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Chaudhry YP, Mekkawy KL, Wenzel A, Campbell C, Sterling RS, Khanuja HS. Comparing Pain and Pain Coping Mechanisms in Patients Undergoing Total Joint Arthroplasty as Part of a Mission Trip to Those in the United States. J Arthroplasty 2023; 38:1700-1704.e6. [PMID: 37054927 DOI: 10.1016/j.arth.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Access to total joint arthroplasty can be difficult in low-resource settings. Service trips are conducted to provide arthroplasty care to populations in need around the world. This study aimed to compare the pain, function, surgical expectations, and coping mechanisms of patients from one such service trip to the United States. METHODS In 2019, the Operation Walk program conducted a service trip in Guyana during which 50 patients had hip or knee arthroplasties. Patient demographics, patient-reported outcome measures, questionnaires assessing pain attitudes and coping, and pain visual analog scales were collected preoperatively and at 3 months postoperatively. These outcomes were compared with a matched cohort of elective total joint arthroplasty at a US tertiary care medical center. There were 37 patients matched between the 2 cohorts. RESULTS The mission cohort had significantly lower preoperative self-reported function scores than the US cohort (38.3 versus 47.5, P = .003), as well as a significantly larger improvement at 3 months (42.4 versus 26.4, P = .014). The mission cohort had significantly higher initial pain (8.0 versus 7.0, P = .015), but there were no differences with regard to pain at 3 months (P = .420) or change in pain (P = .175). The mission cohort had significantly greater preoperative scores in pain attitude and coping responses. CONCLUSION Patients in low-resource settings were more likely to have preoperative functional limitations and pain, and they coped with pain through prayer. Understanding the key differences between these 2 types of populations and how they approach pain and functional limitations may help improve care for each group. LEVEL OF EVIDENCE II, prospective study.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Kevin L Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alyssa Wenzel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Claudia Campbell
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Card EB, Morales CE, Ramirez JM, Billingslea M, Marroquín A, Trueblood E, Javia LR, McCormack SM, Friedland LR, Low DW, Schwartz AJ, Scott M, Jackson OA. Impact of Illustrated Postoperative Instructions on Knowledge and Retention During a Cleft Lip and Palate Surgical Mission. Cleft Palate Craniofac J 2022:10556656221100052. [PMID: 35711155 DOI: 10.1177/10556656221100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the impact of illustrated postoperative instructions on patient-caregiver knowledge and retention. DESIGN Prospective study with all participants receiving an educational intervention. SETTING Pediatric plastic surgical missions in Guatemala City, Guatemala, between 2019 and 2020. PARTICIPANTS A total of 63 majority-indigenous Guatemalan caregivers of patients receiving cleft lip and/or palate surgery. INTERVENTION Illustrated culturally appropriate postoperative care instructions were iteratively developed and given to caregivers who were surveyed on illustration-based and text-based information at preoperative, postoperative, and four-week follow-up time points. MAIN OUTCOME MEASURE Postoperative care knowledge of illustration-based versus text-based information as determined by the ability to answer 11 illustration- and 8 text-based all-or-nothing questions, as well as retention of knowledge as determined by the same survey given at four weeks follow-up. RESULTS Scores for illustration-based and text-based information both significantly increased after caregivers received the postoperative instructions (+13.30 ± 3.78 % SE, + 11.26 ± 4.81 % SE; P < .05). At follow-up, scores were unchanged for illustration-based (-3.42 ± 4.49 % SE, P > .05), but significantly lower for text-based information (-28.46 ± 6.09 % SE, P < .01). Retention of text-based information at follow-up correlated positively with education level and Spanish literacy, but not for illustration-based. CONCLUSIONS In the setting of language and cultural barriers on a surgical mission, understanding of illustration-based and text-based information both increased after verbal explanation of illustrated postoperative instructions. Illustration-based information was more likely to be retained by patient caregivers after four weeks than text-based information, the latter of which correlated with increased education and literacy.
