Determinants of Dissatisfaction After Laparoscopic Cure of Vaginal and/or Rectal Prolapse using Mesh: a Comprehensive Retrospective Cohort Study

INTRODUCTION AND HYPOTHESIS

The primary objective is to identify determinants of dissatisfaction after surgical treatment of vaginal prolapse ± rectal prolapse, using laparoscopic mesh sacrohysteropexy (LSH) or sacrocolpopexy (LSC) ± ventral mesh rectopexy (VMR). The secondary objective is the evaluation of complications and objective/subjective recurrence rates.

METHODS

The study performed was a single-surgeon retrospective review of prospectively collected data. LSH/LSC ± VMR were performed between July 2005 and September 2022. Primary investigated outcome was patients' satisfaction, assessed using the Patient Global Impression of Improvement (PGI-I) score and the bother visual analog scale (VAS) obtained postoperatively (at a 1-month interval and on a 6-month/yearly basis thereafter). We looked for a correlation between the level of satisfaction (as reflected by the VAS) and potential determinants.

RESULTS

There were 355 patients with a mean age of 62 ±12 years. Nearly all the patients (94.3%) had a stage 3 or 4 prolapse according to the POP-Q classification. The mean postoperative bother VAS was 1.8, with only 12.7% of patients reporting a bother VAS score ≥ 3/10, indicating a dissatisfaction. PGI-I showed improvement in the vast majority of patients (96.4% scoring 1 to 3). Patients with anal incontinence preoperatively scored higher on the bother VAS postoperatively (r=0.175, p < 0.05). The use of a posterior arm mesh (for posterior vaginal prolapse) correlated with better satisfaction overall (r= -0.178, p = 0.001), whereas the performance of VMR was associated with a bothering sensation (r = 0.232, p < 0.001). A regression analysis confirmed the impact of posterior mesh and VMR on satisfaction levels, with odds of dissatisfaction being 2.18 higher when VMR was combined with LSH/LSC.

CONCLUSIONS

Posterior mesh use improves patient satisfaction when the posterior compartment is affected. In patients with concomitant vaginal and rectal prolapse, combining VMR with anterior LSC/LSH appears to negatively impact patients' satisfaction. Preoperative anal incontinence was demonstrated to be a risk factor for postoperative dissatisfaction.

Early career midwives' job satisfaction, career goals and intention to leave midwifery: A scoping review

OBJECTIVE

To scope and synthesise literature around the job satisfaction of early career midwives - those in their first five years of post-qualification practice - including the effect on their career aspirations and intention to leave the profession.

DESIGN

Scoping review.

METHODS

Relevant databases were searched for published research studies and grey literature. Literature were selected through adherence to pre-set inclusion and exclusion criteria to ensure relevance. Literature was included that was published from 2012. Selected literature were tabled and common themes were mapped to look for similarities and differences in findings.

FINDINGS

Ten papers were included - seven original research studies, a fact sheet, a non peer-reviewed article, and a conference paper. Negative themes - lack of support, workload stress, and job dissatisfaction, and positive themes - passion for midwifery, collegial relationships, and autonomy - were found across many of the included papers.

KEY CONCLUSIONS

Many midwives are considering leaving their profession due to the stress of their work, role dissatisfaction, and a lack of support. This is more common amongst early career midwives. There were some protective factors such as having pride in the midwifery profession. More research is needed to identify and address the needs specific to early career midwives.

Metrics of student dissatisfaction and disagreement: longitudinal explorations of a national survey instrument

This study explores dissatisfaction and neutrality metrics from 12 years of a national-level undergraduate student survey. The notion of dissatisfaction is much less prevalent in the narratives surrounding student survey outcomes, and the underpinning metrics are seldom considered. This is despite an increasingly vociferous debate about 'value for money' of higher education and the positioning of students as consumers in a marketised sector. We used machine learning methods to explore over 2.7 million national survey outcomes from 154 institutions to describe year-on-year stability in the survey items that best predicted dissatisfaction and neutrality, together with their similarity to known metric predictors of satisfaction. The widely publicised annual increases in student 'satisfaction' are shown to be the result of complex reductions in the proportions of disagreement and neutrality across different survey dimensions. Due to the widespread use of survey metrics in university league tables, we create an anonymised, illustrative table to demonstrate how UK institutional rankings would have differed if dissatisfaction metrics had been the preferred focus for reporting. We conclude by debating the tensions of balancing the provision of valuable information about dissatisfaction, with perpetuating negative impacts that derive from this important subset of the survey population.

Patient dissatisfaction following rhinoplasty: a 10-year experience in Iran

BACKGROUND

The nose is one of the most prominent parts of the face and plays a significant role in peoples' self-satisfaction as well as quality of life. Rhinoplasty is considered as one of the most numerous and delicate cosmetic surgeries all around the world that can be performed for functional issues, esthetic issues, or both. In this study, we aimed to evaluate the dissatisfaction of patients who had undergone rhinoplasty surgery and inform the surgeons to improve the surgical techniques to prevent probable future complaints.

METHOD

This retrospective cross-sectional study was conducted to report various aspects of dissatisfaction of patients following rhinoplasty. All available files in the Fars Forensic Medicine Department between 2011 and 2020 were reviewed, and the required information was extracted.

RESULTS

Out of 117 patients, 68.4% were females and 31.6% were males. Most of the patients were in the age range of 30-34 years. In terms of educational attainment, the highest frequency is associated with academically educated patients and the lowest with a diploma. The majority of cases filed for litigation less than 6 months after their rhinoplasty. The first rank among the factors of dissatisfaction with surgeries belonged to "respiratory problems" (36.8%) followed by "dissatisfaction with the general shape of the nose" (34.2%).

CONCLUSION

Our study shows that middle-aged female patients may be more difficult to satisfy. In general, at younger ages, patients complain about esthetics, and with aging, most patients feel dissatisfied with nasal function.

