Patients' expectations of private osteopathic care in the UK: A national survey of patients

BackgroundPatients' expectations of osteopathic care have been little researched. This quantitative study built on an extensive review of the literature relating to expectations in primary and musculoskeletal care, and on the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients.The aim of the project was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet.MethodsThe design of the study involved development of a questionnaire about patients' expectations of osteopathic care, which was then used for a national patient survey. A random sample of 800 registered osteopaths in private practice across the UK was asked to invite a systematic sample of patients to take part, by completing the questionnaire. Patients were asked to post completed questionnaires to the researchers for analysis. The main outcome measures assessed patients' expectation (the percentage of positive responses for each aspect of expectation) and unmet expectation (computed from the proportion responding that “it did not happen”).Results1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were deemed positively important; listening, respect and information-giving by their osteopath ranked highest. Only 11 expectations were unmet to an unacceptable degree. The expectations most often unmet were “to be made aware that there was a complaints procedure”, “to find it difficult to pay for osteopathic treatment”, and “perceiving there to be communication between the osteopath and their GP”.ConclusionsThe large number of important expectations reflects the complexity of providing health care, and the challenges each osteopath faces in meeting patients' expectations. The results provided a generally positive message about private osteopathic practice, showing that most expectations were met and levels of satisfaction were high. The study has identified certain gaps between expectations and the delivery of care, which can be used to improve the quality of care. Patients' expectations are perhaps changing as osteopathy moves from a marginal to a mainstream profession and as consumers (users) have increasingly high expectations of health services generally. These findings may apply to other healthcare professions. The questionnaire is a resource for future research.     

Beyond consent--improving understanding in surgical patients

BackgroundLittle is known of the actual understanding that underlies patient choices with regard to their surgical treatment. This review explores current knowledge of patient understanding and techniques that may be used to improve this understanding.MethodsMEDLINE and PubMed were searched using the terms “patient understanding,” “patient comprehension,” “consent,” “video,” “multimedia,” “patient information leaflet,” “internet,” “test-feedback,” “extended discussion,” “shared decision making,” and “decision aid.” All retrieved peer-reviewed studies were included in the review.ResultsUnderstanding in surgical patients is poor. There is little evidence to support the use of information leaflets, although multimedia appears to be effective in improving patient understanding. The internet is not used effectively as an aid to consent by health care providers. Patients with lower educational levels may gain most from additional interventions. Improving patient understanding does not impact on their satisfaction with the treatment they have received but may reduce periprocedural anxiety.ConclusionsThere is a need for greater awareness of patients' information needs, and novel approaches that may enhance decision making through improved understanding are required.     

Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico,diagnóstico y terapéutico

IntroductionThe syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area.ObjectivesTo make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment.Materials and methodsWe performed a literature search through the database “Pubmed” using the terms “Pudendal nerve”, “Pudendal nerve entrapment syndrome,” “Pelvic floor neuropathic pain”, “Pelvic floor myofascial syndrome,” “Pudendal nerve decompression”. Also, selected works in English, Spanish and French, also reviewing the articles relate this work.ResultsWe develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery.ConclusionIt is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.     

Psychosocial correlates of pelvic floor disorders in women seeking bariatric surgery

BackgroundWomen who struggle with obesity are at a significant risk for pelvic floor disorders (PFDs), defined as urinary incontinence, pelvic organ prolapse, and/or fecal incontinence. The association between PFDs and reduced quality of life has been demonstrated; however, the psychosocial correlates of PFDs in women undergoing bariatric surgery have yet to be examined. The present study explored the potential psychosocial correlates of PFD. The setting was an academic medical center.MethodsData were analyzed from 421 female patients evaluated for bariatric surgery. Based upon a screening questionnaire, participants were dichotomized as women with PFDs (n = 121) and women without PFDs (n = 300). Patients completed the “Minnesota Multiphasic Personality Inventory, 2nd ed., Restructured Form (MMPI-2-RF),” and medical records were reviewed for demographic data, body mass index, substance abuse/dependence history, history of physical and/or sexual abuse, psychiatric medication usage, and psychiatric diagnoses. MMPI-2-RF scales measuring depression, anxiety, somatic symptoms, and social support were examined.ResultsWomen with PFDs were significantly older (F_1,420 = 3.87, P < .05) and more likely to evidence a history of substance abuse/dependence (chi-square = 4.53, P < .05) and depression (chi-square = 4.31, P < .05) than women without PFDs. There also was a trend for previous inpatient hospitalization (chi-square = 2.93, P < .09), outpatient behavioral health treatment (chi-square = 2.89, P < .09), and psychotropic medication usage (chi-square = 3.32, P < .07). No differences were found in the objective psychological testing.ConclusionWomen with PFDs may be more psychiatrically vulnerable than other bariatric surgery candidates. Additional research on the association among PFDs, substance abuse, and depression is warranted. Future research should consider whether this potential relationship changes postoperative bariatric surgery.     

