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Shapiro LM, Thomas KA, Eppler SL, Behal R, Yao J, Kamal RN. Understanding the Patient Experience: Analysis of 2-Word Assessment and Its Relationship to Likelihood to Recommend in Outpatient Hand Surgery. Hand (N Y) 2022; 17:1201-1206. [PMID: 33478269 PMCID: PMC9608275 DOI: 10.1177/1558944720988078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Actionable feedback from patients after a clinic visit can help inform ways to better deliver patient-centered care. A 2-word assessment may serve as a proxy for lengthy post-visit questionnaires. We tested the use of a 2-word assessment in an outpatient hand clinic. METHODS New patients were asked to provide a 2-word assessment of the following: (1) their physician; (2) their overall experience; and (3) recommendations for improvement and their likelihood to recommend (LTR) after their clinic visit. Sentiment analysis was used to categorize results into positive, neutral, or negative sentiment. Recommendations for improvement were classified into physician issue, system issue, or neither. We evaluated the relationship between LTR status, sentiment, actionable improvement opportunities, and classification (physician issue, system issue, or neither). Recommendations for improvement were classified into themes based on prior literature. RESULTS Sixty-seven (97.1%) patients noted positive sentiment toward their physician; 67 (97.1%) noted positive sentiment toward their overall experience. About 31% of improvement recommendations were system-based, 5.9% were physician-based, and 62.7% were neither. Patients not LTR were more likely to leave actionable opportunities for improvement than those LTR (P = .01). Recommendations for improvement were classified into predetermined themes relating to: (1) physician interaction; (2) check-in process; (3) facilities; (4) unnecessary visit; and (5) appointment delays. CONCLUSION Patients not likely to recommend provided actionable opportunities for improvement using a simple 2-word assessment. Implementation of a 2-word assessment in a hand clinic can be used to obtain actionable, real-time patient feedback that can inform operational change and improve the patient experience.
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Calamia M, Kaseda ET, Price JS, De Vito A, Silver CH, Cherry J, VanLandingham H, Khan H, Sparks PJ, Ellison RL. Mentorship in clinical neuropsychology: Survey of current practices, cultural responsiveness, and untapped potential. J Clin Exp Neuropsychol 2022; 44:366-385. [DOI: 10.1080/13803395.2022.2128068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Erin T. Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Jenessa S. Price
- Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alyssa De Vito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Cheryl H. Silver
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jared Cherry
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Humza Khan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - P. Johnelle Sparks
- Department of Demography, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rachael L. Ellison
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Sabo KG, Mare KU, Berhe H, Berhe H. Inpatient Care Service Experience Among Adult Patients Admitted to Arba Minch General Hospital, Southern Ethiopia: Institution-Based Qualitative Study. J Patient Exp 2022; 9:23743735221140654. [DOI: 10.1177/23743735221140654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acknowledging patients' experience with the care delivered in healthcare settings is crucial in ensuring the quality of healthcare service delivery. In Ethiopia, qualitative evidence of patients’ experience with inpatient care services is limited. This study aimed to explore the experience of inpatient care service among adult patients admitted to Arba Minch General hospital, Southern Ethiopia from April 05-28, 2020. An institution-based qualitative approach was carried out among adult patients discharged from the study hospital. Thirty-one in-depth interviews using a semi-structured interview guide were conducted and audio-recorded data were transcribed verbatim and translated into English. Data were coded, sorted, and themes were developed manually based on the thematic analysis. This study showed that kindness, respecting appointments, and treatment outcomes were the positive experiences highlighted by study participants. Participants reported a lack of drinking water, unpleasant toilet hygiene, lack of bedsheets, and absence of drugs as negative experiences. Therefore, the hospital administration should work on improving the problems mentioned by the participants of this study.
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Affiliation(s)
- Kebede Gemeda Sabo
- Department of Nursing, College of Medical and Health Sciences, Samara University, Samara, Afar, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medical and Health Sciences, Samara University, Samara, Afar, Ethiopia
| | - Hailemariam Berhe
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Haftu Berhe
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Hardy A, Gervais-Hupé J, Desmeules F, Hudon A, Perreault K, Vendittoli PA. Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both. BMC Musculoskelet Disord 2021; 22:978. [PMID: 34814889 PMCID: PMC8611950 DOI: 10.1186/s12891-021-04847-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Optimizing patients' total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs. METHODS We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients' characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. RESULTS The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients' THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (rs = + [0.36-0.66], p-value < 0.01). CONCLUSION Whatever the perioperative program, the key to improving patients' THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients' experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients' THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.
