Imaging Aspects of the Mandibular Incisive Canal: A PROSPERO-Registered Systematic Review and Meta-Analysis of Cone Beam Computed Tomography Studies

PURPOSE

This study aimed to perform a systematic review and meta-analysis of the literature on the mandibular incisive canal (MIC) studies using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

A PROSPERO-registered systematic review (#42017056619) was conducted following the PRISMA statements to summarize current knowledge on the CBCT aspects of the MIC. A search was performed in PubMed's Medline and Scopus databases, without date or language restrictions, using the algorithm {[(Interforaminal region) OR (mandibular incisive channel) OR (mandibular incisive nerve) OR (mental mandible) OR (anterior mandible) (cone beam computed tomography). Also, the references were crosschecked. The Meta-Analysis of Statistics Assessment and Review Instrument and meta-analysis was used to evaluate the selected studies.

RESULTS

A total of 410 articles were found, and 25 studies were selected after a two-step selection process. The CBCT systems differed regarding field of view (FOV) (large, n = 3; medium, n = 2; small, n = 4; not informed, n = 16) and voxel size (0.15 to 0.4 mm). Geographically, the studies were distributed across four continents (South America, North America, Asia, and Europe), and there was a statistical significance of studies from the American and Asian continents (P < .0001). From 3,421 CBCT exams, the number of female patients was slightly higher than male, and the mean age ranged from 29.8 to 59.1 years. The overall mean prevalence of MIC was 89.6% ± 15.08%, and bilateral occurrence was statistically significant (P < .0001). The studies using a voxel size lower than 0.3 mm showed the highest mean prevalence (93.88%) in comparison with voxel size described as ≥ 0.3 mm (89.33%). Diameter (0.45 to 4.12 mm) and length (6.6 to 40.3 mm) showed great variability among the included studies.

CONCLUSION

In summary, the results of this systematic review evidenced a high worldwide prevalence of MIC. There was no prevalence of MIC in relation to sex, and its presence was mainly related to adults between the fourth and sixth decades of life. In addition, great heterogeneity of methodologies was observed.

Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes

BACKGROUND

Up to 15% of children with permanent hearing loss (HL) have auditory neuropathy spectrum disorder (ANSD), which involves normal outer hair cell function and disordered afferent neural activity in the auditory nerve or brainstem. Given the varying presentations of ANSD in children, there is a need for more evidence-based research on appropriate clinical interventions for this population.

PURPOSE

This study compared the speech production, speech perception, and language outcomes of children with ANSD, who are hard of hearing, to children with similar degrees of mild-to-moderately severe sensorineural hearing loss (SNHL), all of whom were fitted with bilateral hearing aids (HAs) based on the American Academy of Audiology pediatric amplification guidelines.

RESEARCH DESIGN

Speech perception and communication outcomes data were gathered in a prospective accelerated longitudinal design, with entry into the study between six mo and seven yr of age. Three sites were involved in participant recruitment: Boys Town National Research Hospital, the University of North Carolina at Chapel Hill, and the University of Iowa.

STUDY SAMPLE

The sample consisted of 12 children with ANSD and 22 children with SNHL. The groups were matched based on better-ear pure-tone average, better-ear aided speech intelligibility index, gender, maternal education level, and newborn hearing screening result (i.e., pass or refer).

DATA COLLECTION AND ANALYSIS

Children and their families participated in an initial baseline visit, followed by visits twice a year for children <2 yr of age and once a yr for children >2 yr of age. Paired-sample t-tests were used to compare children with ANSD to children with SNHL.

RESULTS

Paired t-tests indicated no significant differences between the ANSD and SNHL groups on language and articulation measures. Children with ANSD displayed functional speech perception skills in quiet. Although the number of participants was too small to conduct statistical analyses for speech perception testing, there appeared to be a trend in which the ANSD group performed more poorly in background noise with HAs, compared to the SNHL group.

CONCLUSIONS

The American Academy of Audiology Pediatric Amplification Guidelines recommend that children with ANSD receive an HA trial if their behavioral thresholds are sufficiently high enough to impede speech perception at conversational levels. For children with ANSD in the mild-to-severe HL range, the current results support this recommendation, as children with ANSD can achieve functional outcomes similar to peers with SNHL.