The Effects Of Colostomy On The Quality Of Life In Patients With Spinal Cord Injury: A Retrospective Analysis

Abstract

Purpose: The purpose of this study was to evaluate the effects of colostomy on the quality of life (QOL) in patients with spinal cord injury (SCI) by designing a questionnaire that used self-reported data and correlating these data with the clinical information obtained from patients' medical records.

Materials and methods: A comprehensive QOL questionnaire was designed to specifically address the following 5 domains: physical health, psychosocial adjustment, body image, self-efficacy, and recreation/leisure. This questionnaire was completed during a telephone or an in-person interview. The subjective data derived from the questionnaire were correlated with objective medical information obtained from a review of medical records.

Results: The QOL improved significantly (t = 9.128, P < .0001) after colostomy. All 27 (100%) patients were “satisfied,” and 16 (59%) of them were “very satisfied” with colostomy. Nineteen (70%) patients would have preferred to have the colostomy done earlier, and only 3(11%) patients wished it reversed. Colostomy reduced the number of hospitalizations caused by chronic bowel dysfunction by 70.4%. After colostomy, the average amount of time spent on bowel care was reduced from 117.0 min/day to 12.8 min/day (t = 7.964, P < .0001). All patients stated that colostomy simplified bowel care routine and increased independence. Significant improvements were recorded in the areas of physical health, psychosocial adjustment, and self-efficacy. Stoma prolapse and wound dehiscence were the most common complications of stomal surgery. When compared with medical data, patients were able to reliably recall average time with bowel problems (r = .881, P < .0001) and stomal surgery complications (r = .810, P < .0001).

Conclusion: Colostomy is a safe and effective treatment for chronic bowel dysfunction in patients with spinal cord injury. It is well accepted by the patients and significantly improves QOL and bowel management procedures. Correlation analysis indicates that subjective patient-reported data are consistent with objective data obtained from the medical records.     

Effects of bariatric surgery on food cravings: do food cravings and the consumption of craved foods “normalize” after surgery?

BackgroundThe reported effects of bariatric surgery on food cravings have been inconsistent. Moreover, research has been largely limited to sweet cravings, and no study has examined whether surgery patients' cravings differ from those of normal weight (NW) controls. Our objective was to use an empirically validated instrument to examine changes in bariatric surgery patients' frequency of food cravings and consumption of craved foods from before to 3 and 6 months after surgery and to compare surgery patients' frequency of food cravings to those of NW controls. The setting was private hospitals and research center in the United States.MethodsBariatric surgery patients (n = 32) and NW controls (n = 20) completed the Food Cravings Inventory and had their height and weight measured.ResultsBefore surgery, the patients reported more overall cravings and cravings for high fat and fast foods and a greater consumption of craved high-fat foods than the NW controls. From before to 3 and 6 months after surgery, the patients had significant reductions in overall cravings for, and consumption of, craved foods, with specific effects for sweets and fast food; however, surgery had virtually no effect on the cravings for high-fat foods. Moreover, high-fat and fast food cravings did not reduce to normative levels. The postoperative patients were less likely to consume craved sweets than NW controls, and the patients' postoperative weight loss was largely unrelated to food cravings.ConclusionBariatric surgery is associated with significant reductions in food cravings and consumption of craved foods, with the exception of high-fat foods. Despite these decreases, patients' cravings do not fully reduce to “normative” levels and are not associated with postoperative weight loss.     