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Affiliation(s)
- Alexandre Hardy
- Department of Biomedical Sciences, Faculty of Graduate and Postdoctoral Studies, Université de Montréal, Montreal, Quebec, Canada
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
| | - Jonathan Gervais-Hupé
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Pascal-André Vendittoli
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada.
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada.
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.
- Duval Orthopaedic Clinic, Laval, Quebec, Canada.
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Qi L, Zhou Y, Wang R, Wang Y, Liu Y, Zeng L. Perceived quality of primary healthcare services and its association with institutional trust among caregivers of persons diagnosed with a severe mental illness in China. J Psychiatr Ment Health Nurs 2021; 28:394-408. [PMID: 32881201 DOI: 10.1111/jpm.12687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/08/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Low utilization of the family-oriented community rehabilitation services is a threatening challenge facing low- and middle- income countries. Family caregiver's trust in community healthcare providers is the precondition of service utilization and is shaped by their perceived quality of primary healthcare services from previous experience. Most of the studies concerning the relationship between perceived quality and institutional trust were conducted in western countries, resulting in limited attention paid to conditions in non-western countries. Which aspect of quality predicts institutional trust in China has not been studied yet. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE In China's context, institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Significant rural-urban disparity was observed: among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief; institutional trust was only associated with worry relief in urban respondents. WHAT ARE THE IMPLICATIONS FOR PRACTICE Mental health nurses training or working with community healthcare workers may improve their technical and communicative competence. Priorities may differ between rural and urban areas. Mental health nurses or community healthcare workers may provide more family-oriented psycho-education to rural families, and more emotional support to urban families. Wider public anti-stigma initiatives are needed to reduce the affiliated stigma of families of persons diagnosed with a severe mental illness. ABSTRACT Introduction Prior studies suggested that caregiver's trust in community healthcare providers is the precondition of the utilization of community-based rehabilitation services and is shaped by their perceived quality of primary healthcare services. Nevertheless, the research conducted in non-western countries is scarce, and which aspect of quality is associated with institutional trust in China has not been studied. Aim To explore the association between perceived quality of primary healthcare services and institutional trust in China's context. Methods This cross-sectional study was conducted with 796 family caregivers from Eastern, Central and Western China between August 2018 and October 2019. Perceived quality of primary healthcare services was measured by technical competence, communication, worry relief and risk of privacy leak. Results Institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief. Contrary finding was observed in urban respondents. Discussion and implications for practice With rural-urban disparity considered, strategies such as improving the technical and communicative competence of community healthcare workers, providing family-oriented psycho-education and emotional support, and promoting public anti-stigma initiatives may be worth consideration.
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Affiliation(s)
- Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | | | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Yang Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
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Pulkkinen M, Jousela I, Sintonen H, Engblom J, Salanterä S, Junttila K. A randomized clinical trial of a new perioperative practice model on anxiety and health-related quality of life in arthroplasty patients. Nurs Open 2021; 8:1593-1605. [PMID: 33576579 PMCID: PMC8186686 DOI: 10.1002/nop2.776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
Aims To explore the effectiveness of a new perioperative practice model on anxiety and health‐related quality of life in patients undergoing total hip arthroplasty and total knee arthroplasty under spinal anaesthesia. Design A randomized clinical trial. Methods Control group participants (N = 222) received standard perioperative care, meaning they were cared for by various nurses during their perioperative process without postoperative visits. Intervention group participants (N = 231) were assigned one named anaesthesia nurse during their entire perioperative process who visited them postoperatively. Both groups responded to two self‐reported questionnaires: the generic 15D health‐related quality of life instrument and the State‐Trait Anxiety Inventory (STAI) measuring anxiety two to three weeks pre‐operatively and three months postoperatively. Results There were no statistically significant differences between the groups at baseline or at follow‐up in health‐related quality of life or anxiety.
