Evaluation of the treatment of hallux rigidus by percutaneous surgery

This longitudinal prospective study of 22 patients (26 feet) aimed to evaluate the effectiveness of percutaneous surgery in the treatment of hallux rigidus, and to assess patient satisfaction with the result of this surgical approach. Pain levels (VAS), quality of life (SF-12) and clinical stage (AOFAS) were scored prior to surgery and 18 months after surgery. Pain relief was noted in all cases, with mean pain scores falling from 7.44 before surgery to 1.69. Perception of quality of life also improved, while AOFAS scores rose from 58.45 to 92.36. These results suggest that percutaneous treatment of hallux rigidus, consisting in capsular release, resection of bony spurs and dorsal wedge osteotomy of the first metatarsophalangeal joint, is effective in terms of both clinical outcome and patient satisfaction, as the scores for both measures were noted to be higher than reported using conventional techniques.     

The therapeutic dilemma: how to use psychotherapy

Organic, marital and intrapsychic disturbances mutually interact in the pathogenesis of erectile dysfunction (ED). Sexual psychotherapy (SP) should be considered a useful chance on all occasions. When non-organic causes are predominant, SP could help in solving the problem. Conversely, when ED is mainly a symptom of organic diseases, SP should be considered as an important support, reducing the net contribution of marital and/or intrapsychic components and improving responsiveness and compliance to medical treatments. A correct diagnosis is a crucial step in the evaluation of patients reporting ED, in order to quantify the contribution of different pathogenetic factors. Structured Interview on Erectile Dysfunction (SIEDY) is a useful instrument for the first screening of ED patients, providing scores for organic, marital and intrapsychic components. Other instruments, such as body paint or sexuality tree, might also be used to further analyse the problem and to choose the most effective SP intervention for the patient himself or for the couple. In our view, medical and psychosexual therapies are not indeed two distinct therapeutic entities to be used in different clinical settings, but are two important tools to be simultaneously considered (and often simultaneously employed) to fully rescue the sexual satisfaction of the couple.     

腹腔镜手术后肩痛的危险因素及干预措施研究进展

腹腔镜手术后肩痛是腹腔镜手术后的并发症之一，也是腹腔镜手术后疼痛的主要来源之一，发生率为30%～90%，影响患者术后康复，降低患者满意度。与切口痛比较，腹腔镜手术后肩痛对镇痛药物反应差。因此，尽早识别并给予干预措施防治腹腔镜手术后肩痛的发生，对减轻患者术后疼痛及加速患者术后康复有重要意义。本文对腹腔镜手术后肩痛的危险因素及干预措施进行综述，以期为临床预防及治疗腹腔镜手术后肩痛提供参考。     

护理干预对原发性高血压患者的干预效果分析

目的观察护理干预对原发性高血压患者的疗效,为原发性高血压患者的治疗和护理提供循证依据。方法对笔者所在医院采用综合护理干预措施进行干预护理的152例原发性高血压患者的资料回顾分析,并选择同期未采取护理干预的120例原发性高血压患者为对照组,比较两组患者治疗效果及护理满意度。结果干预组患者血压控制率明显高于对照组,其焦虑、抑郁水平明显低于对照组,且患者依从性、知晓率和满意度比较亦明显高于对照组（P均〈0.01）。结论科学有效的护理干预措施可提高临床疗效及护理满意度。     

Coccygectomy for coccygodynia: does pathogenesis matter?