Barriers to sexual recovery in men with prostate,bladder and colorectal cancer

BackgroundSurvivors of prostate, bladder, and colorectal cancer endure many sexual side-effects of treatment that negatively impact their relationships and diminish their quality of life. Multiple barriers exist in addressing men's sexual concerns in oncological care.ObjectiveTo describe barriers of sexual recovery in men with prostate, bladder, and colorectal cancer.MethodsWe searched PubMed for peer-reviewed, English-language articles published from 1999 to 2019 using the following search terms: “prostate cancer,” or “bladder cancer,” or “colorectal cancer,” and “male,” and “sexual function,” or “sexual barrier” or “sexual dysfunction.” Criteria for inclusion consisted of peer-reviewed articles (review, cross-sectional, longitudinal, interventional, or pilot studies) addressing sexual issues in men with a history of prostate, bladder, or colorectal cancer.ResultsBarriers to sexual recovery in men with prostate, bladder, and colorectal cancer include psychosocial barriers such as the feeling of loss, grief, depression and anxiety, the poor utilization, and excessive cost of pro-erectile aids, a diminished sense of masculinity and reluctance to seek help for sexual problems, as well as poor couple coping. Barriers in healthcare also exist, as healthcare providers often do not effectively address sexual issues due to poor communication, lack of comfort in discussing sexual issues, time constraints, and patients’ hesitation to initiate discussions on sexual dysfunction. Patients with stomas and gay, bisexual, and queer men face additional challenges in their recovery of sexual intimacy. Barriers to sexual recovery are present in men during all stages of cancer and all modalities of treatment including surgery, radiation, or androgen deprivation therapy.ConclusionThere are multiple overlapping psychosocial and healthcare system barriers to sexual recovery after prostate, bladder, and colorectal cancer treatment. Oncological providers must be cognizant of these complex barriers so they can facilitate patients’ access to resources needed for successful sexual recovery after genitourinary cancer treatment. Evidence based interventions, such as couple psychosexual counseling and peer support should be implemented via multidisciplinary care.     

Validation of the brief International Classification of Functioning, Disability, and Health (ICF) core set for hand conditions

Study designCross-sectional multi-centre study.IntroductionThe ICF Core Sets for Hand Conditions (HC) have been developed to describe functioning of patients with HC.Purpose of the studyTo study the content validity of the Brief ICF Core Set for HC.MethodsPatients with HC were interviewed using the Comprehensive ICF Core Set for HC. ICF categories that best explained variation in patients' general health were identified using multiple regression methods.ResultsOverall, 12 of the 23 ICF categories of the Brief ICF Core Set could be validated. Our analyzes further revealed that the categories “b134 Sleep functions”, “s830 Structure of nails”, “e225 Climate” as well as categories referring to “e4 Attitudes” also deserve consideration when assessing functioning in patients with HC.ConclusionsClinicians are encouraged to complement the Brief ICF Core Set for HC by adding sleep functions, structure of nails, climate and attitudes, especially when following patients over time.Level of EvidenceLevel 3.     

Earthquakes and Rehabilitation Needs: Experiences From Bam,Iran

Abstract

Background: In December 2003, a devastating earthquake destroyed Bam and surrounding areas in Iran, leaving many people with residual deficits and disabilities, of which approximately 240 patients had spinal cord injury (SCI).

Methods: As an independent volunteer working in outpatient clinics, I visited the patients as part of a mobile team and set up a short educational course in spinal cord medicine.

Results: I visited 34 patients with SCI in the first 3 months. Eight months after the disaster, I visited 54 patients with SCI, 29 female (53.7%) and 25 male (46.3%). Postdisaster problems were identified, including need for accurate data collection, identification of patients' conditions, attention paid to psychosocial issues, ethical dilemmas, and research needs.

Conclusion: Disaster preparedness for earthquakes should include first aid and injury prevention, coordination of relief efforts, basic education and medical care, and short-and long-term rehabilitation needs. The major focus of rehabilitation medicine specialists' should be education of the general and professional population toward integrating the concept of rehabilitation.     

How patients with diabetic foot ulcers experience telemedicine solutions: A scoping review

Diabetic foot ulcer (DFU) is a common, complex and severe complication of diabetes that is associated with severely decreased health-related quality of life. Treatment of DFUs calls for a multi-sectoral approach, incorporating interdisciplinary care pathways. Telemedicine (TM) may be used as a communication tool between caregivers across healthcare sectors to obligate the need for close follow-up, including early intervention in preventing the recurrence of DFU. The objective of this review was to identify, examine and conceptually map the available literature on patients' experiences and views regarding the use of TM solutions among patients with DFUs. We identified the Population, Concept and Context to pinpoint the focus of this review, word the research question and title as well as facilitate the literature search strategy. The literature examined stems from 13 sources. We imposed no restrictions on the methodological approach of the included studies, neither on the format. During the review process, four main maps emerged: “A whole human not merely a hole in a human,” “Less of a burden on the family, the community and the environment,” “Competences and continuity of care are essential for high-quality care” and “The quality and modality of the technology.” Further investigation from both the patients' and the multi-sectoral caregivers' perspective is needed, focusing on whatever modifications of the TM intervention may fit the DFU care pathway better.     

Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging

Objectives. With significant vaginal prolapse, it is often difficult to differentiate among cystocele, enterocele, and high rectocele by physical examination alone. Our group has previously demonstrated the utility of magnetic resonance imaging (MRI) for evaluating pelvic prolapse. We describe a simple objective grading system for quantifying pelvic floor relaxation and prolapse.Methods. One hundred sixty-four consecutive women presenting with pelvic pain (n = 39) or organ prolapse (n = 125) underwent dynamic MRI. The “H-line” (levator hiatus) measures the distance from the pubis to the posterior anal canal. The “M-line” (muscular pelvic floor relaxation) measures the descent of the levator plate from the pubococcygeal line. The “O” classification (organ prolapse) characterizes the degree of visceral prolapse beyond the H-line.Results. The image acquisition time was 2.5 minutes per study. Each study cost $540. In the pain group, the H-line averaged 5.2 ± 1.1 cm versus 7.5 ± 1.5 cm in the prolapse group (P <0.001). The M-line averaged 1.9 ± 1.2 cm in the pain group versus 4.1 ± 1.5 cm in the prolapse group (P <0.001). Incidental pelvic pathologic features were commonly noted, including uterine fibroids, ovarian cysts, hydroureter, urethral diverticula, and foreign body.Conclusions. The HMO classification provides a straightforward and reproducible method for staging and quantifying pelvic floor relaxation and visceral prolapse. Dynamic MRI requires no patient preparation and is ideal for the objective evaluation and follow-up of patients with pelvic prolapse and pelvic floor relaxation. MRI obviates the need for cystourethrography, pelvic ultrasound, or intravenous urography and has become the study of choice at our institution for evaluating the female pelvis.     

Shoulder and head elevation improves laryngoscopic view for tracheal intubation in nonobese as well as obese individuals

Study ObjectiveTo determine whether shoulder and head elevation, such that the patient's ear lies at or higher than the sternum (“ramp”), improves laryngoscopic grade in adult patients of various body mass index (BMI) values.DesignProspective, unblinded study, with patients and laryngoscopists acting as their own controls.SettingOperating room of a university-affiliated hospital.Patients189 adult ASA physical status 1, 2, and 3 patients.InterventionsAfter performing a standard preoperative airway evaluation and inducing general anesthesia, the anesthetist performed and graded two laryngoscopies: one in the “ramp” position and one in the “sniff” position.MeasurementsPatient BMI, Mallampati airway class, thyromental distance, neck circumference, cervical extension ability, Cormack and Lehane laryngoscopic grade for each laryngoscopy, subjective lifting force required, and need for external laryngeal pressure were recorded.Main ResultsUse of the “ramp” provided significantly better or equal laryngoscopic views, relative to those with the “sniff” position, in the entire study population.ConclusionsShoulder and head elevation by any means that brings the patient's sternum onto the horizontal plane of the external auditory meatus maintains or improves laryngoscopic view significantly.     

A survey of patients' understanding and expectations of persistent postsurgical pain in a preoperative testing center

Study ObjectiveAcute postoperative pain may transition to persistent/chronic pain in up to 50% or more of patients after certain surgeries. Despite this concern, it is unclear that patients' preprocedure understanding and expectations are aligned with these potential outcomes. This study was designed to evaluate the extent of this alignment and the potential impact on the quality of risk/benefit discussions before procedures.DesignProspective survey.SettingA large, tertiary care preoperative assessment clinic.PatientsA total of 1481 adult patients.InterventionsSurvey administration.MeasurementsThe survey items evaluated patients' expectations of postoperative pain and how familiar patients were with the risk of persistent postsurgical pain based on their specific characteristics and procedure type.Main ResultsThe overwhelming majority (80%) of patients were unaware of the risk of persistent postsurgical pain. Given the choice, most patients (65%) wanted to be informed of their risk, and 25% stated that it might even affect their decision to proceed with surgery.ConclusionsThere is great need for health care providers to discuss the significant risk of persistent postsurgical pain with patients in the preoperative setting. Patients need to be armed with realistic data to ensure high-quality discussions of risk/benefit, align expectations with outcomes, and potentially identify high-risk groups in which preoperative intervention can reduce the likelihood or severity of persistent postoperative pain syndromes.     