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Affiliation(s)
- Maria Pulkkinen
- Helsinki University HospitalHelsinki UniversityHelsinkiFinland
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
| | - Irma Jousela
- Helsinki University HospitalHelsinki UniversityHelsinkiFinland
- University of Eastern FinlandKuopioFinland
| | - Harri Sintonen
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Janne Engblom
- Department of Mathematics and StatisticsUniversity of TurkuTurkuFinland
- School of EconomicsUniversity of TurkuTurkuFinland
| | - Sanna Salanterä
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University HospitalTurkuFinland
| | - Kristiina Junttila
- Helsinki University HospitalHelsinki UniversityHelsinkiFinland
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Nursing Research CenterHelsinki University HospitalHelsinkiFinland
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Jäppinen AM, Muñoz M, Kettunen T, Piirainen A. Patients' narratives of patient education in physiotherapy after total hip arthroplasty. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1862. [PMID: 32573053 DOI: 10.1002/pri.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 03/27/2020] [Accepted: 05/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to explore patients' narratives of patient education in physiotherapy after a total hip arthroplasty (THA). METHOD The data was collected via open thematic interviews from ten patients who had had a primary THA. The interviews were analysed using a qualitative, narrative method. RESULTS Three story models of patient education in physiotherapy were identified: Supportive patient education in physiotherapy, Co-operative patient education in physiotherapy and Contradictory patient education in physiotherapy. The emphasis of narration in the first story model was on the trust in the guidance, functioning interaction in the second and insufficient patient education in physiotherapy in the third story model. DISCUSSION According to the results of this study, patients with THA experience functioning interaction and trust in the patient education in physiotherapy as enhancing the rehabilitation process. Conversely insufficient patient education about exercising and follow-up physiotherapy made the patients feel insecure and according to them might have slowed down the rehabilitation process. These findings can be utilized in planning and improving patient education in physiotherapy after THA.
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Affiliation(s)
- Anna-Maija Jäppinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland.,Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
| | - Minna Muñoz
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland.,Validia Rehabilitation, Helsinki, Finland
| | - Tarja Kettunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland.,Unit of Primary Health Care, Central Finland Health Care District, Jyväskylän, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland
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8
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Patients' experiences of discontentment one year after total knee arthroplasty- a qualitative study. BMC Musculoskelet Disord 2020; 21:29. [PMID: 31937282 PMCID: PMC6961288 DOI: 10.1186/s12891-020-3041-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate. Methods Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment 1 year after total knee arthroplasty. Results The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.
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Lape EC, Hudak P, Davis AM, Katz JN. Body-Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework. ACR Open Rheumatol 2019; 1:90-96. [PMID: 31777785 PMCID: PMC6857960 DOI: 10.1002/acr2.1014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Medical research increasingly makes use of embodiment concepts to understand how illness disrupts unity of body and self. However, few have applied embodiment concepts in total joint replacement (TJR), an effective treatment for end‐stage arthritis. In considering why a troubling proportion of TJR recipients have continued pain and functional limitation, we ask: what role might be played by the embodied experience of living with an implant? Relevant theoretical models and prior research on embodiment in musculoskeletal health and transplantation are reviewed. Our findings suggest a research agenda with implications for addressing suboptimal outcomes in TJR.