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Affiliation(s)
- Elizabeth B Card
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Carrie E Morales
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Juan M Ramirez
- Partner for Surgery, Guatemala City, Guatemala, Guatemala
| | | | | | - Eo Trueblood
- Stream Studios, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luv R Javia
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, USA
| | - Susan M McCormack
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Leonard R Friedland
- Research and Development Department, 33139GlaxoSmithKline, Philadelphia, PA, USA
| | - David W Low
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Alan Jay Schwartz
- The Children's Hospital of Philadelphia, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Scott
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Oksana A Jackson
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
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Velin L, Lantz A, Ameh EA, Roy N, Jumbam DT, Williams O, Elobu A, Seyi-Olajide J, Hagander L. Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries. BMJ Glob Health 2022; 7:e008791. [PMID: 35483711 PMCID: PMC9052057 DOI: 10.1136/bmjgh-2022-008791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The shortage of surgeons, anaesthesiologists and obstetricians in low-income and middle-income countries (LMICs) is occasionally bridged by foreign surgical teams from high-income countries on short-term visits. To advise on ethical guidelines for such activities, the aim of this study was to present LMIC stakeholders' perceptions of visiting surgical teams from high-income countries. METHOD We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in November 2021, using standardised search terms in PubMed/Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO) and Global Index Medicus, and complementary hand searches in African Journals Online and Google Scholar. Included studies were analysed thematically using a meta-ethnographic approach. RESULTS Out of 3867 identified studies, 30 articles from 15 countries were included for analysis. Advantages of visiting surgical teams included alleviating clinical care needs, skills improvement, system-level strengthening, academic and career benefits and broader collaboration opportunities. Disadvantages of visiting surgical teams involved poor quality of care and lack of follow-up, insufficient knowledge transfers, dilemmas of ethics and equity, competition, administrative and financial issues and language barriers. CONCLUSION Surgical short-term visits from high-income countries are insufficiently described from the perspective of stakeholders in LMICs, yet such perspectives are essential for quality of care, ethics and equity, skills and knowledge transfer and sustainable health system strengthening. More in-depth studies, particularly of LMIC perceptions, are required to inform further development of ethical guidelines for global surgery and support ethical and sustainable strengthening of LMIC surgical systems.
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Affiliation(s)
- Lotta Velin
- Department of Biomedical and Clinical Sciences, Linköping University, Centre for Teaching and Research in Disaster Medicine and Traumatology, Linkoping, Sweden
| | - Adam Lantz
- Department of Clinical Sciences in Lund, Orthopedic Surgery, Helsingborg Hospital, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emmanuel A Ameh
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Mumbai, India
- The George Institute for Global Health, New Delhi, India
| | - Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Omolara Williams
- Department of Surgery, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Alex Elobu
- Gastrointestinal Surgery, Mulago Hospital, Kampala, Uganda
- Institute of Digestive Diseases, Kampala, Uganda
| | - Justina Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Hu DA, Harold RE, de Cândida Soares Pereira E, Trindade Cavalcante E, Paula Mariz da Silveira Barros M, Nunes Medeiros de Souza S, Souza J, Brander VA, Stulberg SD. Patient-Reported Outcomes After Total Hip Arthroplasty in a Low-Resource Country by a Visiting Surgical Team. Arthroplast Today 2021; 10:41-45. [PMID: 34307809 PMCID: PMC8283035 DOI: 10.1016/j.artd.2021.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a highly successful procedure but limited in many low-resource nations. In response, organizations globally have conducted service trips to provide arthroplasty care to underserved populations. Few outcomes data are currently available related to these trips. Our study aims to demonstrate the feasibility of tracking patient-reported outcomes and complications after THA in a low-resource setting and that outcomes are comparable to those in developed countries. METHODS We completed an arthroplasty service trip to Brazil in 2017 where we performed 46 THAs on 38 patients. The mean patient age was 48.8 years. Forty-seven percent were female. Patient-reported outcome scores were collected preoperatively and postoperatively at 2, 6, and 12 weeks and 1 year. A multivariate regression analysis was performed to identify associations between patient factors and 12-week outcomes. RESULTS The mean modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Patient-Reported Outcome Measurement Information System Short Form (PROMIS-SF) Pain Interference, and PROMIS-SF Physical Function all improved significantly compared to baseline at 2, 6, and 12 weeks and 1 year postoperatively. At 1 year, only 29% of patients (11 of 38) were reachable by phone for follow-up.Multivariate regression analysis at 12 weeks found that females had more improvement in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores (P = .003) and PROMIS-SF Pain Interference scores (P = .01) than males, and patients with rheumatoid arthritis had more improvement in PROMIS-SF Pain Interference scores (P = .008) compared with all other diagnoses. CONCLUSION Patients in low-resource countries benefitted significantly from THA performed by a visiting surgical team. However, following up patients is difficult in low-resource countries once they leave the hospital.
