient immersion experience. The effectiveness of the programme was evaluated using pre- and post-curriculum assessments in first-year postgraduate trainee doctors (residents). RESULTS: The anaesthesiology residents reported high satisfaction scores. Pre-/post-Jefferson Scale of Patient Perceptions of Physician Empathy showed an increase in empathy ratings with a median improvement of 12 points (range; P=0.013). After training, patients rated the residents as more empathetic (31 [4] vs 22 [5]; P<0.001; 95% confidence interval [CI]: 7-12) and professional (47 [3] vs 35 [8]; P<0.001; 95% CI: 9-16). Patient overall satisfaction with their anaesthesia provider improved after training (51 [6] vs 37 [10]; P<0.001; 95% CI: 10-18). Patients rated their anxiety lower in the post-training period compared with pretraining (1.8 [2.3] vs 3.6 [1.6]; P=0.001; 95% CI: 0.8-2.9). Patient-reported pain scores decreased after training (2.3 [2.5] vs 3.8 [2.1]; P=0.010; 95% CI: 0.4-2.8). CONCLUSIONS: Implementation of a humanism curriculum during postgraduate anaesthesiology training was well accepted, and can result in increased physician empathy and professionalism. This may improve patient pain, anxiety, and overall satisfaction with perioperative care.


Assuntos
Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Currículo , Humanismo , Internato e Residência , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologia/métodos , Atitude do Pessoal de Saúde , Empatia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina/psicologia , Adulto Jovem
14.
Rev Saude Publica ; 53: 87, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31576946

RESUMO

OBJECTIVE: To analyze the trend of opinion and satisfaction indicators of the Spanish national health system from 2005 to 2017. METHODS: Ecological study of time series analyzing the trend of eight indicators of opinion and satisfaction on the Spanish national health system and its autonomous communities from 2005 to 2017. The data was obtained from the Ministry of Health, Social Services and Equality and from the Health Barometer. The Prais-Winsten regression method was used. RESULTS: A static tendency was observed in the perception of users on how the health system works (APC = 1.898, 95%CI -0.954 - 4.751) and decreasing opinion on the improvement of primary care (APC = -0.283; 95%CI -0.335 - -0.121), specialized (APC = -0.241, 95%CI -0.74 - -0.109) and hospitalization (APC = -0.171, 95%CI -0.307 - -0.036). Satisfaction with knowledge and follow-up by the family doctor and pediatrician showed an increasing trend (APC = 7.939, 95%CI 3.965 - 11.914). Satisfaction with medical and nursing professionals was static. No large differences were observed in the trends of the indicators studied in the autonomous communities. CONCLUSIONS: A negative trend was observed in the opinion of the Spanish national health system users. Financing, human resources, quality management systems and differences in the autonomous communities may be some of the causes.


Assuntos
Programas Nacionais de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/tendências , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Valores de Referência , Análise de Regressão , Espanha , Fatores de Tempo
15.
Medicine (Baltimore) ; 98(41): e17520, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593122

RESUMO

BACKGROUND: Evidence suggests that dry CO2 insufflation during laparoscopic colorectal surgery results in greater structural injury to the peritoneum and longer hospital stay than the use of warm, humidified CO2. We aimed to test the hypothesis that warm, humidified CO2 insufflation could reduce postoperative pain and improve recovery in laparoscopic colorectal surgery. METHODS: One hundred fifty elderly patients undergoing laparoscopic colorectal surgery under general anesthesia from May 2017 to October 2018 were randomly divided into 3 groups. The primary outcomes were resting pain, cough pain, and consumption of sufentanil at 2, 4, 6, 12, 24, and 48 hours postoperatively. Quality of visual image, hemodynamic changes, esophageal temperature, mean skin temperature, mean body temperature, recovery time, days to first flatus and solid food intake, shivering, incidence of postoperative ileus, length of hospital stay, surgical site infections, patients and surgeon satisfaction scores, adverse events, prothrombin time, activated partial thromboplastin time, and thrombin time were recorded. RESULTS: Group CE patients were associated with significantly higher early postoperative cough pain and sufentanil consumption than the other 2 groups (P < .05). Compared with group CE, patients in both groups WH and CF had significantly reduced intraoperative hypothermia, recovery time of PACU, days to first flatus and solid food intake, and length of hospital stay, while the satisfaction scores of both patients and surgeon were significantly higher (P < .05). Prothrombin time, activated partial thromboplastin time, and thrombin time were significantly higher in group CE from 60 minutes after pneumoperitoneum to the end of pneumoperitoneum than the other 2 groups (P < .05). The number of patients with a shivering grade of 0 was significantly lower and grade of 3 was significantly higher in group CE than in the other 2 groups (P < .05). CONCLUSION: Use of either warm, humidified CO2 insufflations or 20°C, 0% relative humidity CO2 combined with forced-air warmer set to 38°C during insufflations can both reduce intraoperative hypothermia, dysfunction of coagulation, early postoperative cough pain, sufentanil consumption, days to first flatus, solid food intake, and length of hospital stay.