Clinical significance of superior articular process as a reference point for free-hand pedicle screw insertion in thoracic spine

The trajectory of the pedicle screw perpendicular to the SAP (superior articular process) is consistent with the universal trajectory presented in the previous study of the entry point using computed tomography. The ideal entry point and trajectory of pedicle screw insertion have been a matter of considerable debate. We attempted to find the relationship between SAP and entry point and trajectory of the pedicle screw.Thoracic spine CT (computed tomography) scans of 9 volunteers were studied. A safe zone for the trajectory of the screw in the axial (MarginAx) and sagittal (MarginSag) was defined as the zone between lines perpendicular to the SAP along the medial and lateral cortex of the pedicle in the axial section, and the superior and inferior cortex in the sagittal section without violation of the pedicle walls. The midline of MarginAx and MarginSag was defined as the safe entry point of the trajectory in the axial and sagittal planes (TrajectoryAx and TrajectorySag), respectively.MarginAx and MarginSag were 4.14 ± 0.99 and 9.03 ± 2.01 mm, respectively. There was a statistically significant difference in TrajectoryAx between the upper and middle, and between the upper and lower (P = .0076 in both cases), but not between the middle and lower thoracic spine (P = .066). TrajectorySag was within 1 mm at the levels of T4, T8, T11 vertebrae and at 0 mm at the other levels. Thus, the midpoint of MarginSag was within 1 mm from the SAP base.There was a constant angular relationship with the SAP and the pedicle axis; the line perpendicular to the SAP can act as a trajectory. Therefore, we suggest that the SAP might be the only accurate and safe reference for pedicle screw insertion in the thoracic spine perpendicular to the SAP using freehand technique.

The Effect of Alignment Changes on Unilateral Transtibial Amputee's Gait: A Systematic Review

Introduction

Prosthetic alignment, positioning of a prosthetic foot relative to a socket, is an iterative process in which an amputee’s gait is optimized through repetitive optical gait observation and induction of alignment adjustments when deviations are detected in spatiotemporal and kinematic gait parameters. An important limitation of the current prosthetic alignment approach is the subjectivity and the lack of standardized quantifiable baseline values. The purpose of this systematic review is to investigate if an optimal alignment criterion can be derived from published articles. Moreover, we investigated the effect of alignment changes on spatiotemporal, kinematic and kinetic gait parameters.

Results

A total of 11 studies were included, two controlled before-and-after studies and nine-interrupted time series studies.

Discussion

The results demonstrate that alignment changes have a predictable influence on the included kinetic parameters. However, the effect of alignment changes on spatio-temporal and kinematic gait parameters are generally unpredictable. These findings suggest that it is imperative to include kinetics in the process of dynamic prosthetic alignment. Partially this can be established by communication with the prosthetic user in terms of perceived socket comfort, but the use of measurement tools should also be considered. While current literature is not conclusive about an optimal alignment, future alignment research should focus on alignment optimisation based on kinetic outcomes.

[Practical tips and tricks in fitting soft contact lenses]

This review is intended to give supportive information for beginners in contact lens fitting who are interested in providing a quality-related service to customers and patients. In Germany the proportion of contact lens wearers is significantly lower than in most other countries; therefore, there is a potentially fast growing market. The aim of this paper is to provide comprehensive guidelines for practitioners to develop and improve contact lens fitting practice and minimize unnecessary or preventable complications. The fundamental requirement for starting in contact lens fitting is to have correct education in the field and for the practice to be appropriately equipped. The key to providing a safe a reliable contact lens fitting practice is to continually update knowledge in the field and to maintain the practice to the highest professional standards.

