Good mid-term outcome of the rotating hinge knee in primary total knee arthroplasty – Results of a single center cohort of 106 knees with a median follow-up of 6.3 years

BackgroundThe prognosis of complex primary total knee arthroplasty (TKA) with severe deformity and ligament deficiency is not clear. There is a paucity of evidence in the current literature on treatment outcomes of the rotating hinge knee implants in primary TKA. The aim of this study was to determine the mid-term clinical, radiographic, and health-related quality of life (HRQoL) outcomes in patients who had undergone complex primary TKA using single hinged knee replacement.MethodsIn total, 106 complex primary TKAs (101 patients) were performed using the single rotating hinged knee (RHK) implant design at our institution between January 2004 and December 2013. We conducted a retrospective analysis of prospectively collected outcome data of these patients, obtaining also information on all possible revision surgeries from the Finnish Arthroplasty Register, and conducted a prospective follow-up study of all living patients.ResultsThe 10-year Kaplan-Meier survival rate of the RHK knees was 91.6% (95% CI 86.0% to 97.2%) with revision for any reason as the endpoint. Overall, eight knees (7.5 %) underwent revision surgery during the follow-up. None of the unrevised RHK knees were radiographically loose. The majority of patients evinced good clinical outcome and quality of life as measured with patient reported outcome measures.ConclusionThe hinge knee replacement which was assessed current study can be regarded as a suitable option in complex primary TKA, provided adequate attention is paid to the correct indications and patient selection.     

Patient-important outcomes to inform shared decision making and goal setting for diabetes treatment

ObjectiveDespite well-established treatment guidelines, diabetes is difficult to manage for many individuals. The importance of using shared decision making to optimize diabetes treatment is recognized, yet what matters most to individuals with diabetes is not well established. Our goal was to identify patients’ goals and priorities for diabetes management.MethodsWe engaged 141 participants through interviews and group concept mapping to identify patient-important outcomes (PIOs) for diabetes care. We generated a master list of PIOs by aggregating interview data coded to “goals” and ideas brainstormed during concept mapping, and then a patient advisory board sorted the PIOs into higher-level domains.ResultsWe identified 41 PIOs sorted into 7 broad domains: optimize daily self-care, optimize long term health, learn about diabetes, achieve measurable goals, manage medications, manage diet and best utilize medical / professional services.ConclusionsMost (4/7) of PIO domains focused on personal and life goals, not medically-oriented goals. Use of these PIOs and domains may facilitate more effective SDM discussions for patients with diabetes.Practice implicationsUse of PIOs from this work can enable the empowerment of patients to voice their priorities during SDM conversations, thus facilitating development of truly individualized diabetes treatment plans.     

Factors associated with patient activation in a socially deprived population: Evidence from Germany

ObjectivePatient activation has been identified as a crucial determinant of health, but little is known about its own determinants, particularly in low socioeconomic status populations. To address this research gap, we analyzed factors that might explain variation in patient activation in such a population.MethodsWe conducted a cross-sectional patient survey (n = 582) in a low socioeconomic status urban district in Germany in 2017. Using multivariate linear regressions, we examined the association between patient activation and a range of psychological, sociodemographic, and health-related factors. To assess the relative importance of these factors, we used dominance analysis.ResultsOur results suggest that age, employment status, linguistic acculturation, health status, and self-efficacy were significantly associated with patient activation. Dominance analysis indicated that self-efficacy was the most important factor explaining variation in patient activation.ConclusionsAge, employment status, linguistic acculturation, health status, and self-efficacy are important determinants of patient activation.Practice implicationsOur results can inform decision makers about approaches for more targeted and effective interventions to improve patient activation in low socioeconomic status populations. Much might be gained by investing in interventions that focus on age, employment status, linguistic acculturation, and health status. Interventions that improve self-efficacy may represent a particularly promising approach.     

The Phone: Communication in the Age of COVID-19

In April, as the COVID-19 outbreak intensified in New York City, a radiation oncology was redeployed to an internal medicine service. In this submission, he discusses his experience updating families on the statuses of their loved ones over the phone during the outbreak.     

Evaluación de la efectividad de la versión en español de un curso de comunicación de malas noticias

IntroductionGood communication by health professionals is associated with better patient outcomes. The Program to Enhance Relational and Communication Skills (PERCS) has been adapted to other cultures. The objective of this study is to describe the effectiveness of the Spanish version of the PERCS program, from the perspective of the participants, at the end of the course and 6 months after the course.MethodsA process of cultural and epidemiological adaptation of the PERCS program to the reality of Peru was carried out. A qualitative and quantitative approach was used to evaluate the educational impact of the program.ResultsThirty-nine professionals participated voluntarily. Participants found it more difficult to communicate ominous diagnoses (48.15%). Anxiety is the most frequent emotion when faced with difficult communications (77.78%). Almost all (92%) stated that the course improved their preparation, and 88.9% that it reduced their anxiety. At 6 months, participants recognised the importance of honesty and empathy, as well as some steps in conducting the patient-centred interview.DiscussionAn intensive training program in difficult communication can be adapted to Spanish, and positively impact the skills, self-confidence, and self-perception of learning in Peruvian professionals, in relation to promoting communication focused on the needs of the patient and family.     

Low perceived service quality in community pharmacy is associated with poor medication adherence

ObjectiveCommunity pharmacists are highly accessible healthcare professionals, whose regular contact with patients provides ongoing opportunities to improve medication safety and promote medication adherence. This study investigates whether patients who experience low service quality in community pharmacies are less adherent to their regular medications.MethodsEight Australian pharmacies were recruited, 5 self-identified as having a price promotion business strategy and 3 with a service-focused business strategy. Patients taking regular prescribed medicines who had previously attended the pharmacy completed e-surveys in-store with measures of perceived service quality (pSQ) and self-reported adherence. Multivariate regression using multilevel modelling with bootstrapping was used to explore the relationships between variables.ResultsSurveys were completed by 319 respondents. Attending pharmacies with a price promotion business strategy was predictive of lower pSQ and poor medication adherence. The between-pharmacy slope of the relationship between pSQ and adherence was 2.25 (with 95 % confidence intervals = 1.50, 2.86) and was highest in pharmacies with lowest pSQ.ConclusionThis study highlights that when patients experience low service quality, in community pharmacies they are more likely to report poor adherence to their regular prescribed medicines.Practice implicationsCommunity pharmacies need to be designed and managed to allow pharmacists to provide high levels of patient-centred care.     

老年上腹部术后自控镇痛用成人剂量时的潜在风险与护理

目的探讨老年上腹部手术后自控镇痛用成人剂量时存在的潜在风险及护理。方法回顾性分析100例上腹部手术的患者,分老年组与成人组,根据镇痛药的不同,每组以住院号的尾数单双再分为吗啡组与芬太尼组,观察镇痛总药量、镇痛、镇静效果及不良反应。结果两组镇痛总药量、镇痛效果无显著性差异（P〉0.05）;镇静（Ramesay）效果老年组的吗啡组高于芬太尼组（P〈0.05）;吗啡组的老年组高于成人组,差异均有统计学意义（P〈0.01）。不良反应老年组高于成人组,差异有统计学意义（P〈0.01）。结论老年上腹部手术后自控镇痛用成人剂量时的潜在风险高,在护理上要提高认识,早期预防,从而提高老年患者术后镇痛的安全。