BACKGROUND: Severity of vertical impact to the coccyx can range from mere contusion to a dislocated fracture of the coccyx. With early conservative management, most patients have a good prognosis and heal within weeks to months after the initial trauma. Occasionally, persisting symptoms make a surgical intervention with coccygectomy necessary. METHODS: We report on the results of patients surgically managed for traumatically induced, persisting coccygodynia and compare these to patients operatively treated for idiopathic coccygodynia. Sixteen patients with an average follow-up of 7.3 years were evaluated. Of these, eight were surgically treated for traumatic and eight for idiopathic coccygodynia. The clinical results were assessed by means of the Hambly Score and the Oswestry Low Back Pain Disability questionnaire. Patient satisfaction with the postoperative result was assessed by a visual analog scale. RESULTS: Seven of eight (88%) patients treated for traumatically induced coccygodynia had a good or excellent postoperative result, in contrast to only three of eight (38%) patients with idiopathic coccygodynia. The former group had better results in terms of sitting tolerance and general pain intensity as represented by the Oswestry Low Back Pain Disability questionnaire. According to the significantly better clinical results, personal satisfaction was clearly higher in the traumatic group. CONCLUSION: These results suggest that, in patients where all conservative treatment methods work to no avail, particularly those with traumatically induced persisting coccygodynia benefit from surgical intervention with coccygectomy.     

What Are the Benefits of Hip Resurfacing in Appropriate Patients? A Retrospective,Propensity Score-Matched Analysis

Background

Hip arthritis is one of the major causes of disability worldwide. Hip resurfacing arthroplasty (HRA) has emerged in recent years as an alternative to total hip arthroplasty (THA), but complications of HRA have limited the patient population to younger male patients with primary osteoarthritis and large hip anatomy. How the functional benefits of HRA in this population compare with those of THA is not entirely clear.

Questions/Purposes

The primary aim of this study was to determine whether there were differences in hip disability and patient satisfaction with surgery between these two groups at 2 years after surgery, using patient-reported outcome measures (PROMs) and subjective measures of patient satisfaction. Additionally, we sought to determine whether there were differences in post-operative discharge disposition, revision rates, or adverse events.

Methods

We searched an institutional database to identify patients undergoing unilateral HRA or THA between January 2007 and July 2011 who met today’s recommended criteria for HRA: younger male patients with large-enough hip anatomy to make surgery viable (a femoral head of at least 48 mm in HRA patients and, in THA patients, an acetabular shell size of 54 mm, the minimum outer shell size that could accommodate a femoral head component of 48 mm; for matching purposes, acetabular shell size in THA was used as a surrogate for the femoral head size used in HRA). We used propensity score matching to control for potentially confounding pre-operative variables and administered the Hip Disability and Osteoarthritis Outcome Score (HOOS) survey, including its subdomains, at the 2-year mark. We also assessed differences between groups in Lower Extremity Activity Scale scores, 12-item Short Form Health Survey results, and answers regarding satisfaction with surgery. We calculated minimal detectable change, minimum clinically important change, and substantial clinical benefit using anchor-based techniques for multiple outcome measures.

Results

There were 251 patients in each group. HRA patients scored significantly higher than THA patients on the 2-year HOOS sports and recreation (92 versus 87, respectively) and on rates of overall satisfaction (94% versus 89%, respectively). The HRA group also had a greater chance of achieving minimum clinically important change (18.75 points) in the HOOS sports and recreation subdomains than the THA group (97% versus 91%). No significant difference was found in 6-month adverse event rates. HRA patients also had a significantly shorter mean hospital stay, a higher rate of discharge to home, and a lower incidence of a “significant” limp after surgery.

Conclusion

HRA may provide a functional benefit in sports and recreation and greater satisfaction in patients who meet the current criteria for HRA. Because these benefits may be small, pre-operative counseling should focus on balancing the possible functional benefits against the longer-term risks associated with metal-on-metal bearings.

     

Should age be a contraindication for degenerative lumbar surgery?

Introduction and purpose

The purpose of this study was to evaluate and compare disability, quality of life and satisfaction outcomes between young people and elderly who were operated on for degenerative lumbar disease.

Material and methods

A database of 263 patients undergoing lumbar surgery for degenerative conditions was collected. There were 74 patients who were 65 years old or above and 189 who were below 65 who had complete preoperative and 2-year postoperative HRQOL data measures: ODI, SF-36 and COMI.