Manufacturer-provided effective orifice area index charts and the prevention of prosthesis-patient mismatch

Prosthesis-patient mismatch (PPM) occurs when an implanted prosthesis is too small relative to the patient's body surface area (BSA). However, mismatch can often be prevented by indexing the expected effective orifice area (EOA) of a prosthesis to the patient's BSA and then selecting the largest implantable prosthesis to avoid mismatch. Previously, prosthesis manufacturers have attempted to simplify this process by providing charts that include the expected EOA for their prosthesis, already indexed into an array of BSA values. One caveat with these charts is that the expected EOA data must truly be reliable, or the charts will misguide the implanting surgeon. Manufacturer-provided charts could be improved by standardizing the EOA data, with one potential source being the hemodynamic data submitted to the United States Food and Drug Administration. This review discusses PPM, manufacturer-provided EOA charts, and the regulation of EOA data.

[Study of benefit and of acclimatization in recent users of hearing aids]

BACKGROUND

benefit and acclimatization.

AIM

to characterize the short-term benefits presented by adults, recent users of hearing aids, through objective (functional gain) and subjective (self-evaluation questionnaires) procedures. The possible occurrence of the phenomenon of acclimatization was also investigated based on the analysis of the speech recognition percent index (SRPI) before the fitting of the hearing aids and after four and 16/18 weeks of hearing aids use.

METHOD

sixteen subjects, with ages between 17 and 89 years, with symmetric moderate or severe sensorineural hearing loss, recent hearing aid users, were evaluated. The study was divided in three phases: before the hearing aids fitting, and after four and 16/18 weeks following the fitting process. In all of the phases the following procedures were used: pure tone audiometry, speech recognition percent index, speech recognition threshold and the Hearing Handicap Inventory for Elderly Screening Version or the Hearing Handicap Inventory for the Adults Screening Version, and the Abbreviated Profile of Hearing Aid Benefit. After the hearing aid fitting process, subjects were submitted to free field audiometry.

RESULTS

results showed statistically significant differences between objective and subjective measures after the use of hearing aids, indicating short-term benefit. However, as time went by, the benefit obtained with the use of hearing aids did not improve significantly, suggesting that benefit does not increase with time. SRPI as well as subjective measures improved with long-term hearing aid use, but such differences were not statistically significant.

CONCLUSIONS

short-term benefits were obtained with the use of hearing aids, however the phenomenon of acclimatization was not observed through the SRPI.

The application of a computerised videokeratography (CVK) based contact lens fitting software programme on irregularly shaped corneal surfaces

PURPOSE

To explore the success of the application of a computerised videokeratography (CVK) software system for the fitting of rigid gas permeable (RGP) contact lenses (CLs) on irregular corneal surfaces and compare it to the standard diagnostic fitting procedure.

METHODS

This was a comparative prospective study, over a 1-year period (2004-2005). It included 41 RGP CL wearers (68 eyes) with irregular corneal surfaces. Of these, 51 (75%) had keratoconus, 7 (10%) corneal scarring (infectious or traumatic), 6 (6.82%) corneal transplants, 2 (2.9%) astigmatism, and 2 (2.9%) aphakia. Each eye was being re-fitted with a new RGP CL based on a topographical measurement in conjunction with a CL fitting software programme. The performance of the CLs was evaluated regarding visual outcome, fitting characteristics, and efficiency of the fitting procedure.

RESULTS

Of the 68 eyes, 53 (77.94%) chose the CL fitted using the CVK software system, 9 (13.24%) chose the CL fitted using the standard procedure, and 6 (8.82%) showed no preference for either CL. There was a statistically significant improvement regarding visual outcome [contrast sensitivity at the spatial frequencies of 0.66 (p=0.029), 3.40 (p=0.008), and 17 (p=0.032), subjective vision (p=0.009)], fitting characteristics [grading scale (p=0.00), lens comfort (p=0.00) and daily wearing time (p=0.002)], and efficiency [number of trial lenses required (p=0.00)] with the CL fitted using the CVK software system. Correlating factors for the likely preference for the CL fitted using the CVK software system were subjective vision (p=0.004), lens comfort (p=0.009), and convenience of the fitting procedure (p=0.023).

CONCLUSION

The application of a CVK software system for the fitting procedure of RGP CLs on irregular corneal surfaces was a safe procedure and shown to be more successful and efficient than the standard diagnostic fitting method.

Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: which is the best method?