Continued rationale of why hospital mortality is not an appropriate measure of trauma outcomes

BackgroundWe hypothesized that standardized withdrawal of care (WOC) practices and an aggressive long-term acute care facility (LTAC) discharge protocol could change hospital mortality and national ranking among trauma centers.Study DesignPatients who died while admitted to the trauma service at a level 1 trauma center were classified as either an “LTAC candidate” or “not a LTAC candidate” at 4 time points before death.ResultsA total of 216 patients died, and 48% had WOC. Hospital mortality was 3.3%. More than 26% of these qualified as LTAC candidates. The aggressive LTAC discharge protocol reduced hospital mortality by .9%. This was sufficient to move a trauma center into a lower quartile on the National Trauma DataBank benchmark report for 2009.ConlusionsIt is possible to reduce hospital mortality and improve quality ranking with standardized WOC and LTAC discharge protocols. This highlights the importance of measuring outcomes beyond discharge.     

Pelvic floor symptoms in female cyclists and possible remedies: a narrative review

Introduction and hypothesis

Cycling has become a popular athletic activity worldwide and can lead to genital and pelvic floor dysfunction. This review summarizes the current body of evidence about the epidemiology of genital and pelvic floor symptoms in female cyclists, the therapy, and preventive interventions.

Methods

Two electronic meta-databases, OvidSP? and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI), comprising 40 individual databases, were searched for studies that described genital and pelvic floor symptoms in association with cycling and studies that tested possible therapies and prophylactic measures. For the literature search we explored the search terms “female”, “bicycling”, “pelvic floor”, “lower urinary tract symptoms”, and “vulvar diseases”.

Results

The search retrieved 1,219 articles, leaving 763 articles after removal of duplicates, and finally 12 articles eligible for review. We assessed 10 observational and 2 experimental studies. Genital and pelvic floor symptoms related to bicycling were pain, tenderness, neuropathy, urological dysfunction and skin lesions. Broader and conventionally shaped saddles were associated with fewer symptoms compared with cut-out saddle designs.

Conclusion

The quality of existing studies is generally low, but there is evidence that female cyclists suffer from similar problems to male cyclists, ranging from minor skin lesions to severe sequelae such as pain and neurological deficiencies.

     

Paediatric dental pain and infection during the COVID period

BackgroundDuring the coronavirus pandemic, paediatric patients will still likely present with dental pain and infection.In order to streamline care at King's College Hospital (KCH), Paediatric Dentistry and Oral and Maxillofacial Surgery (OMFS) have developed a collaborative working approach allowing patients to be treated effectively and to streamline patient care in the absence of easy access to general anaesthetic facilities.MethodPresenting complaints, treatment need and the treatment received were recorded for all paediatric patients presenting with dental pain and infection in the “lockdown” period (23rd March- 14th June) during “normal” working hours and “out of hours” to either paediatric dentistry or OMFS.Results420 calls were triaged which converted to 67 patients seen face-to-face for oro-facial pain and infection. 41% of children were treated successfully under Local anaesthetic alone, only 13% required a general anaesthetic (GA) in the “lockdown” period. The vast majority of patients had antibiotics prescribed prior to attendance (80%).ConclusionWe have demonstrated the demographic, presenting complaints and treatment need of patients who presented to KCH during the lockdown period with dental pain and infection. The majority were able to be treated without needing for GA facilities. This paper highlights how a collaborative approach between paediatric dentistry and OMFS can help streamline patient care and is a model which can be adopted by other units in the event of further “lockdowns”.     

Cues to action: Pelvic floor muscle exercise compliance in women with stress urinary incontinence

Pelvic floor muscle exercises are recommended as an initial treatment to women with stress urinary incontinence. This treatment is often unsuccessful because of patient noncompliance. A post-test, experimental control group design was used to examine Pender's (1992) concept of an external cue to action, an audiocassette tape, to enhance patient compliance to pelvic floor exercises. Eighty-six women with urodynamically evaluated stress urinary incontinence participated through a Pelvic Floor Exercise Unit at a large teaching hospital. Patients received biofeedback training and written information to reinforce pelvic floor muscle exercises during a 45-min appointment with a nurse. Patients were instructed to perform the exercises for 10 min twice daily. Forty-three woman randomly assigned to an experimental group received an audiocassette tape. Four to 6 weeks later all patients completed a researcher-developed questionnare that was validity and reliability tested assessing pelvic floor exercise compliance. The 43 patients (100%) who received the audiocassette tape reported compliance with “routine” exercises. Twenty-two of 34 patients (65%) who did not receive the tape were compliant (P = 0.0003). Thirty-four of 41 patients (83%) who received the tape reported exercise compliance twice a day, while 4 of 34 patients (12%) in the control group were similarly compliant (P = 0.0000). The findings suggest adding an audiocassette tape to a pelvic floor exercise program enhances patient compliance for incontinent women compared to verbal and written instruction combined with biofeedback. Neurourol. Urodynam. 16:167–177, 1997. © 1997 Wiley-Liss, Inc.     