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Affiliation(s)
- Emma C Lape
- Brigham and Women's Hospital Boston Massachusetts
| | - Pamela Hudak
- Alternative Dispute Resolution Practice, Inc. Toronto Canada
| | - Aileen M Davis
- Krembil Research Institute University Health Network and University of Toronto Toronto Canada
| | - Jeffrey N Katz
- Harvard Medical School and Brigham and Women's Hospital Boston Massachusetts
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10
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Cram P. Hospital Length of Stay … A Measure of What, Exactly? Med Care 2019; 57:751-752. [PMID: 31415346 PMCID: PMC6742542 DOI: 10.1097/mlr.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peter Cram
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
- North American Observatory on Health Systems and Policies, Institute for Health Policy, Management, and Evaluation, University of Toronto
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Berg U, Berg M, Rolfson O, Erichsen-Andersson A. Fast-track program of elective joint replacement in hip and knee-patients' experiences of the clinical pathway and care process. J Orthop Surg Res 2019; 14:186. [PMID: 31227003 PMCID: PMC6587282 DOI: 10.1186/s13018-019-1232-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/10/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The clinical pathway and care program in elective total hip and knee replacement (THR/TKR) has, during the last decade, undergone considerable changes in many countries influenced by the concept of fast-track surgery, resulting in a very short hospital stay. Studies into patients' experiences of the entire fast-track program, from decision-making regarding surgery until recovery 3 months after surgery, are lacking. The aim of the study was to increase the knowledge about patients' experiences of the clinical pathway and care in a fast-track program of elective THR/TKR in order to identify factors that may influence recovery and clinical outcome. METHODS A qualitative research design was chosen with data collected from interviews 3 months after surgery and analyzed using an inductive content analysis method. In total, 24 patients from three hospitals with a fast-track care program were included in the study: 14 women and 10 men, 13 with THR and 11 with TKR. The mean age was 65 years (range 44-85). RESULTS The analysis identified three chronological phases in the clinical pathway: preparation, hospital stay for surgery, and recovery. In the preparation phase, patients' experiences and involvement in the planning of the operation were highlighted. The need to know the risks and expectations of recovery and outcome were also central, although there was great diversity in needs for information and involvement. In the hospital stay for the surgery phase, there were mainly positive experiences regarding admission, early mobilization, and early discharge. Experiences about the recovery phase focused on management of daily life, rehabilitation program, and recovery. Rehabilitation involved uncertainty as to whether or not the progress was normal. The recovery phase was also filled with questions about unfulfilled expectations. Regardless of the different phases, we found the importance of a person-centered care to be a pervasive theme. CONCLUSION Our study supports the view that a person-centered approach, from surgery decision until recovery, is an important element in optimizing care in a THR and TKR fast-track care program. More focus on the period after hospital discharge may improve recovery, patient satisfaction, and functional outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/rehabilitation
- Critical Pathways
- Female
- Humans
- Interviews as Topic
- Length of Stay
- Male
- Middle Aged
- Patient Satisfaction
- Patient-Centered Care
- Preoperative Care
- Treatment Outcome
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Affiliation(s)
- Urban Berg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery and Orthopaedics, Kungälv Hospital, Kungälv, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Annette Erichsen-Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Drew S, Judge A, Cohen R, Fitzpatrick R, Barker K, Gooberman-Hill R. Enhanced Recovery After Surgery implementation in practice: an ethnographic study of services for hip and knee replacement. BMJ Open 2019; 9:e024431. [PMID: 30842111 PMCID: PMC6429914 DOI: 10.1136/bmjopen-2018-024431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Enhanced Recovery After Surgery (ERAS) programmes aim to improve care quality by optimising components of the care pathway and programmes for hip and knee replacement exist across the UK. However, there is variation in delivery and outcomes. This study aims to understand processes that influence implementation using the Consolidated Framework for Implementation Research (CFIR) to inform the design and delivery of services. DESIGN An ethnographic study using observations and interviews with staff involved in service delivery. Data were analysed using a thematic analysis, followed by an abductive approach whereby themes were mapped onto the 31 constructs and 5 domains of the CFIR. SETTING Four hospital sites in the UK delivering ERAS services for hip and knee replacement. PARTICIPANTS 38 staff participated including orthopaedic surgeons, nurses and physiotherapists. RESULTS Results showed 17 CFIR constructs influenced implementation in all five domains. Within 'intervention characteristics', participants thought ERAS afforded advantages over alternative solutions and guidance was adaptable. In the 'outer setting', it was felt ERAS should be tailored to patients and education used to empower them in their recovery. However, there were concerns about postdischarge support and tensions with primary care. Within the 'inner setting', effective multidisciplinary collaboration was achieved by transferring knowledge about patients along the care pathway and multidisciplinary working practices. ERAS was viewed as a 'message' that had to be communicated consistently. There were concerns about resources and high volumes of patients. Staff access to information varied. At the domain 'characteristics of individuals', knowledge and beliefs impacted on implementation. Within 'process', involving opinion leaders in development and 'champions' who acted as a central point of contact, helped to engage staff. Formal and informal feedback helped to develop services. CONCLUSIONS Findings demonstrate successful implementation involves empowering patients to work towards recovery, providing postdischarge support and promoting successful multidisciplinary team working.
