Delivery styles and formats for different stroke information topics: Patient and carer preferences

Objective

To identify the preferences of patients with stroke and their carers for format and delivery style, of different categories of stroke information, and whether these preferences changed over time.

Methods

A semi-structured questionnaire, designed to explore preferences for four topic categories was administered to 34 acute stroke unit patients and 18 carers prior to discharge and again, 3 months after discharge to 27 of these patients and 16 of these carers.

Results

Overall format preferences were a combination of face-to-face, written and telephone for both patients and carers prior to discharge. This combination continued for carers following discharge, while patients preferred face-to-face, written and alternative formats of online and audiovisual at this time. Patients and carers most frequently preferred delivery styles appeared to be a mix of active and passive delivery styles, across all topics. Access to a telephone hotline was a popular delivery style.

Conclusion

Patient and carer preferences varied, supporting the need to offer a variety of formats and delivery styles at each point of contact.

Practice implications

By focusing on specific formats and delivery styles for different topics, health professionals may maximise the access to, and relevance of, stroke information for patients and their carers.     

Sounding the 'citizen-patient': the politics of voice at the Hospice Des Quinze-vingts in post-revolutionary Paris

This essay explores new models of the citizen-patient by attending to the post-Revolutionary blind 'voice'. Voice, in both a literal and figurative sense, was central to the way in which members of the Hospice des Quinze-Vingts, an institution for the blind and partially sighted, interacted with those in the community. Musical voices had been used by members to collect alms and to project the particular spiritual principle of their institution since its foundation in the thirteenth century. At the time of the Revolution, the Quinze-Vingts voice was understood by some political authorities as an exemplary call of humanity. Yet many others perceived it as deeply threatening. After 1800, productive dialogue between those in political control and Quinze-Vingts blind members broke down. Authorities attempted to silence the voice of members through the control of blind musicians and institutional management. The Quinze-Vingts blind continued to reassert their voices until around 1850, providing a powerful form of resistance to political control. The blind 'voice' ultimately recognised the right of the citizen-patient to dialogue with their political carers.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Evaluation and treatment of female sexual disorders

This paper presents a pilot study exploring the utility and feasibility of use of a vesicovaginal fistula (VVF) patient educational brochure. Women awaiting or recently having undergone VVF surgery examined a six-paneled educational brochure detailing the causes, treatment options, and prevention methods of VVF. Participants answered demographic questions and gave detailed responses to a questionnaire that addressed the brochure material. A convenience sample of 50 patients, with a mean age of 26.1 years, participated. Universally, these women felt that the information they learned from the brochure was useful. Suggestions by participants regarding prevention of VVF included laboring in a hospital (80%), educating other women (30%), and discouraging early marriage (8%). Primary barriers to prevention and treatment included financial restraints (84%) and transportation difficulties (30%). The utilization of a simple, low-cost educational brochure has the ability to educate women on the causes, treatment, and prevention of VVF. Oral presentation Annual Meeting of the Society of Gynecologic Surgeons, Savannah, GA, April 14–16, 2008. Partially funded by the National Institute of Diabetes and Digestive and Kidney Diseases, DK068389 to H.E.R.     

Combined posterior–anterior stabilisation of thoracolumbar injuries utilising a vertebral body replacing implant

The authors report on a prospectively followed series of 35 patients with injuries of the thoracolumbar spine from T7 to L3. The radiological course after combined posterior–anterior surgery with anterior column reconstruction with a distractible vertebral body replacing implant demonstrated a stable reconstruction technique with almost no re-kyphosing. In 18/18 patients with CT follow-up intervertebral fusion was observed as bony bridging lateral to the VBR implant. The functional/clinical outcome of the patients was analysed with a set of eight validated outcome scales. After an average follow-up period of 2½ years encouraging results were noticed. The neurological improvement rate (≥1 Frankel/ASIA grade) was 8/12 patients (67%) with a complete recovery in 6 cases. 17/29 patients returned to former occupation; 20/29 patients returned to former leisure activities; 24/28 patients rated their general outcome as “unlimited and pain free” or “occasionally and/or mild complaints” with a VAS score of >80 (scale 0–100). The psychometric questionnaires revealed good results with strong correlation comparing the different scoring systems statistically: mean McGill Pain Questionnaire 12.5 (0–40); mean Oswestry Disability Index 20% (0–51). 13/29 patients scored <4 in the Roland and Morris Disability Questionnaire. The German back pain questionnaire (Funktionsfragebogen Hannover Rücken) showed a mean “functional capacity” of 75%, corresponding with moderate restriction. We concluded the presented method as highly effective to completely reduce and maintain an anatomic spinal alignment. The outcome tended to be better in comparison with non-operatively treated patients as well as with norm populations with low back pain.     