Body image as a multidimensional concept: A systematic review of body image facets in eating disorders and muscle dysmorphia

Body image disturbance is core to the psychopathology of eating disorders (EDs), and related disorders such as muscle dysmorphia (MD). Global measures of body image fail to quantify specific aspects of body image disturbance that characterizes EDs, and may be differentially associated to outcomes. The aim of this systematic review was to provide an overview of specific body image facets and synthesize findings from controlled studies that compared clinical ED/MD and control-comparison groups in body image disturbance. One-hundred sixty-seven studies met inclusion criteria, and reported on comparisons among 30,584 individuals in 28 body image facets, which were more broadly grouped into evaluative, perceptual, cognitive-affective and motivational categories for the purpose of the present review. Effect sizes were calculated as Cohen's d for every comparison between ED and control groups. Body dissatisfaction (evaluative category) was the most prevalent facet assessed across studies (62 %), and differences between clinical and control groups were the largest in this category, especially for bulimia nervosa (d = 1.37). Scarcity of studies with male and MD clinical samples, and use of single-item and non-validated measures, should encourage development of instruments for body image facets pertinent to EDs and MD that can be validly applied across gender.

Distinguishing delusional beliefs from overvalued ideas in Anorexia Nervosa: An exploratory pilot study

BACKGROUND

Characterised by the belief that more weight needs to be lost-despite emaciation, failing organs, medical instability and prospect of death-Anorexia Nervosa (AN) is a condition in which irrational, and highly-skewed, beliefs can be of delusional intensity. However, the nexus between delusion and rational awareness and how this is related to body image acceptance and perception has yet to be examined in AN. The current study aims to investigate the relationship between body dissatisfaction and beliefs of delusional intensity in an adult AN inpatient sample.

METHODS

Twenty-one adults (n_(women) = 20; n_(men) = 1), with a mean age of 27 years old (SD = 10), presenting for inpatient treatment for AN (ranging in severity from mild to severe; M_{(Body Mass Index)} = 17 kg/m²; M_{(Length of Stay)} = 22 days) participated in the study. Participants' dominant beliefs (related to AN) and level of insight (delusional; overvalued idea; or fair insight) were measured using either the Brown Assessment of Beliefs Scale (BABS) or the Nepean Beliefs Scale (NBS). The degree of body dissatisfaction was determined by examining the discrepancy between "perceived" and "ideal" body perception. To determine subjective and objective beliefs both the Contour Drawing Rating Scale (subjective) and computerised Body Image Assessment Software (objective) were used.

RESULTS

Almost one quarter (23.7%; n = 5) of participants appeared to have beliefs of delusional intensity related to their body shape (M = 27.4; SD = 23.03). Although a positive linear trend was indicated, there were no significant differences in body dissatisfaction scores between level-of-insight. Individuals whose belief was categorised as delusional were more likely to hold a negative affective body image state based on their ratings on the body image state survey when compared to the group who had good/fair insight (95% CI [0.53, 18.19]; p = 0.03).

CONCLUSIONS

The current exploratory pilot study concurs with others in the published literature that demonstrate that approximately 25 percent of participants with AN may have delusional ideas. The implications for treatment in similar samples warrant attention. Future research should also seek to understand the clinical significance of this delusional categorisation, the benefits of its utility in this population, and its relation to the severity of AN or stage of illness.

Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis

PURPOSE

The association between severity of radiographic osteoarthritis with patient pain, function, and satisfaction following total knee arthroplasty has been disputed. The discrepancies in current literature prompt us to further examine this association in a systematic review and meta-analysis.

METHODS

The OVID-Medline, Embase, and Web of Science databases were searched from their inception up to Mar 2020. The main independent variable was osteoarthritis severity as defined by preoperative radiographs. The outcomes measured were pain, function and satisfaction following total knee arthroplasty. A minimum of three studies assessing the same patient-reported outcome measures were included in the meta-analysis, as well as those separating patients by chronic pain or dissatisfaction.

RESULTS

29 studies were included in this study. Significant heterogeneity was seen between radiographic evaluation and reported outcomes. Patients with only mild radiographic osteoarthritis were more likely to suffer from chronic pain (odds ratio = 2.45, 95% CI = 1.80-3.34, p < 0.001) and dissatisfaction (odds ratio = 2.43, 95% CI = 1.79-3.31, p < 0.001) compared to patients with severe osteoarthritis. A significant association was found between mild radiographic severity and lower total Western Ontario and McMaster Universities Osteoarthritis scores (95% CI = - 0.37-0.06, p = 0.006) as well as Knee Society Scores (CI: - 0.54-0.16, p < 0.001).

CONCLUSION

Patients with mild radiographic osteoarthritis are anticipated to gain less from total knee arthroplasty compared to those with severe osteoarthritis. They are also at risk for chronic pain and dissatisfaction and should be consulted about this risk prior to surgery.

LEVEL OF EVIDENCE

III.

Retear bigger than preoperative tear size would lead to treatment failure after rotator cuff repair

BACKGROUND

This study aimed to (1) define treatment failure using the referred patient acceptable symptomatic state (PASS) values for pain visual analog scale (PVAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE) clinical scores and (2) identify the factors that lead to patient dissatisfaction after arthroscopic rotator cuff repair (ARCR).

METHODS

We analyzed the arthroscopic rotator cuff surgery registry data from January 2015 to December 2016. Patients were followed for ≥2 years and categorized as dissatisfied or satisfied based on our own definition of treatment failure at 2 years postoperatively. For defining treatment failure, the referred PASS values for the PVAS, ASES, and SANE scores were used. Patients who failed to attain the PASS value for the PVAS, ASES, or SANE score were categorized into the dissatisfied group. Pre- and postoperative imaging and basic demographic data were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify the factors affecting patient satisfaction at 2 years after rotator cuff repair.

RESULTS

Of 117 patients, 30 (25.6%) were defined as the dissatisfied group (mean follow-up period, 37.5 months). Seventeen patients (14.5%) had confirmed retear on follow-up magnetic resonance imaging. In the univariate analysis, sex significantly differed between the groups (female, satisfied vs. dissatisfied groups: 39 [44.8%] vs. 22 [73.3%]; P = .010). Retear alone did not affect patient satisfaction in the univariate analysis (P = .11). Progressed retear size featured a significantly higher risk of patient dissatisfaction (P = .024; odds ratio 6.430, 95% confidence interval 1.270-32.541) in the multivariable analysis using symptom duration, sex, preoperative ASES score, preoperative tear size, retear, and progressed retear size as variables. Moreover, female sex had an increased odds for dissatisfaction (odds ratio 4.646, 95% confidence interval 1.590-13.578; P = .005).

CONCLUSION

Two years after ARCR, most patients (74.4%) reported satisfaction with their outcomes. However, satisfaction levels can be altered by female sex or progressed retear size compared with the preoperative state.