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Affiliation(s)
- Daniel A. Hu
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan E. Harold
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Julio Souza
- Hospital Dom Helder Câmara, Cabo de Santo Agostinho, PE, Brazil
| | - Victoria A. Brander
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S. David Stulberg
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wyles CC, Hevesi M, Ubl DS, Habermann EB, Gazelka HM, Trousdale RT, Turner NS, Pagnano MW, Mabry TM. Implementation of Procedure-Specific Opioid Guidelines: A Readily Employable Strategy to Improve Consistency and Decrease Excessive Prescribing Following Orthopaedic Surgery. JB JS Open Access 2020; 5:e0050. [PMID: 32309760 PMCID: PMC7147632 DOI: 10.2106/jbjs.oa.19.00050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Evidence-based, procedure-specific guidelines for prescribing opioids are urgently needed to optimize pain relief while minimizing excessive opioid prescribing and potential opioid diversion in our communities. A multidisciplinary panel at our institution recently developed procedure-specific guidelines for discharge opioid prescriptions for common orthopaedic surgical procedures. The purpose of this study was to evaluate postoperative opioid prescription quantities, variability, and 30-day refill rates before and after implementation of the guidelines. Methods: This retrospective cohort study was conducted at a single academic institution from December 2016 to March 2018. Guidelines were implemented on August 1, 2017, with a recommended maximum opioid prescription quantity for 14 common orthopaedic procedures. Patients who underwent these 14 procedures during the period of December 2016 to May 2017 made up the pre-guideline cohort (n = 2,223), and patients who underwent these procedures from October 2017 to March 2018 made up the post-guideline cohort (n = 2,300). Opioid prescription quantities were reported as oral morphine equivalents (OME), with medians and interquartile ranges (IQRs). Four levels were established for recommended prescription maximums, ranging from 100 to 400 OME. Results: In the pre-guideline cohort, the median amount of prescribed opioids across all procedures was 600 OME (IQR, 390 to 863 OME), which decreased by 38% in the post-guideline period, to a median of 375 OME (IQR, 239 to 400 OME) in the post-guideline cohort (p < 0.001). The 30-day refill rate did not change significantly, from a rate of 24% in the pre-guideline cohort to 25% in the post-guideline cohort (p = 0.43). Multivariable analysis demonstrated that guideline implementation was the factor most strongly associated with prescriptions exceeding guideline maximums (odds ratio [OR] = 9.9; p < 0.001). Age groups of <80 years (OR = 2.0 to 2.4; p < 0.001) and males (OR = 1.2; p = 0.025) were also shown to have higher odds of exceeding guideline maximums. Conclusions: Procedure-specific guidelines are capable of substantially decreasing opioid prescription amounts and variability. Furthermore, the absence of change in refill rates suggests that pain control remains similar to pre-guideline prescribing practices. Evidence-based guidelines are a readily employable solution that can drive rapid change in practice and enhance the ability of orthopaedic surgeons to provide responsible pain management.