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Affiliation(s)
- Sarah Drew
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Cohen
- School of Population Health Sciences, Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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13
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Pedoia V, Majumdar S. Translation of morphological and functional musculoskeletal imaging. J Orthop Res 2019; 37:23-34. [PMID: 30273968 DOI: 10.1002/jor.24151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
In an effort to develop quantitative biomarkers for degenerative joint disease and fill the void that exists for diagnosing, monitoring, and assessing the extent of whole joint degeneration, the past decade has been marked by a greatly increased role of noninvasive imaging. This coupled with recent advances in image processing and deep learning opens new possibilities for promising quantitative techniques. The clinical translation of quantitative imaging was previously hampered by tedious non-scalable and subjective image analysis. Osteoarthritis (OA) diagnosis using X-rays can be automated by the use of deep learning models and pilot studies showed feasibility of using similar techniques to reliably segment multiple musculoskeletal tissues and detect and stage the severity of morphological abnormalities in magnetic resonance imaging (MRI). Automation and more advanced feature extraction techniques have applications on larger more heterogeneous samples. Analyses based on voxel based relaxometry have shown local patterns in relaxation time elevations and local correlations with outcome variables. Bone cartilage interactions are also enhanced by the analysis of three-dimensional bone morphology and the potential for the assessment of metabolic activity with simultaneous Positron Emission Tomography (PET)/MR systems. Novel techniques in image processing and deep learning are augmenting imaging to be a source of quantitative and reliable data and new multidimensional analytics allow us to exploit the interactions of data from various sources. In this review, we aim to summarize recent advances in quantitative imaging, the application of image processing and deep learning techniques to study knee and hip OA. ©2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res XX:XX-XX, 2018.
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Grants
- GE Healthcare
- P50 AR060752 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- R01AR046905 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- K99AR070902 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- R00AR070902 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- R61AR073552 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
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Affiliation(s)
- Valentina Pedoia
- Department of Radiology and Biomedical Imaging, QB3 Building, 2nd Floor, Suite 203, 1700 - 4th Street, University of California, San Francisco, California, 94158
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, QB3 Building, 2nd Floor, Suite 203, 1700 - 4th Street, University of California, San Francisco, California, 94158
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Dunne C, Dunsmore AWJ, Power J, Dubrowski A. Emergency Department Presentation of a Patient with Altered Mental Status: A Simulation Case for Training Residents and Clinical Clerks. Cureus 2018; 10:e2578. [PMID: 29984120 PMCID: PMC6034765 DOI: 10.7759/cureus.2578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Emergency physicians frequently are required to perform timely assessments on patients who are unable to provide a comprehensive history due to an altered level of responsiveness. The etiology of their altered mental status (AMS) causes a diagnostic dilemma due to its wide differential diagnosis. Physicians must use a timely combination of collateral history, physical examination skills, and investigations to diagnose the cause of the patient's AMS, as many of the potential etiologies can be life-threatening if not quickly managed. For this reason, training learners to perform the required actions accurately and effectively proves difficult during real-life emergencies, where an individual's life may be at risk. Simulation-based education (SBE) offers one solution to this challenge. It allows learners to build confidence by dealing with life-threatening conditions in a safe environment and has been shown to be superior to other forms of clinical training. This scenario explores learners' comfort in some less-practiced, but very important, areas of medicine including obtaining consent for treatment from a substitute decision maker (SDM), explaining various goals of care, and eliciting an advanced care directive from the SDM. Learners and physicians in all fields of medicine must be able to confidently discuss these subjects with patients and their families in order to provide individualized and appropriate management. In this simulation, learners will have the opportunity to explore an unusual AMS presentation and develop their clinical and communication skills by working as a team to manage the patient.