Results

There were no significant differences in the outcomes between the two age groups (p > 0.05). An improvement from baseline in all quality of life measures in the two age groups was observed. A median improvement of 6.0 points was found in the ODI in the younger patients versus 12.0 in older ones. A median improvement in the SF36 physical component score of 6.95 was seen in the younger group while improvement was reported at 6.36 points in patients over 65. The SF36 mental component score improved by 4.48 points and 4.96 points, respectively. COMI improved a median of 1.2 points in both groups. In terms of satisfaction, 66.9 % of the younger patients were pleased or very pleased whereas this was found to be 59.7 % for the older group.

Conclusion

Older patients can see substantial clinical improvement after degenerative lumbar disease surgery similar to that obtained in younger patients in terms of quality of life and satisfaction. The improvement in terms of the disability is greater for older patients. Thus, age should not be a contraindication for this procedure.     

Evaluating Clinical Use of a Ceramide-dominant, Physiologic Lipid-based Topical Emulsion for Atopic Dermatitis

Objectives: The objective of this study was to evaluate the efficacy of a ceramide-dominant, physiologic lipid-based topical emulsion, inclusive of ceramides, cholesterol, and fatty acids in a 3:1:1 ratio, in the clinical practice setting in subjects with mild-to-moderate atopic dermatitis. The included subjects presented with a wide range of demographic characteristics thus building upon the results reported with this agent from an earlier clinical trial in atopic dermatitis subjects. In addition, the utility of this important treatment approach of starting with a product directed at epidermal barrier repair was explored. Methods: In a 50-center, open-label, interventional study, the ceramide-dominant, physiologic lipid barrier repair emulsion was evaluated for three weeks in 207 patients either as monotherapy or in combination with another atopic dermatitis treatment. Outcome measures included investigator global assessment, investigator and subject satisfaction, subject-perceived improvement in atopic dermatitis, pruritus severity, and two quality-of-life questions. Results: Overall, approximately half of the subjects achieved success with investigator global assessment (clear or almost clear investigator global assessment scores) after three weeks of treatment with the ceramide-dominant, physiologic lipid barrier repair emulsion as monotherapy or in combination with another treatment. A large proportion of subjects (75% of subjects) and investigators (for 77% of subjects) reported satisfaction after three weeks of treatment. Pruritus and quality of life improved during the study. Conclusion: The ceramide-dominant, physiologic lipid-based product was shown to be an effective agent, with or without additional topical therapy, to provide good clinical efficacy and high levels of investigator and patient satisfaction for many patients with mild-to-moderate atopic dermatitis. The results of this study are consistent with results noted in a previous study of atopic dermatitis patients using this same barrier repair agent. The treatment approach of using a skin barrier repair cream as an integral and standard component of initial atopic dermatitis therapy, either as monotherapy or as a part of combination topical therapy, is supported by the outcomes observed in this study. This specific ceramide-dominant, physiologic lipid-based product may be used when initiating topical therapy for atopic dermatitis based on results from this and other studies.     

Surveillance and follow-up after revascularization for critical limb ischemia

The purpose of a structured and cost-effective surveillance program after surgical or endovascular intervention for critical limb ischemia is to optimize limb salvage and preserve arterial repair function. Surveillance programs should include clinical, vascular laboratory, and radiographic follow-up, and, when a high-grade progressive stenosis is identified, appropriately timed intervention should be performed. Because many patients with critical limb ischemia are older and many are frail with limited mobility, optimizing the durability of arterial intervention and keeping these patients ambulatory is an important factor in retaining an independent lifestyle and quality of life. Despite the importance of surveillance after arterial intervention, there is a lack of consensus in the literature regarding the efficacy of surveillance, how it should be performed, and well-defined evidence-based guidelines. This review provides an up-to-date scrutiny on this topic and provides recommendations for optimal testing methods, limitations of surveillance testing, and when and how to intervene. These recommendations should be considered in the care of the patient with critical limb ischemia, but with the understanding that patients vary widely and care should be individualized.     