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Affiliation(s)
- Cody C Wyles
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Mario Hevesi
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Daniel S Ubl
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Halena M Gazelka
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Robert T Trousdale
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Norman S Turner
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Mark W Pagnano
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
| | - Tad M Mabry
- Department of Orthopedic Surgery (C.C.W., M.H., R.T.T, N.S.T., M.W.P., and T.M.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program (D.S.U. and E.B.H.), and Division of Pain Medicine, Department of Anesthesiology and Perioperative Pain Medicine (H.M.G.), Mayo Clinic, Rochester, Minnesota
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Wyles CC, Hevesi M, Trousdale ER, Ubl DS, Gazelka HM, Habermann EB, Trousdale RT, Pagnano MW, Mabry TM. The 2018 Chitranjan S. Ranawat, MD Award: Developing and Implementing a Novel Institutional Guideline Strategy Reduced Postoperative Opioid Prescribing After TKA and THA. Clin Orthop Relat Res 2019; 477:104-113. [PMID: 30794233 PMCID: PMC6345303 DOI: 10.1007/s11999.0000000000000292] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Opioid prescription management is challenging for orthopaedic surgeons, and we lack evidence-based guidelines for responsible opioid prescribing. Our institution recently developed opioid prescription guidelines for patients undergoing several common orthopaedic procedures including TKA and THA in an effort to reduce and standardize prescribing patterns. QUESTIONS/PURPOSES (1) How do opioid prescriptions at discharge and 30-day refill rates change in opioid-naïve patients undergoing primary TKA and THA before and after implementation of a novel prescribing guideline strategy? (2) What patient, surgical, and in-hospital factors influence opioid prescription quantity and refill rate? METHODS New institutional guidelines for patients undergoing TKA and THA recommend a maximum postoperative prescription of 400 oral morphine equivalents (OME), comparable to 50 tablets of 5 mg oxycodone or 80 tablets of 50 mg tramadol. All opioid-naïve patients, defined as those who did not take any opioids within 90 days preceding surgery, undergoing primary TKA and THA at a single tertiary care institution were evaluated from program initiation on August 1, 2017, through December 31, 2017, as the postguideline era cohort. This group (n = 751 patients) was compared with all opioid-naïve patients undergoing TKA and THA from 2016 at the same institution (n = 1822 patients). Some providers were early adopters of the guidelines as they were being developed, which is why January to July 2017 was not evaluated. Patients in the preguideline and postguideline eras were not different in terms of age, sex, race, body mass index, education level, employment status, psychiatric illness, marital status, smoking history, outpatient use of benzodiazepines or gabapentinoids, or diagnoses of diabetes mellitus, peripheral neuropathy, or cancer. The primary outcome assessed was adherence to the new guidelines with a secondary outcome of opioid medication refills ordered within 30 days from any provider. Multivariable logistic regression analyses were performed with outcomes of guideline compliance and refills and adjusted for demographic, surgical, and patient care factors. Patients were followed for 30 days after surgery and no patients were lost to followup. RESULTS Median opioid prescription and range of prescriptions decreased in the postguideline era compared with the preguideline era (750 OME, interquartile range [IQR] 575-900 OME versus 388 OME, IQR 350-389; difference of medians = 362 OME; p < 0.001). There was no difference among patients undergoing TKA before and after guideline implementation in terms of the 30-day refill rate (35% [349 of 1011] versus 35% [141 of 399]; p = 0.77); this relationship was similar among patient undergoing THA (16% [129 of 811] versus 17% [61 of 352]; p = 0.55). After controlling for relevant patient-level factors, we found that implementation of an institutional guideline was the strongest factor associated with a prescription of ≤ 400 OME (adjusted odds ratio, 36; 95% confidence interval, 25-52; p < 0.001); although a number of patient-level factors also were associated with prescription quantity, the effect sizes were much smaller. CONCLUSIONS This study provides a proof of concept that institutional guidelines to reduce postoperative opioid prescribing can improve aftercare in patients undergoing arthroplasty in a short period of time. The current report evaluates our experience with the first 5 months of this program; therefore, longer term data will be mandatory to determine longitudinal guideline adherence and whether the cutoffs established by this pilot initiative require further refinement for individual procedures. LEVEL OF EVIDENCE Level II, therapeutic study.