Lessons learned from the institution of the Surgical Care Improvement Project at a teaching medical center

Background

The Surgical Care Improvement Project (SCIP) was designed to reduce perioperative complications. We describe our institutional experience in 6 major areas: surgical site infection, venous thromboembolism prevention, use of perioperative β-blockade, serum glucose level greater than 200 mg/dL, normothermia, and the use of electric razors for hair removal.

Methods

This was a retrospective review of surgical cases. Evidence-based training and standardization of system and process were undertaken. Compliance with SCIP guidelines was determined.

Results

Overall SCIP compliance improved from 80% to 94% over a 2-year period. Standardized antibiotic dosing times improved compliance to more than 90%. Appropriate preoperative antibiotic choice improved to 100%. Cessation of antibiotics postoperatively within 24 hours remains a difficult task. Venous thromboembolism prophylaxis has been difficult to achieve because of postoperative bleeding concerns. Administration of β-blockers has remained one of the most difficult problems to correct because of the multiplicity of avenues by which a patient may arrive to the operating suite.

Conclusions

Achievement of the SCIP goals is a formidable, but achievable, process requiring individual, cultural, systems, and institutional changes to achieve success.     

Evaluation of ceiling lifts: Transfer time, patient comfort and staff perceptions

Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.     

Informed consent: how much and what do patients understand?

Objective

We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research.

Methods

We conducted a systematic search of PubMed (1961-2006) to identify relevant articles.

Results

We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research.

Conclusions

Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.     

Predictors of patient and surgeon satisfaction after orthopaedic trauma

Introduction

Patient satisfaction has only recently gained attention as an outcome measure in orthopaedics, where it has been reported for joint replacement surgery. Little has been published regarding predictors of patient satisfaction in orthopaedic trauma. This study aims to explore the predictors of patient satisfaction, and of surgeon satisfaction, after orthopaedic trauma.

Materials and methods

Adult patients admitted to hospital with fractures after motor vehicle trauma were surveyed on admission, and at six months. Demographic, injury, socio-economic and compensation-related factors were measured. The two outcomes were satisfaction with progress of the injury, and satisfaction with recovery. The treating surgeons were also surveyed at six months to determine surgeon satisfaction with progress, and recovery (using the same questions), and the presence or absence of fracture union and any complications. Multivariate analysis was used to determine significant predictors of satisfaction for both groups, and satisfaction rates were compared between surgeons and patients.

Results

Of 306 patients recruited, 232 (75.8%) returned completed questionnaires, but only 141 (46.1%) surgeons responded. Patients rated their satisfaction with progress and recovery as 74.6% and 44.4%, respectively, whereas surgeon-rated satisfaction with progress and recovery was significantly higher, at 88.0% and 66.7%, respectively (p < 0.0001).Significant predictors of patient dissatisfaction were: blaming others for the injury, being female, and using a lawyer. Patient-rated satisfaction was not significantly associated with objective injury or treatment factors. The only significant predictor of surgeon dissatisfaction was fracture non-union.

Conclusions

Orthopaedic surgeons overestimated the progress of the injury and the level of recovery compared to patients’ own ratings. Surgeons’ ratings were influenced by objective, treatment-related factors, whereas patients’ ratings were not. Measures of outcome commonly used by orthopaedic surgeons, such as fracture union, do not predict patient satisfaction.

Level of evidence

Level II evidence (prognostic, prospective study).