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Affiliation(s)
- Cody Dunne
- Faculty of Medicine, Memorial University of Newfoundland
| | | | - Jeff Power
- Faculty of Medicine, Memorial University of Newfoundland
| | - Adam Dubrowski
- Emergency Medicine, Pediatrics, Memorial University of Newfoundland
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15
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Barber SK, Lam Y, Hodge TM, Pavitt S. Is social media the way to empower patients to share their experiences of dental care? J Am Dent Assoc 2018; 149:451-459.e9. [PMID: 29656806 DOI: 10.1016/j.adaj.2018.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/05/2017] [Accepted: 01/04/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Social media present opportunities to understand patient experience and information needs. In this study, the authors use hypodontia as an example to explore social media use by dental patients and how this provides for understanding patient experience. METHODS The cross-sectional survey design involved systematic search of 6 social media online environments with hypodontia-related terms. The authors categorized records by using a coding system for user, type and theme of post, and target audience. The authors used a thematic framework approach to analyze qualitatively the word content of posts from people affected by hypodontia (nondentists). RESULTS The authors searched and identified 571 records and included 467 of them in their study. The authors analyzed the content of records from people affected by hypodontia (n = 176). Themes emerged about the experience of untreated hypodontia, treatment experience and outcomes, and decision making. Content analysis provided evidence about peer-to-peer communication, areas of information need, and desire for peer support. CONCLUSIONS Social media communities have responded to the need for information exchange and peer support by the public. Analysis of communications helped identify a need for dissemination of understandable information to patients and improved dentist awareness of patient needs. PRACTICAL IMPLICATIONS Clinicians should reassess understanding and information needs actively throughout treatment and identify support needs. Clinicians should refer patients to quality information sources and peer support groups.
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Pedoia V, Samaan MA, Inamdar G, Gallo MC, Souza RB, Majumdar S. Study of the interactions between proximal femur 3d bone shape, cartilage health, and biomechanics in patients with hip Osteoarthritis. J Orthop Res 2018; 36:330-341. [PMID: 28688198 PMCID: PMC5962017 DOI: 10.1002/jor.23649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/05/2017] [Indexed: 02/04/2023]
Abstract
In this study quantitative MRI and gait analysis were used to investigate the relationships between proximal femur 3D bone shape, cartilage morphology, cartilage biochemical composition, and joint biomechanics in subject with hip Osteoarthritis (OA). Eighty subjects underwent unilateral hip MR-imaging: T1ρ and T2 relaxation times were extracted through voxel based relaxometry and bone shape was assessed with 3D MRI-based statistical shape modeling. In addition, 3D gait analysis was performed in seventy-six of the studied subjects. Associations between shape, cartilage lesion presence, severity, and cartilage T1ρ and T2 were analyzed with linear regression and statistical parametric mapping. An ad hoc analysis was performed to investigate biomechanics and shape associations. Our results showed that subjects with a higher neck shaft angle in the coronal plane (higher mode 1, coxa valga), thicker femoral neck and a less spherical femoral head (higher mode 5, pistol grip) exhibited more severe acetabular and femoral cartilage abnormalities, showing different interactions with demographics factors. Subjects with coxa valga also demonstrated a prolongation of T1ρ and T2. Subjects with pistol grip deformity exhibited reduced hip internal rotation angles and subjects with coxa valga exhibited higher peak hip adduction moment and moment impulse. The results of this study establish a clear relationship between 3D proximal femur shape variations and markers of hip joint degeneration-morphological, compositional, well as insight on the possible interactions with demographics and biomechanics, suggesting that 3D MRI-based bone shape maybe a promising biomarker of early hip joint degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:330-341, 2018.
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Affiliation(s)
- Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Michael A. Samaan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Gaurav Inamdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Matthew C. Gallo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, CA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
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Goldsmith LJ, Suryaprakash N, Randall E, Shum J, MacDonald V, Sawatzky R, Hejazi S, Davis JC, McAllister P, Bryan S. The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation. BMC Musculoskelet Disord 2017; 18:127. [PMID: 28340610 PMCID: PMC5366158 DOI: 10.1186/s12891-017-1474-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/06/2017] [Indexed: 01/17/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature. Methods We report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals’ knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders. Results Participants’ descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves. Conclusions Patient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience.
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Affiliation(s)
- Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 10506, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Nitya Suryaprakash
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Ellen Randall
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jessica Shum
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, 10th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Valerie MacDonald
- Burnaby Hospital & Surgical Network, Fraser Health, 3935 Kincaid Street, Burnaby, BC, V5K 2X6, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Samar Hejazi
- Department of Evaluation and Research Service, Fraser Health, Suite 400, Central City Tower, 13450 102 Avenue, Surrey, BC, V3T 0H1, Canada
| | - Jennifer C Davis
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Aging, Mobility, and Cognitive Neurosciences Lab, University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | | | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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