Determination and importance of clinical and patient-based measures in outcome assessment of peripheral arterial occlusive disease

Therapeutic effectiveness is the overall effect of an intervention on clinical and quality-of-life measures. Traditionally, in peripheral arterial disease, this has been evaluated in terms of clinical outcomes only. The lack of correlation between quality-of-life and clinical measures means that these cannot adequately describe overall patient benefit or adverse effects from an intervention. Therefore, patient-based measures such as changes in disease-specific questionnaire scores must be included in the evaluation of therapeutic effectiveness.     

Editorial Commentary: Maximal Outcome Improvement: Another Arrow in the Quiver

Clinically important outcome assessment has been a point of increasing emphasis in the orthopaedic literature. The minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit are the most reported in the hip preservation literature. Maximal outcome improvement (MOI) is now also being reported; however, its relation to patients undergoing hip preservation surgery is not well understood. The threshold values that represented satisfaction with surgery were 54.8%, 52.5%, 55.5%, and 55.8% of the MOI for the modified Harris Hip Score, Nonarthritic Hip Score, visual analog scale score for pain, and International Hip Outcome Tool-12 score, respectively. Although the MOI is helpful for characterizing outcome improvement, established measures such as substantial clinical benefit may be better used to grade outcomes in patients with high preoperative function.     

Improving Flexibility and Quality of Life for Your Patients: A Must?

ContextProstate cancer (PCa) and androgen deprivation therapy (ADT) have a significant impact on the quality of life (QoL) of patients. Therefore, QoL is an important factor to be considered before and during ADT, and appropriate measures should be taken to maintain or improve it.ObjectiveThis paper discusses several aspects considered important in the maintenance or improvement of the QoL of PCa patients treated with ADT.Evidence acquisitionDuring the 2009 European Association of Urology (EAU) Congress in Stockholm, Sweden, a satellite symposium was held on PCa. This paper is based on one of the presentations held at this symposium. Data were retrieved from recent review articles, original articles, and abstracts.Evidence synthesisEffective, patient-centred communication will ensure that the patient is well informed about the treatment and its potential side-effects, may reduce suffering, and enhances the patient's well-being. ADT may induce side-effects that affect QoL and also cause potentially serious medical problems. Therefore, measures should be taken to prevent or manage these side-effects before and during ADT. Integrating the patient's expectations, preferences, and needs in daily clinical practice, such as during treatment decisions, will ensure well-informed decisions and may minimise future regret and improve treatment satisfaction. A treatment such as the luteinising hormone-releasing hormone agonist Eligard^®, which is available in 1-, 3- and 6-mo depot formulations, enabling administration at different time intervals, offers patients flexibility and is another step in improving QoL.ConclusionsQoL is an important factor to be considered before and during ADT for PCa. Effective and open communication between the patient and physician, prevention and management of ADT-related side-effects, and integration of patient's expectations in clinical practice are measures that can be taken to maintain or improve the QoL of ADT-treated patients.     

Mild traumatic brain injuries: the impact of early intervention on late sequelae. A randomized controlled trial

Summary Background. Positive results from early clinical intervention of mild traumatic brain injury (MTBI) patients by rehabilitation specialists have been reported. Various treatments have been used, but few controlled studies are published. We hypothesised that early rehabilitation of selected MTBI patients would reduce long term sequelae. Method. A randomised controlled trial with one year follow-up. Among 1719 consecutive patients with MTBI, 395 individuals, 16–60 years of age, met the MTBI definition. Exclusion criteria were: previous clinically significant brain disorders and/or a history of substance abuse. The control group (n = 131) received regular care. The intervention group (n = 264) was examined by a rehabilitation specialist. 78 patients were mainly referred to an occupational therapist. The problems were identified in daily activities and in terms of post-concussion symptoms (PCS), an individualised, tailored treatment was given. Primary endpoint was change in rate of PCS and in life satisfaction at one-year follow-up between the groups. Findings. No statistical differences were found between the intervention and control groups. Patients who experienced few PCS two to eight weeks after the injury and declined rehabilitation recovered and returned to their pre-injury status. Patients who suffered several PCS and accepted rehabilitation did not recover after one year. Interpretation. In this particular MTBI sample, early active rehabilitation did not change the outcome to a statistically-significant degree. Further studies should focus on patients with several complaints during the first 1–3 months and test various types of interventions.     