Assuntos
Dióxido de Carbono/efeitos adversos , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Peritônio/lesões , Idoso , Analgésicos Opioides/uso terapêutico , Cirurgia Colorretal/normas , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Umidade/efeitos adversos , Hipotermia/etiologia , Insuflação/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Satisfação do Paciente/estatística & dados numéricos , Tremor por Sensação de Frio/fisiologia , Sufentanil/administração & dosagem , Sufentanil/uso terapêutico
16.
Medicine (Baltimore) ; 98(41): e17542, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593133

RESUMO

BACKGROUND: Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia are 2 common methods of maintaining analgesia after cesarean section. In recent years, transversus abdominis plane block (TAPB) has been gradually applied clinically to reduce opioid analgesics and has achieved good results. Therefore, we performed this study to compare the efficacy and side effects of TAPB and PCIA in analgesia after cesarean section. METHODS: One hundred patients who underwent cesarean section were randomly classified into 2 groups. Following surgery, one group underwent ultrasound-guided TAPB and the other group underwent PCIA. Pain intensity according to the visual analog scale (VAS; 0 for no pain and 10 for severe intolerable pain) was assessed at 2, 4, 6, 8, 12, and 24-hour postsurgery in both groups. The postoperative complication rate and patient satisfaction were also measured. RESULTS: No significant differences were found in the VAS scores between the groups (P > .05). However, the incidence of postoperative complications in the TAPB group was significantly lower than that in the PCIA group (P < .05). Furthermore, patient satisfaction in the TAPB group was significantly higher than that in the PCIA group (P < .05). CONCLUSION: This study demonstrated that ultrasound-guided TAPB can achieve the same analgesic effect as PCIA after cesarean section but with even higher patient satisfaction.


Assuntos
Músculos Abdominais/inervação , Analgesia Controlada pelo Paciente/métodos , Cesárea/efeitos adversos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/efeitos dos fármacos , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Cesárea/métodos , Feminino , Humanos , Incidência , Bloqueio Nervoso/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Qualidade de Vida , Escala Visual Analógica
17.
Middle East Afr J Ophthalmol ; 26(2): 65-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543662

RESUMO

PURPOSE: The aim of the study is to evaluate patients' satisfaction and subjective vision 12 months after monocular KAMRA corneal inlay implantation for the surgical compensation of presbyopia. SUBJECTS AND METHODS: Medical records of patients who underwent corneal inlay implantation in the nondominant eye between 2013 and 2014 were retrospectively reviewed. Data were collected from several centers in Lebanon. Patients with hyperopia or myopia with presbyopia between 45 and 70 years not suffering from any other ocular pathology were eligible for inclusion. Twelve-month postoperative satisfaction score was evaluated in all patients as well as the subjective vision score for near, intermediate, and distant tasks. RESULTS: This study included 73 patients. Almost 95% (69/73) of patients were satisfied or very satisfied with their vision and 93% (68/73) never or almost never used reading glasses while performing daily tasks. Subjective vision scores were found to be higher for distant and intermediate tasks performed during the day than for those performed during the night (P < 0.001). The average subjective vision score for reading a book or a newspaper in dim light was the lowest among all average subjective vision scores. No difference in satisfaction was found between patients with myopia or hyperopia or between males and females. CONCLUSION: The implant of a small-aperture corneal inlay resulted in a substantial improvement in patients' distant, intermediate, and near subjective vision, better in normal light than in dim light, and most patients became spectacles independent.