ESSM Position Statement on Surgical Treatment of Peyronie's Disease

INTRODUCTION

Patients with Peyronie's disease may experience significat distress. The choice of treatment depends on a variety of factors, including the stage of the disease, the presence of pain, severity and direction of the curvature, penile length and the quality of erectile function.

AIM

To review the evidence associated with surgical treatment of Peyronie`s Disease and provide clinical recommendations on behalf of the European Society for Sexual Medicine. 131 peer-reviewed studies and systematic reviews, which were published from 2009 to 2019 in the English language, were included.

METHODS

MEDLINE, Google Scholar and EMBASE were searched for randomized clinical trials, meta-analyses, open-label prospective and retrospective studies.

MAIN OUTCOME MEASURE

The panel provided statements on clinically relevant questions including patient involvement in the decision process, indications for surgery, choice of the approach, and the management of patient expectations. A comparison of the different grafts used in patients who have undergone plaque incision/excision and grafting in order to identify an ideal graft, has been carried out. The prevalence of postoperative complications has been summarized. Levels of evidence were provided according to the Oxford 2011 criteria and Oxford Centre for Evidence-Based Medicine recommendations.

RESULTS

In order to allow shared decision making, a patient preoperative counselling regarding the pros and cons of each intervention is recommended. In particular, adverse effects of surgical treatments should be discussed to set realistic understanding and expectations of surgical outcomes and ultimately improve postoperative satisfaction rates. Surgical treatment should be only offered in the chronic phase of the condition, when the deformity and/or degree of erectile dysfunction, prevent patients from engaging in satisfying sexual interaction, or if the deformity is the cause of severe bother.

CONCLUSIONS

Current European Society for Sexual Medicine recommendations cover several aspects of Peyronie's disease treatment. These recommendations aim both to ensure patients and partners have accurate and realistic expectations of their treatment options, as well as to formulate algorithms to guide clinician management pathways. Osmonov D. et al., ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med 2022;10:100459.

The impact that family members' health care experiences have on patients' trust in physicians

BACKGROUND

A family member's negative experiences with medical care have long-term effects on a patient's attitudes and emotions. However, the impact of family members' experiences on patients' trust in their own physicians and in physicians generally is poorly understood. This study aims to quantify these associations.

METHODS

A cross-sectional online survey involving adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease) was conducted in Japan during April 2020. The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients' (N = 661) own trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. Both 5-item scales (general and individual physician trust) were translated and validated for the study. The total scores were transformed into a scale of 0-100 points. A series of linear mixed-effects models with consideration for clustering effect by prefectures were fit.

RESULTS

The results showed a lower rating for trust in physicians generally as compared to trust in the respondent's personal physician (mean 57.0 vs. 66.4 points; p < 0.001). Furthermore, dissatisfaction with a family member's medical care was associated with lower trust in physicians generally (mean difference - 9.58, 95 %CI -12.4 to -6.76). Interestingly, dissatisfaction with a family member's care was also associated with lower trust in the respondent's personal physician (mean difference - 3.19, 95 %CI -6.02 to -0.36), but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally.

CONCLUSIONS

We suggest that physicians enquire about past patients' negative experiences, including dissatisfaction with family members' medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.

National Health Insurance Scheme: An Assessment of Service Quality and Clients' Dissatisfaction

Background

Health Insurance Scheme (NHIS), a medical package to start with a fraction of Nigerians at its inception, with the expectation of optimal services to all in the long The Nigerian government established National run. However, there are complaints and dissatisfaction of enrolees of the scheme. This study determined factors responsible for enrolees' dissatisfaction of services in a general hospital within the federal capital territory, Abuja.

Method

Three hundred enrolees of National Health Insurance Scheme at the Kubwa general hospital were enrolled. Semi structured questionnaires were used to obtain information on socio-demography, education, enrolee status, perception of the scheme and factors responsible for enrolees' dissatisfaction. SPSS version 22 was used to analyse Data using percentage.

Results

Majority (66.3%) of the respondents were between 35 and 54 years while 28.5% were below 35years and 11.8% (32) were above 54years with the male to female ratio was 1.03:1. Sixty percent (179) of the respondents had a minimum of tertiary education with just 1.8% having primary education. Most (69.9% and 79.6%) respondents were principal enrolees and public servants respectively. Seventy percent of the respondents have been enrolled in NHIS for more than 3years and had a good perspective of the scheme. However, 30% of the respondents were not satisfied with NHIS services with 8.6% and 15.4% describing the services as substandard and below expectations respectively. Half (50.7%) of the respondents would consider an alternative to NHIS suggesting their dissatisfaction. The major factors responsible for dissatisfaction were billing system, long waiting hours and staff attitude accounting for 46.9%, 59.4% and 7.8% respectively.

Conclusion

This study revealed that the level of clients' dissatisfaction with NHIS services is high despite their acceptance of the scheme with the major areas of concern being the billing system, waiting time and staff attitude. Therefore, it is necessary for the providers to look more into these areas as targets for service delivery improvement.

Feeling about living arrangements and associated health outcomes among older adults in India: a cross-sectional study

INTRODUCTION

Advancement in the field of gerontology has been concerned with the well-being of older adults in a family setup that is associated with caregiving and support. While family life and well-being are defined by emotion, caregiving, and support activities, dissatisfaction/discontent with living arrangements is a public health concern, which is increasing with a rise in the proportion of the older population in the country. The study examines the association of dissatisfaction with living arrangements with health outcomes among older men and women in India.

METHODS

The present research used data from the 'Building a Knowledge Base on Population Aging in India'. The effective sample size for the analysis was 9181 older adults. Descriptive statistics and bivariate analysis were performed to present the preliminary estimates. For finding the association between various health outcomes over explanatory variables, binary logistic regression model was used separately for men and women.