Surgical treatment of hemorrhoids in day-surgery

The Authors report their own experience with day-surgery treatment of haemorrhoids and underline the advantages in terms of patients' compliance and reduction of the sanitary management in order to the cost that this way suggests. The serie here reported includes 72 patients treated, by two years, with day-surgery haemorrhoidectomy. Here are indicated criteria of selection of the patients, related to the state of the illness, association of other pathologies and social factors. All the patients, moreover, have been treated according to a scheme that generally includes: a careful preoperatory valuation, local anaesthesia, standardized surgical method (Milligan-Morgan intervention), dimission few hours after the operation, control of the patients at their own home. The results obtained, careful examinted through an objective valuation (complications, relapses, time or reability) and subjective one (index of satisfaction of the patients), can be considered extremely positive.     

To test or to estimate? P-values versus effect sizes

Most research in transplant medicine includes statistical analysis of observed data. Too often authors solely rely on P-values derived by statistical tests to answer their research questions. A P-value smaller than 0.05 is typically used to declare “statistical significance” and hence, “proves” that, for example, an intervention has an effect on the outcome of interest. Especially in observational studies, such an approach is highly problematic and can lead to false conclusions. Instead, adequate estimates of the observed size of the effect, for example, expressed as the risk difference, the relative risk or the hazard ratio, should be reported. These effect size measures have to be accompanied with an estimate of their precision, like a 95% confidence interval. Such a duo of effect size measure and confidence interval can then be used to answer the important question of clinical relevance.     

Development of the Facial Lines Treatment Satisfaction Questionnaire and Initial Results for Botulinum Toxin Type A–Treated Patients

Background. Botulinum toxin type A treatment is a safe and effective treatment for facial lines. Patient satisfaction with treatment has not yet been systematically measured and reported.
Objective. To create a valid and reliable questionnaire to assess patient satisfaction with facial line treatment and to assess treatment satisfaction in facial line patients.
Methods. Development of the Facial Line Treatment Satisfaction (FTS) Questionnaire followed the five-step process recommended by the Patient Reported Outcomes Harmonization Committee.
Results. One hundred fifty-two pilot test participants received botulinum toxin type A treatment alone or in combination with a minimally invasive facial line treatment and were satisfied or very satisfied with their facial lines treatment.
Conclusion. The FTS is a valid and reliable 14-item questionnaire that measures an aesthetic patient's satisfaction with facial line treatment. The FTS can be used in clinical practice or clinical trials of facial line treatments. Botulinum toxin type A treatment is associated with high patient satisfaction.     

Glycaemic control,treatment satisfaction and quality of life in type 2 diabetes patients in Greece: The PANORAMA study Greek results

AIM: To provide an update on glycaemic control inEuropean patients with type 2 diabetes mellitus(T2DM). We present the Greek population data of the study. METHODS: An observational multicenter, cross-sectional study evaluating glycaemic control and a range of other clinical and biological measures as well as quality of life(Qo L) and treatment satisfaction in 375 patients with T2 DM enrolled by 25 primary care sites from Greece. RESULTS: The mean age of the patients was 63.5 years and the male/female ratio 48.9%/51.1%. 79.7% of the patients exerted none or light physical activity, 82.4% were overweight or obese and 32.9% did not meet Hb A1 c target of less than 7.0%(53 mmol/mol). Patients reported high satisfaction to continue with treatment, high satisfaction with administered treatment and increased willingness to recommend treatment to others(mean Diabetes Treatment Satisfaction Questionnaire score 29.1 ± 5.6). However, 80% of the patients reported that their Qo L would be better without diabetes. Finally, the most challenging parameter reported was the lack of freedom to eat and drink. CONCLUSION: This analysis of the Greek Panorama study results showed that a considerable percentage of T2 DM patients in Greece do not achieve glycaemic target levels, despite the favourably reported patient satisfaction from administered therapy. Additionally, the majority of primary care T2 DM patients in Greece depict the negative effect of the disease in their Qo L.     