Assuntos
Substância Própria/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Presbiopia/cirurgia , Próteses e Implantes , Implantação de Prótese , Acuidade Visual/fisiologia , Idoso , Feminino , Humanos , Hiperopia/cirurgia , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Inquéritos e Questionários
18.
Artigo em Inglês | MEDLINE | ID: mdl-31505840

RESUMO

Patient satisfaction is a measure of the extent to which a patient is content with the health care they received from their health care provider. Patient satisfaction is one of the most important factors to determine the success of a health care facility. The purpose of this study was to determine patient satisfaction with healthcare services and encompass the physician's behavior as moderation between patient satisfaction and healthcare services. The study seeks to measure the health care services, like a laboratory and diagnostic care, preventive healthcare and prenatal care, to patient satisfaction in the public health sectors of Pakistan. A descriptive survey research design was used for this study. The target population was patients from the out-patient department (OPD) of three public hospitals from Pakistan. By using the convenient sampling technique, 290 sample participants were selected from the target population. The reliability scales were tallied by using Cronbach's Alpha. The findings of the study are gleaned by using regression to explore patient satisfaction with the health care services, and whether or not the physician's behavior moderates the link of patient satisfaction and healthcare services. SPSS Hayes process was used for the moderation effect of the physician's behavior. The main results of the regression analysis validate that health care services, such as laboratory and diagnostic care, preventive healthcare, and prenatal care, have a significant and positive effect on patient satisfaction. Specifically, the study suggests that the physician's behavior significantly moderates the effect of health care services on the satisfaction of patients. The overall opinions about the satisfaction level of patients for the availability of health services in the hospitals were good. The degree of satisfaction was satisfactory with respect to laboratory and diagnostic care, preventive healthcare, and prenatal care services. Based on the outcomes, the study confirms that the proposed hypotheses are statistically significant. Furthermore, the directions for future research of the study are offered.


Assuntos
Serviços de Saúde , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Paquistão , Médicos/psicologia , Adulto Jovem
19.
BMC Health Serv Res ; 19(1): 669, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533708

RESUMO

BACKGROUND: Measuring patient satisfaction has become an important parameter of the continuous quality assessment and improvement in anaesthesia services. The aim of this study was to assess the level of patient satisfaction with perioperative anaesthesia care and to determine the factors that influence satisfaction. METHOD: This study is an cross sectional design, conducted on 470 patients who underwent different types of surgeries at two National Referral Hospitals in Asmara, Eritrea between January and March of 2018. Patients were interviewed 24 h after the operation using a Tigrigna translated Leiden Perioperative Care Patient Satisfaction questionnaire (LPPSq). Descriptive and inferential analysis were made using SPSS (version 22). Statistical significance level was set at P < 0.05. RESULTS: The overall satisfaction score was 68.8%. Less fear and concern was observed among patients with satisfaction scores of 87.5%. Staff-patient relationship satisfaction score was 75%. Patients were least satisfied with information provision (45%). Multivariable analysis revealed that satisfaction of patients who did surgery at Halibet hospital is significantly higher (p < 0.001) than those patients who did at Orotta hospital. Moreover, those patients who did elective surgery had higher level of satisfaction that those who did emergency surgery (p < 0.001). CONCLUSION: Moderate level of satisfaction was observed among the patients. Generally, the study emphasized that the information provision about anesthesia and surgery was low. Patients described better staff-patient relationship and low fear and concern related to anesthesia and surgery was observed.


Assuntos
Anestesia/normas , Satisfação do Paciente/estatística & dados numéricos , Assistência Perioperatória/normas , Adulto , Anestesia/psicologia , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/psicologia , Tratamento de Emergência/normas , Eritreia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
20.
Mayo Clin Proc ; 94(11): 2291-2301, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563425

RESUMO

Ensuring that the patient's voice is routinely incorporated in all aspects of health care in oncology is essential to provide quality care. Patient reported outcomes (PROs) are standardized measures that are used to obtain the patient's perspective and are increasingly used in all aspects of health care to ensure optimal delivery of patient-centered care. The US Food and Drug Administration encourages that PROs be used in studies for label indications. There are no uniform standardized methods to use PROs nor is there consensus on which PROs are best for regulatory approval, comparative effectiveness research, toxicity assessment, health-related quality of life, or symptom monitoring. For this review, we conducted a literature search using PubMed and Google Scholar, and herein summarize the evidence related to the use of PROs in clinic care and research. Using valid, reliable, and easily interpretable PROs developed in comparable populations will provide the most useful results. Various ways that PROs can be used successfully in oncology have been exemplified in this overview to provide clinicians and researchers practical guidance.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida , Humanos , Oncologia , Neoplasias , Assistência Centrada no Paciente/organização & administração
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