RESULTS

About 22.8% of men and 30.8% of women who were living alone were dissatisfied with their present living arrangement. It was revealed that both men and women who were dissatisfied with their present living arrangements had significantly higher odds of experiencing poor self-rated health [OR:4.45, 3.25 ~ 6.09 and OR:3.32, 2.54 ~ 4.34], low psychological health [OR: 2.15, 1.61 ~ 2.86 and OR: 1.99, 1.57 ~ 2.53], low subjective well-being [OR: 3.37, 2.54 ~ 4.45 and OR: 3.03, 2.36 ~ 3.38], low ADL [OR: 1.77, 1.2 ~ 2.62 and OR: 1.59, 1.17 ~ 2.18, low IADL] [OR: 1.32, 1.03 ~ 1.69 and OR: 1.57, 1.24 ~ 1.98] and low cognitive ability [OR: 1.26, 0.98 ~ 1.61 and OR:1.44, 1.13 ~ 1.82] in comparison to their counterpart from men and women respectively.

CONCLUSION

It is found that dissatisfaction with the living arrangement of older men and women is negatively associated with major health outcomes. Hence, appropriate policies and programs must be developed to promote increased family care and support and an improved residential environment that would create a feeling of comfort and happiness among older individuals.

The influence of social media on body dissatisfaction among college students

BACKGROUND

Social media is growing rapidly in the last few years and it became daily used by individuals, especially adolescents and young adults. Although social media has several benefits such as easy communication between individuals, it has also other drawbacks and negative influence on individuals.

AIM

To assess the association between the level of social media use and body dissatisfaction among male and female college students and to examine these associations according to different types of social media.

METHOD

This is a cross-sectional study that was conducted on students at King Saud University in Riyadh-Saudi Arabia, using self-administrated questionnaire "The Body Shape Questionnaire BSQ-8." Data were analyzed using SPSS statistical software (Version 21.0).

RESULTS

The present study included 204 students, females were more dominant (53.9%). Around 47.1% of participants spent >4 h, and the most used type of social media used was Twitter (46.6%). There were 71.1% who had low dissatisfaction. Several factors significantly had an impact on the level of dissatisfaction including upper class status (P = 0.015), using social media for 3-4 h (P = 0.05) and suing social media for more than 4 h (P = 0.011).

CONCLUSION

There was low level of dissatisfaction level among students, however this level didn't differ between gender, so social media in Saudi Arabia didn't have the huge effect seen in other countries, especially among females.

Pre-operative predictors of lower extremity swelling following total knee arthroplasty in patients with venous insufficiency and osteoarthritis

PURPOSE

Post-operative swelling and oedema following total knee arthroplasty (TKA) are one of the most important causes of dissatisfaction. We aimed to assess the clinical variables associated with post-operative swelling and edema after TKA and to compare their performance in respect of predicting them pre-operatively.

METHODS

The study cohort comprised 116 patients who underwent TKA between January 2018 and May 2019 in our centre. The diameters and the grade of venous insufficiency (VI) in the lower extremity veins were measured with duplex ultrasonography preoperatively and at one and three months post-operatively. The study cohort was divided into the patients with leg swelling positive with a difference in leg circumference of > 2 cm (n = 56, 48.2%) and leg swelling negative with a difference of ≤ 2 cm (n = 60, 51.7%) from the pre-operative leg diameter.

RESULTS

Independent predictors for lower extremity swelling were pre-operative great saphenous diameter (GSV) diameter > 5.5 mm [odds ratio (OR) 2.51, 95% CI 0.24-0.91; p = 0.0012], GSV reflux > 1 s [OR 3.28, 95% CI 1.16-12.1; p = 0.003], deep only VI [OR 1.32, 95% CI 0.74-1.87; p = 0.021], CEAP C4-6 [OR 1.62, 95% CI 0.36-0.91; p = 0.018], and hypothyroidism [OR 1.55, 95% CI 1.31-11.2; p = 0.031].

CONCLUSION

GSV diameter of > 5.38 mm and GSV reflux duration > 1.23 s had the best predictive value for lower extremity oedema following TKA.

Why are patients dissatisfied following a total knee replacement? A systematic review

BACKGROUND

Although total knee replacement (TKR) is an effective intervention for end-stage arthritis of the knee, a significant number of patients remain dissatisfied following this procedure. Our aim was to identify and assess the factors affecting patient satisfaction following a TKR.

MATERIALS AND METHODS

In accordance with the PRISMA guidelines, two reviewers searched the online databases for literature describing factors affecting patient satisfaction following a TKR. The research question and eligibility criteria were established a priori. Any clinical outcome study that described factors relating to overall satisfaction after primary TKR was included. Quality assessment for the included studies was performed by two accredited orthopaedic surgeons experienced in clinical research.

RESULTS

The systematic review identified 181 relevant articles in total. A history of mental health problems was the most frequently reported factor affecting patient satisfaction (13 reportings). When the results of the quality assessment were taken into consideration, a negative history of mental health problems, use of a mobile-bearing insert, patellar resurfacing, severe pre-operative radiological degenerative change, negative history of low back pain, no/less post-operative pain, good post-operative physical function and pre-operative expectations being met were considered to be important factors leading to better patient satisfaction following a TKR.

CONCLUSION

Surgeons performing a TKR should take these factors into consideration prior to deciding whether a patient is suitable for a TKR. Secondarily, a detailed explanation of these factors should form part of the process of informed consent to achieve better patient satisfaction following TKR. There is a great need for a unified approach to assessing satisfaction following a TKR and also the time at which satisfaction is assessed.

Alignment in total knee arthroplasty

Dissatisfaction following total knee arthroplasty is a well-documented phenomenon. Although many factors have been implicated, including modifiable and nonmodifiable patient factors, emphasis over the past decade has been on implant alignment and stability as both a cause of, and a solution to, this problem. Several alignment targets have evolved with a proliferation of techniques following the introduction of computer and robotic-assisted surgery. Mechanical alignment targets may achieve mechanically-sound alignment while ignoring the soft tissue envelope; kinematic alignment respects the soft tissue envelope while ignoring the mechanical environment. Functional alignment is proposed as a hybrid technique to allow mechanically-sound, soft tissue-friendly alignment targets to be identified and achieved. Cite this article: Bone Joint J 2020;102-B(3):276-279.

Low-cost self-paced interventions increase birth satisfaction in first time fathers

OBJECTIVE

This research aims to investigate whether a skills or birth stories intervention for fathers can improve birth satisfaction of fathers.

STUDY DESIGN

One hundred and seventy-four men were recruited and randomly assigned to a skills preparation group, a birth stories group, or a treatment as usual (TAU) group. One hundred sixteen men completed the three questionnaires relevant for this report (67% retention rate). Birth satisfaction was measured soon after birth.