Development of the Facial Lines Treatment Satisfaction Questionnaire and initial results for botulinum toxin type A-treated patients.

BACKGROUND: Botulinum toxin type A treatment is a safe and effective treatment for facial lines. Patient satisfaction with treatment has not yet been systematically measured and reported. OBJECTIVE: To create a valid and reliable questionnaire to assess patient satisfaction with facial line treatment and to assess treatment satisfaction in facial line patients. METHODS: Development of the Facial Line Treatment Satisfaction (FTS) Questionnaire followed the five-step process recommended by the Patient Reported Outcomes Harmonization Committee. RESULTS: One hundred fifty-two pilot test participants received botulinum toxin type A treatment alone or in combination with a minimally invasive facial line treatment and were satisfied or very satisfied with their facial lines treatment. CONCLUSION: The FTS is a valid and reliable 14-item questionnaire that measures an aesthetic patient's satisfaction with facial line treatment. The FTS can be used in clinical practice or clinical trials of facial line treatments. Botulinum toxin type A treatment is associated with high patient satisfaction.     

Satisfaction with care in peritoneal dialysis patients

Patient satisfaction is an important aspect of dialysis care, only recently evaluated in clinical studies. We developed a tool to assess peritoneal dialysis (PD) customer satisfaction, and sought to evaluate and validate the Customer Satisfaction Questionnaire (CSQ), quantifying PD patient satisfaction. The CSQ included questions regarding administrative issues, Delivery Service, PD Training, Handling Requests, and transportation. The study was performed using interviews in all Hungarian Fresenius Medical Care dialysis centers offering PD. CSQ results were compared with psychosocial measures to identify if patient satisfaction was associated with perception of social support and illness burden, or depression. We assessed CSQ internal consistency and validity. Factor analysis explored potential underlying dimensions of the CSQ. One hundred and thirty-three patients treated with PD for end-stage renal disease for more than 3 months were interviewed. The CSQ had high internal consistency. There was high patient satisfaction with customer service. PD patient satisfaction scores correlated with quality of life (QOL) and social support measures, but not with medical or demographic factors, or depressive affect. The CSQ is a reliable tool to assess PD customer satisfaction. PD patient satisfaction is associated with perception of QOL. Efforts to improve customer satisfaction may improve PD patients' quantity as well as QOL.     

Caregivers of lung transplant candidates: do they benefit when the patient is receiving psychological services?

BACKGROUND: We recently demonstrated that a targeted psychological intervention has quality of life, mood, and social intimacy benefits for patients awaiting lung transplantation. OBJECTIVE: To evaluate the impact of the patient's participation in treatment on caregiver functioning. DESIGN AND INTERVENTION: Caregivers of patients participating in a randomized clinical trial designed to compare 2 telephone-based psychological interventions completed outcome measures at baseline and at 1 and 3 months after patients completed treatment. Patients were randomized to receive either supportive therapy (emotional and educational support) or quality-of-life therapy (a cognitive-behavioral intervention that provided specific intervention strategies to boost happiness and satisfaction in life domains that compromise overall quality of life). Caregivers did not participate directly in the interventions. Setting and Participants-Participants were 28 caregivers from a large lung transplant center in the southeastern United States. MAIN OUTCOME MEASURES: Quality of life (Quality of Life Inventory), mood disturbance (Profile of Mood States-Short Form), and social intimacy (Miller Social Intimacy Scale). RESULTS AND CONCLUSIONS: Caregivers reported higher quality of life and lower mood disturbance scores, and comparable social intimacy scores relative to the patients for whom they were caring. Caregivers whose patients received quality-of-life therapy reported vicarious gains in quality of life, mood disturbance, and social intimacy, relative to those whose patients received support therapy. Finally, the degree of change in patients' quality of life, mood disturbance, and social intimacy contributed significantly to predicting caregivers' functioning at the 3-month follow-up assessment. These findings suggest that telephone-based quality-of-life therapy has beneficial effects that extend beyond patients to their caregivers.