Identification of physical and psychosocial problems associated with diabetic nephropathy using the International Classification of Functioning,Disability and Health Core Set for Diabetes Mellitus

Background

We previously demonstrated validation of the Comprehensive International Classification of Functioning, Disability and Health Core Set for Diabetes Mellitus (ICF-CS for DM) in patients with diabetic nephropathy (DMN). The objective of the present study was to identify differences in experience of physical and psychosocial problems between DMN patients with and without hemodialysis (HD), and diabetes patients without nephropathy using the ICF-CS for DM.

Methods

A total of 302 diabetes outpatients (men, 68 %; mean age, 62 years) were interviewed using four components of the ICF-CS for DM including “Body functions”, “Body structures”, “Activities and participation”, and “Environmental factors”.

Results

The mean number of categories in which difficulty was experienced in the four components was significantly greater in DMN patients with HD followed by DMN patients without HD, and diabetes patients without nephropathy (23.9 vs. 18.0 vs. 13.1, respectively). Multivariate logistic regression models revealed that, compared with diabetes patients without nephropathy, diabetes patients with nephropathy were more likely to have difficulty with physical problems and social activities and participation. Among DMN patients, dialysis patients were found to have larger numbers of problems, and face difficulty with employment status after adjusting for sex, age, type, and duration of diabetes.

Conclusion

The results of this study using the ICF-CS for DM identified the areas for improvement among physical and psychosocial problems in DMN patients with and without HD in contrast to diabetes patients without nephropathy.

     

全人护理模式在骨科病房的实践与成效

目的探讨创建、推进及进一步深化全人护理模式在骨科病房的实践及应用效果。方法完善支持系统,改革功能制护理为责任制整体护理,在落实基础护理的基础上提供高品质的专科特色护理,开展社区及家庭延续护理服务,注重患者"身、心、社、灵"的需求。结果 2010年3月至2014年3月骨科护理质控结果、电话调查出院患者满意度、护士工作满意度均稳步提高。结论在全人护理理念下构建医院-社区-家庭一体化照护模式对提高护理质量,保障患者安全,提高患者满意度和护士工作满意度起到积极的推动作用。     

Patients older than 55 years prefer biceps tenodesis over tenotomy to the same degree as young patients

Background55 years of age used to be the cutoff point when deciding between biceps tenotomy and tenodesis for treating biceps tendon pathologies.MethodsPatients aged ≥18 years who had tendonitis in the long head of the biceps and were admitted for arthroscopic surgery were included. A questionnaire with a series of questions assessing patients' current symptoms, their concerns about their outcomes, and personal demographic information was introduced to the participants on the day before the surgery. The patients' preference toward tenotomy and tenodesis was assessed, and χ2 tests and logistic regressions were used to test the association with the categorical and ordinal variables, respectively.ResultsA total of 135 patients enrolled in the study, with 83 males and 52 females, the mean age of which was 56 years (range, 18–75 years). Of all patients, 86 (63.7%) preferred biceps tenodesis as opposed to tenotomy; meanwhile, there was no difference in preference toward tenodesis in each age- and gender-subgroup (range, 55.1% to 71.4%). The different subgroups had specific factors that were predictive of choosing either a tenotomy or tenodesis. In most subgroups, concerns about postoperative arm appearance and the so-called “Popeye” deformity due to tenotomy were factors predictive of choosing biceps tenodesis, whereas concern about longer rehabilitation due to tenodesis was the factor predictive of choosing biceps tenotomy.ConclusionsBiceps tenodesis is a more preferable choice for patients with biceps tendinopathies in all age and gender subgroups. Patients' concerns on postoperative arm appearance, “Popeye” deformity due to tenotomy, and longer rehabilitation due to tenodesis are the most important predictive factors.