MEASURES

Demographic data and data related to partners pregnancy, birth and preparation were collected. The Mackey Childbirth Satisfaction Rating Scale was the primary outcome measure.

RESULTS

It was found that men who received either of the birth preparation interventions (skills or birth stories booklet) had significantly higher birth satisfaction scores. An analysis found that, irrespective of intervention, his partner having an induction, a caesarean section, and his not being in full-time employment had a negative effect on birth satisfaction, while his partner having an epidural, his experiencing family life satisfaction before the birth, his finding antenatal classes useful, and having his birth delivery expectations met had a positive impact on birth satisfaction.

CONCLUSION

Increasing the father's understanding, role expectations, and preparation for his partner's childbirth, may be important for fathers birth satisfaction. Expectations around childbirth and expectations of himself might be better managed to improve satisfaction. This study found evidence that simple low-cost interventions can improve birth satisfaction for new fathers.

Clinical Recommendations From the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances

INTRODUCTION

To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied.

AIM

The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and systematic reviews, which were published from 2007-2018 in the English language, were included.

METHODS

MEDLINE and EMBASE were searched for randomized clinical trials, meta-analyses, and open-label prospective and retrospective studies.

MAIN OUTCOME MEASURE

The panel provided statements exploring patients and partner expectations, satisfaction in male and phalloplasty cohorts, the impact of penile length, girth and implant type, reservoir placement, the influence of comorbidities, and social circumstances. Levels of evidence were provided according to the Oxford 2011 criteria and graded as for the Oxford Centre for Evidence-Based Medicine recommendations.

RESULTS

In the preoperative setting, it is fundamental to identify and interact with difficult patients with the intention of enhancing the surgeon's ability to establish the surgeon-patient relationship, reduce physical and legal risk, as well as enhancing patient satisfaction. To address this need, the mnemonic Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric ("CURSED") has been suggested to identify patients who are at high risk of dissatisfaction. The current recommendations suggest improving glycemic control in patients with diabetes. Available evidence suggests evaluating transplant recipients with the criteria of Barry, consisting of stable graft function for >6 months, avoidance of intra-abdominal reservoir placement, and low-dose immunosuppression. HIV status does not represent a contraindication for surgery. Smoking, peripheral vascular disease, and hypertension may be associated with an increased risk of revision surgery. Patients with spinal cord injury may receive IPP. Patients aged ≥70 years, as well as obese patients, can be offered IPP. The IPP implantation can be performed in patients with stable Peyronie's disease. Ectopic high submuscular reservoir placement can be considered as an alternative method.

CLINICAL IMPLICATIONS

There is a relevant lack of high-level data and definite conclusions in certain areas remain difficult to draw.

STRENGTH & LIMITATIONS

All studies have been evaluated by a panel of experts providing recommendations for clinical practice. Because of lack of sufficient prospective data, some of the included studies are retrospective and this could be stated as a limitation.

CONCLUSION

This ESSM position statement provides recommendations on optimization of patient outcome by patient selection, and individualized peri- and intra-operative management. ESSM encourages centers to collaborate and to create prospective, multicenter registries in order to address this topic of increasing importance. Osmonov D, Christopher AN, Blecher GA, et al. Clinical Recommendations from the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020;17:210-237.

Patient satisfaction and associated factors among psychiatry outpatients of St Paulo's Hospital, Ethiopia

Background

Patient satisfaction with mental healthcare service is recognised as an important integral part of measuring the outcomes and performance of clinical service delivery. It is not well studied in Ethiopia. Therefore, it is essential to improve service in the future.

Aims

To assess patient satisfaction and associated factors among psychiatry outpatients at St. Paulo’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Methods

An institutional-based cross-sectional study was conducted with consecutive sampling technique from May to June 2018. Data were collected using a Client Satisfaction Questionnaire (CSQ-8). Both bivariate and multivariate ordinal logistic regression analyses were used. Variables with p value <0.05 at multivariate analysis were considered statistically significant.

Results

A total of 589 participants were enrolled with a response rate of 98.2%. In regard to the magnitude of patient satisfaction, 50.3% (95% CI 46.0 to 54.2) were highly satisfied, 31.0% (95% CI 27.2 to 34.8) were satisfied, and 18.7% (95% CI 15.4 to 22.1) were dissatisfied. Male sex (adjusted OR (AOR) 2.30, 95% CI 1.57 to 3.36), inability to read and write (AOR 2.23, 95% CI 1.10 to 4.66), being unemployed (AOR 1.69, 95% CI 1.15 to 2.47), obtaining services for free (AOR 1.57, 95% CI 1.11 to 2.22), and availability of medication (AOR 1.62, 95% CI 1.13 to 2.23) were significantly associated with patient satisfaction.

Conclusions

The study showed that further improvements in patient satisfaction are required. Male sex, inability to read and write, being unemployed, obtaining services free of charge, and availability of medication were significantly associated with patient satisfaction. More than half of the participants were dissatisfied with the waiting time to receive services. The provision of services within a reasonable timeframe and meeting patient expectations are helpful for good health outcomes.

How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia?

Introduction

Most premenopausal women in China have normal lipid profiles while the sexual function among them was scarcely demonstrated.

Aim

To find out the characteristics of the sexual function in premenopausal Chinese women without hyperlipidemia using the Female Sexual Function Index (FSFI) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS).

Methods

This cross-sectional study was performed to find out the characteristics of sexual function in premenopausal Chinese women without hyperlipidemia. Between January 2019 and March 2019, we recruited 216 women, 25–49 years of age. Data from questionnaires and health checkups were collected and analyzed.

Main Outcome Measure

We report the prevalence of and factors related to female sexual dysfunction (FSD) in premenopausal Chinese women without hyperlipidemia in accordance with the FSFI and the GRISS.

Results

The prevalence of FSD in our study was 46.2%. The mean age was 38.07 ± 6.94 years. More highly educated women suffered from FSD than those in the control group (61.1% vs 35.2%, P < .05). Binge eating was significantly different between the groups (P = .023). Multiple logistic regression analyses demonstrated that total cholesterol level was positively associated with low desire (OR, 2.13; 95% CI, 1.10–4.13; P = .025) and so was the low-density lipoprotein level (OR, 2.18; 95% CI, 1.03–4.62; P = .0.041). The high-density lipoprotein level was inversely associated with infrequency (OR, 0.18; 95% CI, 0.06–0.59; P = .004). More women with FSD had orgasm disorder than those in the control group, for 83.3% vs 35.2% in the FSFI (P < .001), 88.9% vs 54.3% in the GRISS (P < .001), respectively. Dissatisfaction remained the most common issue for the control group in both the FSFI and the GRISS (90.50% and 58.10%, respectively).