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MESH Headings
- Aged
- Aged, 80 and over
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Knee/adverse effects
- Awards and Prizes
- Drug Administration Schedule
- Drug Prescriptions
- Female
- Guideline Adherence/standards
- Humans
- Male
- Middle Aged
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Pilot Projects
- Policy Making
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Program Evaluation
- Proof of Concept Study
- Retrospective Studies
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Cody C Wyles
- C. C. Wyles, M. Hevesi, R. T. Trousdale, M. W. Pagnano, T. M. Mabry Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA E. R. Trousdale, H. M. Gazelka Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA D. S. Ubl, E. B. Habermann Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
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Roche S, Brockington M, Fathima S, Nandi M, Silverberg B, Rice HE, Hall-Clifford R. Freedom of choice, expressions of gratitude: Patient experiences of short-term surgical missions in Guatemala. Soc Sci Med 2018; 208:117-125. [PMID: 29803969 DOI: 10.1016/j.socscimed.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/28/2022]
Abstract
Lack of surgical care has been highlighted as a critical global health problem, and short-term medical missions (STMMs) have become a de facto measure to address this shortfall. Participation in STMMs is an increasingly popular activity for foreign medical professionals to undertake in low- and middle-income countries (LMICs) where their clinical skills may be in short supply. While there is emerging literature on the STMM phenomenon, patient experiences of surgical missions are underrepresented. This research addresses this gap through thirty-seven in-depth interviews with patients or caregivers who received care from a short-term surgical mission within the three years prior to the four-week data collection period in July and August 2013. Interviews were conducted in Antigua, Guatemala and nearby communities, and participants came from 9 different departments of the country. These first-hand accounts of health-seeking through a surgical mission provide important insights into the benefits and challenges of STMMs that patients encounter, including waiting time, ancillary costs, and access to care. Patient agency in care-seeking is considered within the pluralistic, privatized health care context in Guatemala in which foreign participants deliver STMM care.
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Affiliation(s)
- Stephanie Roche
- NAPA-OT Field School, Guatemala; University of Washington, Department of Global Health, United States
| | | | | | | | - Benjamin Silverberg
- NAPA-OT Field School, Guatemala; Duke University, Global Health Institute, United States
| | - Henry E Rice
- Duke University, Global Health Institute, United States
| | - Rachel Hall-Clifford
- NAPA-OT Field School, Guatemala; Agnes Scott College Departments of Sociology and Anthropology and Public Health, United States.
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Roche S, Hall-Clifford R. Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala. Glob Public Health 2016; 10:1201-14. [PMID: 25734638 DOI: 10.1080/17441692.2015.1011189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.
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Affiliation(s)
- Stephanie Roche
- a Department of Global Health , Boston University , Boston , MA , USA
| | - Rachel Hall-Clifford
- b Department of Anthropology , Agnes Scott College , Decatur , GA , USA.,c Department of Public Health , Agnes Scott College , Decatur , GA , USA
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Kavolus JJ, Ritter MA, Claverie JG, Salas MD, Kavolus CH, Trousdale RT. Cultural Nuance in Orthopedic Foreign Aid: Differences in Patient Concerns. J Arthroplasty 2016; 31:27-30. [PMID: 26350258 DOI: 10.1016/j.arth.2015.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/10/2015] [Indexed: 02/01/2023] Open
Abstract
Orthopedic aid to developing nations is expanding and becoming a unique facet of the specialty. This investigation seeks to compare patient impressions and concerns regarding the care patients receive as part of an itinerant surgical aid trip in 2 nations. In 2013 and 2014, patients from 2 separate nations completed a Likert scale survey assessing impressions of the care they received at the hands of a surgical team from abroad. Mean response scores were calculated and compared using a t test. This is the first investigation to compare patient concerns across 2 nations in a surgical aid trip setting. The results highlight the importance of culture in understanding patients and the impressions of the care they receive.
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Affiliation(s)
- Joseph J Kavolus
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | | | - Marcos D Salas
- Instituto Medico Bolonia, Hospital Militar, Managua, Nicaragua
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