Conclusions

FSD is frequent in premenopausal Chinese women without hyperlipidemia. Dissatisfaction as the common problem influenced over half of them and orgasm disorder is a severe sexual issue for women with FSD.

Xiang Y, Tang Y, Li J, et al. How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia. J Sex Med 2019;8:65–75.

Does total contact of the patella with the femoral trochlea during no thumb test significantly reduce anterior knee pain?

BACKGROUND

Complications such as anterior knee pain (AKP) and crepitus continue to be causes of dissatisfaction after total knee arthroplasty (TKA). This prospective study aimed to study the significance of total patellar contact with the femoral trochlea of the implant, with the no thumb test during trial reduction, and its effect on reducing AKP.

METHODS

Between 2014 and 2016, 445 patellofemoral joints (M:F 126:319, age 45-80 years) and their contact with the trochlea of the femoral component were graded at trial reduction without lateral retinaculum release (Grades I, Ia, II, III based on existing publications). The aim was to restore all patellae to pre-operative thickness. Posterior stabilized implants with a domed patella were used in all cases. The Knee Society Score (KSS) and Visual Analogue Scale (VAS) score were noted at follow up between 12 and 24 months after surgery.

RESULTS

AKP was significantly lower with 100% patellofemoral contact. The KSS and VAS had statistically significant P-values of 0.021 and 0.025 in Grade I and Ia contact, respectively. Better results were achieved where patellar thickness was restored in Grades I and Ia with P-values of 0.041 and 0.046 for VAS change and 0.038 and 0.044 for KSS change, respectively.

CONCLUSION

At follow up, superior results were obtained where there was a complete patellofemoral contact at trial reduction in Grade I and Grade Ia, and when other confounding factors such as patellar thickness and normal rotation of the femoral and tibial components were standardized. To minimize AKP it is imperative to have total patellar contact with the femoral trochlea.

Analyses of effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL: a retrospective cohort study

Objectives

This study aimed to investigate the effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL.

Methods

In this study, 194 patients, who underwent open-door laminoplasty for cervical OPLL from January 2009 to January 2016, were retrospectively reviewed. The Patient Satisfaction Index (PSI) was collected at discharge, 6 months, 1 year, and the last follow-up. According to the PSI, patients were divided into satisfied group and dissatisfied group. The possible effect factors included demographic variables and surgery-related variables.

Results

At discharge, 42 (21.6%) patients were in the dissatisfied group, as compared to the satisfied group, the hospitalization cost, hospital stay, postoperative depression, the axial neck pain, delayed wound healing, and VAS-neck had significant statistical differences. At 6-month follow-up, 25 (12.9%) patients were in the dissatisfied group. The axial neck pain and JOA score had significant statistical differences between the two groups, and no significant differences were found between the two groups in other items. At 1 year with 18 (9.3%) dissatisfied patients and last follow-up with 14 (7.2%) dissatisfied patients, the JOA score and symptom recurrence had significant statistical differences. For further analysis, the dissatisfied patients with axial neck pain at 6 months were significantly higher than that at other terms and the JOA score of the two groups increased gradually with prolonging of restoration years but compared with the dissatisfied group, the JOA scores were obviously better in the satisfied group at the last follow-up.

Conclusions

Overall, to patients undergoing open-door laminoplasty for cervical OPLL, hospitalization cost and neck pain might be mainly associated with patient dissatisfaction at the early and middle recovery. Patient dissatisfaction at the long-term treatment outcome might be mainly associated with the low improvement rate of JOA score and symptom recurrence.

Visual outcomes, spectacle independence and satisfaction after diffractive trifocal intraocular lens implantation

PURPOSE

To investigate visual outcomes, spectacle independence, and patient satisfaction after trifocal intraocular lens implantation.

METHODS

A retrospective study conducted on 5,186 patients who underwent phacoemulsification and were implanted with a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL SA, Liège, Belgium).

RESULTS

The mean pre-operative keratometry was 43.61±1.55 D, and mean keratometric cylinder was -0.86±0.66 D. At 3 months post-operatively, values changed to 43.59±1.56 and -0.71±0.46 D, respectively. Mean sphere varied from 2.04±2.60 to 0.14±0.38 D, and mean spherical equivalent from 1.64±2.61 to -0.05±0.36 D. More than 60% of the patients achieved better corrected distance visual acuity. The majority had a final residual refractive error (predictability) lower than 1 D (99.1%), with 14.3% needing optical adjustment (bioptics). Posterior capsulotomy was performed in 2.2%, and the lens was replaced in 5 patients. A high percentage of patients were satisfied in terms of vision and spectacle independence at all distances. Although 2% referred to worsening of night vision quality, only 2% were not very satisfied and 20 patients were dissatisfied. The causes were: blurred vision (7 cases), spectacle dependence (10), dysphotopsia (7), and dry eye (4).

CONCLUSIONS

The implantation of this model provided good visual performance in all distances, as well as high levels of spectacle independence and satisfaction.

The relative associations of shape and weight over-evaluation, preoccupation, dissatisfaction, and fear of weight gain with measures of psychopathology: An extension study in individuals with anorexia nervosa

Recent research has demonstrated that certain components of body image (i.e., shape and weight over-evaluation, preoccupation, and dissatisfaction) in secondary school students shared a distinct clinical significance because of their differential relation to measures of psychopathology. The present study aimed to replicate and extend on these findings by examining the distinctiveness of these body image constructs, in addition to a fear of weight gain, in individuals with anorexia nervosa (AN)-a disorder this is facilitated and maintained by extreme body image concerns. Treatment-seeking females with AN (n = 124) completed a questionnaire battery that measured these constructs. Findings demonstrated that once any shared variance between body image components was removed in regression analyses, fear of weight gain was the only unique predictor of eating disorder psychopathology (e.g., dietary restraint and compulsive exercise), while over-evaluation and preoccupation were the only unique predictors of general psychopathology (e.g., depressive and anxiety symptoms). Overall, these findings demonstrate certain components of body image may operate differently in AN, and reinforce previous calls to consider and assess for distinct facets of body image in this population.

Hand-Holding during Cystoscopy Decreases Patient Anxiety, Pain, and Dissatisfaction: A Pilot Randomized Controlled Trial

OBJECTIVE

Often a sick or an anxious person can experience pain or anxiety relief if another person holds his or her hand. In this study, we conducted investigations to determine whether hand-holding during cystoscopy decreases patient anxiety, pain, and dissatisfaction while at the same time increasing patient comfort and tolerance during the procedure.

PATIENTS AND METHODS

Eighty-six male patients who underwent flexible cystoscopy between November 2015 and March 2017 were randomized as follows: hand-holding (group I, n = 43) or non-hand-holding (group II, n = 43) during the procedure. Before flexible cystoscopy, lidocaine gel was instilled in the urethra. Patients' anxiety levels were quantified using the State-Trait Anxiety Inventory. A visual analog scale (0-10) was used for self-assessment of satisfaction, discomfort, and willingness to undergo repeat cystoscopy.

RESULTS

Demographic characteristics, mean age, procedure duration, procedure indications, and preprocedural analyses did not differ significantly between the 2 groups. In group I, the postprocedural mean anxiety level, pain score, heart rate, and systolic blood pressure were significantly lower compared with those in group II (p = 0.009, p = 0.003, p = 0.022, and p = 0.014, respectively). In group I, postprocedural mean satisfaction score were higher, and patients were more likely to undergo a repeat cystoscopy, compared with those in group II (p = 0.001 and p = 0.004, respectively).

CONCLUSIONS

Hand-holding during cystoscopy significantly reduced patients' feelings of anxiety, pain, discomfort, and dissatisfaction. Hand-holding served as a simple, inexpensive, and effective adjunct to sedation during cystoscopy.

Satisfaction with sex life among patients with schizophrenia

BACKGROUND

Whilst subjective quality of life has been extensively studied in patients with schizophrenia, little is known specifically about their satisfaction with their sex lives. Aim To assess the level of satisfaction with sex lives of patients with schizophrenia and explore patient characteristics associated with lower satisfaction.

METHOD

Data of five independent samples of patients with schizophrenia or related disorders (ICD-10 F20-29) were analysed. Quality of life including satisfaction with sex life was assessed on the Manchester Short Assessment of Quality of Life.

RESULTS

Across all patients (N=1404), satisfaction with sex life was significantly lower than satisfaction with any other life domain, and in each sample mean scores were below the middle scale point, indicating explicit dissatisfaction. Lower satisfaction was associated with male gender, being unmarried and more affective symptoms.

CONCLUSION

Patients with schizophrenia experience their sex life as an area of particular dissatisfaction. Future research should identify context and reasons for this dissatisfaction.

Patterns of participation over four rounds of annual fecal immunochemical test-based screening for colorectal cancer: what predicts rescreening?

BACKGROUND

Participation at the recommended intervals is critical for screening to be effective in reducing colorectal cancer (CRC) incidence. This study describes patterns of screening participation over four rounds of fecal immunochemical testing (FIT) to identify whether demographic variables and prior screening satisfaction are significantly associated with patterns of re-participation.

METHODS

Baseline surveys were mailed to 4000 South Australians randomly selected from the electoral-roll. Respondents (n = 1928/48.2%) were offered four annual FIT rounds. Screening participation and satisfaction at each round were recorded.

RESULTS

Study participation was 58.5, 66.9, 73.1 and 71.4% respectively over four rounds. Three participation patterns were described: consistent participation (43.1%), consistent non-participation (26.4%) and inconsistent participation (changeable; 30.5%), including intermittent and sustained change patterns. Sustained change described those who changed participatory behavior and then maintained for at least two rounds (n = 375/19.5%). Older people, and those not working were most likely to sustain participation. Younger invitees, especially men, were more likely to change participatory behavior and sustain the change. People with higher disadvantage, less education, not working and with no prior (pre-trial) screening experience were more likely to start participating and drop out. People dissatisfied with a prior screening test, including finding aspects embarrassing or unpleasant, were also more likely not to participate in annual screening or to drop out.

CONCLUSIONS

The findings identify those at risk of non- or inconsistent participation in rescreening. They should aid targeting of interventions for demographic groups at risk and ensuring screening experiences are not perceived as unpleasant or difficult.

Body image perception of African immigrants in Europe

Nutritional disorders are now spreading worldwide both in developed and developing countries. Body image ideals and dissatisfaction have been linked to a number of poor health outcomes, including nutritional disorders. While previous studies have offered insight into weight status and body image perception of immigrants in North America, very few studies have analysed these aspects in migrants from Africa to Europe. Our review examines the effects of the migration process on beauty ideals and body dissatisfaction in African immigrants in Europe compared to residents in their own countries. The PubMed, PsycINFO and Google Scholar databases were searched for studies published from January 2000 till November 2015. Of the 730 titles identified, 26 met the inclusion criteria and were included in the present review. Among African residents, the body preferences depend on the country of residence and their socio-cultural status. Ethnic groups living in great isolation or with low incomes still have an ancestral idea of beauty, preferring a shapely body. However ethnic groups living in urban areas are moving toward Westernization of beauty ideals, preferring underweight or normal weight bodies. This review highlights that both residents and migrants are at high risk of nutritional disorders due to the adoption of Western beauty ideals. The results suggest that body dissatisfaction and BMI are increasing from Southern Africa to Europe according to a geographical gradient (described for females by Spearman's coefficient and linear regression, respectively). We emphasize the need for monitoring of the weight and psychological status of immigrants and the development of specific preventive strategies in European countries.

Comparing Heterosexuals' and Gay Men/Lesbians' Responses to Relationship Problems and the Effects of Internalized Homophobia on Gay Men/Lesbians' Responses to Relationship Problems in Turkey

The purpose of the present study was twofold: (1) to investigate the effects of sexual orientation (heterosexuals and gay men/lesbians) and gender difference on responses to romantic relationship problems (Exit, Voice, Loyalty, and Neglect [EVLN] responses) and of perceived partner's EVLN responses in Turkey, and (2) to examine whether internalized homophobia was associated with EVLN responses and perceived partner's EVLN responses for gay men and lesbians. Responses to Dissatisfaction Scale-Accommodation Instrument, Internalized Homophobia, and Demographics Information were administered to 187 participants (44 lesbians, 44 gay men, 53 heterosexual women, 46 heterosexual men).The MANCOVA results showed that men reported higher loyalty than women, whereas women presented more exit responses than men. Further, the interactions between gender and sexual orientation on the participants' EVLN responses and on the perceived partner's EVLN responses were significant. With respect to heterosexual women, heterosexual men displayed more loyalty responses. Lesbians had higher scores on loyalty than did heterosexual women. Lesbians also had higher scores on perceived partner's exit response than did heterosexual women and gay men. On the contrary, heterosexual women reported more perceived partner's voice response than lesbians. In addition, lesbians reported higher perceived partner's neglect responses than heterosexual women. Compared to heterosexual women, heterosexual men reported higher perceived partner's exit response. Finally, internalized homophobia was associated with destructive responses for both lesbians and gay men.

An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center

Background. Physician wellness is a vital element of a well-functioning health care system. Not only is physician wellness empirically associated with quality and patient outcomes, but its ramifications span individual, interpersonal, organizational, and societal levels. The purpose of this study was to explore academic physicians’ perceptions about their work-related wellness, including the following questions: (a) What are the workplace barriers and facilitators to their wellness? (b) What workplace solutions do theythinkwouldimprove their wellness? (c)What motivates their work? and (d) What existing wellness programs are they aware of?

Methods. A multi-method design was applied to conduct a total of 19 focus group sessions in 17 clinical departments. All academic faculty ranks and career lines were represented in the 64 participating physicians, who began the sessions with five open-ended survey questions pertaining to physician wellness in their work environment. Participants entered their answers into a web-based survey program that enabled anonymous data collection. The initial survey component was followed by semi-structured focus group discussion. Data analysis of this qualitative study was informed by the general inductive approach as well as a review of extant literature through September 2015 on physician wellness, professional fulfillment, satisfaction, dissatisfaction, burnout and work-life.

Results. Factors intrinsic to the work of physicians dominated the expressed reasons for work motivation. These factors all related to the theme of overall contribution, with categories of meaningful work, patient care, teaching, scientific discovery, self-motivation and matching of career interests. Extrinsic factors such as perceptions of suboptimal goal alignment, inadequate support, restricted autonomy, lack of appreciation, and suboptimal compensation and benefits dominated the risk of professional dissatisfaction.

Discussion. Our findings indicate that the factors that enhance professional fulfillment and those that precipitate burnout are distinct: motivation and quality of work performed were supported by domains intrinsic to the work itself, whereas external dysfunctional work aspects resulted in frustration. Thus, it can be anticipated that optimization of physician wellness would require tailored approaches in each of these dimensions with sustained funding and support for wellness initiatives. Physicians identified the availability of resources to enable them to thrive and provide excellent patient care as their most important wellness-enhancing factor.

Jordanian women's dissatisfaction with childbirth care

BACKGROUND

Dissatisfaction with childbirth care can have a negative impact on a woman's health and well-being, as well as her relationships with her infant.

AIM

To investigate the prevalence and associated factors of dissatisfaction with intrapartum care by Jordanian women.

METHOD

A descriptive cross-sectional study was used. Participants (n = 320) who were 7 weeks post-partum were recruited from five maternal and child health centres in Irbid city in northern Jordan. Participants provided personal and obstetric information, and completed the Satisfaction with Childbirth Care Scale.

RESULTS

The majority of women (75.6%) were dissatisfied with their intrapartum care. Dissatisfaction was associated with the attendance of unknown and unwanted persons during childbirth, experiencing labour as more painful than expected, and perceptions of inadequate help from healthcare providers to manage pain during labour.

LIMITATIONS

Findings are limited to Jordanian women accessing public sector perinatal health services.

CONCLUSION

The high percentage of women reporting dissatisfaction with intrapartum care in this study is of concern. Women's perception of pain and expectations of staff during labour and birth need to be addressed through education and improved communication by staff.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Development of national evidence-based policies and quality assurance systems would help reduce the rate of obstetric interventions and give greater emphasis to respect for women's preferences during labour and birth.

Factors in patient dissatisfaction and refusal regarding spinal anesthesia

BACKGROUND

Spinal anesthesia is the most common regional anesthesia conducted for many surgical procedures. Multiple factors can affect the success, the side effects, and patient satisfaction with the procedure. This study was undertaken prospectively to discover factors affecting dissatisfaction and refusal of spinal anesthesia.

METHODS

Starting in December 2007, patients who underwent spinal anesthesia in the operating rooms of our hospital were surveyed over a period of a year. Before attempting the procedure, patient characteristics and previous history of anesthesia were recorded. Spinal anesthesia was administered with 0.5% heavy bupivacaine combined with fentanyl 0-20 µg. Intraoperative data and postoperative data on the day after surgery were collected. The patients were also asked about their general satisfaction with spinal anesthesia, causes of dissatisfaction with the procedure, and causes of their refusal to have spinal anesthesia again.

RESULTS

Six patients among 1,197 cases were excluded from the study because of spinal anesthesia failure. The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%, and its risk factors were postoperative backache and dissatisfaction.

CONCLUSIONS

Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.

Structural equation model to predict subjective quality of life: a comparison of scales with different numerical anchoring

OBJECTIVE

The main aim of the current survey was to evaluate a hypothesized model on subjective quality of life (SQOL), and to survey the role of scale anchoring on satisfaction and dissatisfaction ratings.

METHOD

The sample consisted of 456 volunteering students who were randomly assigned in to two different conditions, and rated their current overall life (dis)satisfaction and their (dis)satisfaction on six different domains of life. Each condition used one of the two rating scale formats; the formats differed in anchoring (-5 to +5 and 0 to 10). In order to find how the six different domains of life combine to produce an overall measure of subjective quality of life, a SQOL model was designed; and the strength of this hypothesized model of SQOL was examined using structural equation modeling.

RESULTS

The results of testing for multiple group invariance of the hypothesized model indicated a cross-validity for the studied model for measuring SQOL. Our results also indicated that comparing the two different response formats, only for scores derived from Horizontal (0 to 10) response format, all the paths in the model were found to be significant.

CONCLUSION

The results of the confirmatory factor analysis (CFA) support the conclusion that the proposed model of SQOL fit the data well, and is able to predict SQOL.