BACKGROUND

To predict the occurrence of valve prosthesis-patient mismatch (VP-PM) after aortic valve replacement (AVR), the surgeon needs to estimate the postoperative effective orifice area index (EOAI).

AIM

To compare different methods of predicting VP-PM.

METHODS

The effective orifice area (EOA) of 383 patients who had undergone AVR between July 2000 and January 2005 with various aortic valve prostheses was obtained echocardiographically 6 months after the operation. We tested the efficacy of (1) EOAI calculated from the echo data obtained in our own laboratory, (2) indexed geometric orifice area, (3) EOAI estimated from charts provided by prosthesis manufacturers (which are based either on in vitro or on echo data) and (4) EOAI estimated from reference echo data published in the literature to predict VP-PM.

RESULTS

Sensitivity and specificity to predict VP-PM were 53% and 83% (method 1), 80% and 53% (charts based on echo data, parts of method 3) and 71% and 67% (method 4) using reference data derived from echocardiographic examinations. The sensitivity of method 2 and of charts based on in vitro data (parts of method 3) to predict VP-PM was 0-17%. The incidence of severe VP-PM could be reduced from 8.7% to 0.8% after the introduction of the systematic estimation of the EOAI at the time of operation (p = 0.003, method 1).

CONCLUSIONS

The best method of predicting VP-PM is the use of mean (SD) EOAs derived from echocardiographic examinations, whereas the use of in vitro data or the geometric orifice area is unreliable. After the surgeon's anticipation of VP-PM prior to AVR, the incidence of VP-PM could be reduced.

Effects of applied contact force and volume control setting on output force levels of the BAHA Softband

The BAHA Softband has been developed to provide a transcutaneous anchor for a BAHA until a child is a surgical candidate for the percutaneous BAHA implant. We tested the objective output force level of the BAHA Classic 300 and Compact connected to a Softband on an artificial mastoid to determine: (1) the effects of direct contact force on output force levels (dB); and (2) the required volume control setting to ensure audibility of speech (assuming an average adult reference equivalent threshold force level). Direct contact force was varied from 2 to 5 N in 1 N steps. Output force level increased with increasing contact force. However, the average increase was 3 dB or lower, suggesting that the contact force is of minor importance. Volume control setting appears to be of much greater importance. It is suggested that the volume setting of either device be set to at least 2.5 to ensure audibility of conversational speech. Data from normal-hearing adults with simulated conductive hearing losses are presented to validate this conclusion.

Toward identifying specification requirements for digital bone-anchored prosthesis design incorporating substructure fabrication: a pilot study

PURPOSE

This paper is the first in a series that aims to identify the specification requirements for advanced digital technologies that may be used to design and fabricate complex, soft tissue facial prostheses.

MATERIALS AND METHODS

Following a review of previously reported techniques, appropriate and currently available technologies were selected and applied in a pilot study. This study uses a range of optical surface scanning, computerized tomography, computer-aided design, and rapid prototyping technologies to capture, design, and fabricate a bone-anchored auricular prosthesis, including the retentive components. The techniques are assessed in terms of their effectiveness, and the results are used to identify future research and specification requirements to direct developments.

RESULTS

The case study identifies that while digital technologies may be used to design implant-retained facial prostheses, many limitations need to be addressed to make the techniques clinically viable. It also identifies the need to develop a more robust specification that covers areas such as resolution, accuracy, materials, and design, against which potential technologies may be assessed.

CONCLUSION

There is a need to develop a specification against which potential technologies may be assessed for their suitability in soft tissue facial prosthetics. The specification will be developed using further experimental research studies.

The real impact of randomized clinical trials in heart valve surgery

PURPOSE OF REVIEW

The aim of this article is to evaluate the findings of clinical trials in cardiac valve surgery and to determine the real impact in standard of care. Also, publications on randomized clinical trials were reviewed as to integrity and validity. Nineteen randomized clinical trials were identified in 11 areas of operative and clinical management.

RECENT DEVELOPMENTS

The Veterans Affairs and Edinburgh Heart Valve Trials confirmed the guidelines for indications for bioprostheses and mechanical prostheses. Even current prostheses have advanced technologies but the same valve-related complications determine indications. Randomized clinical trials of mechanical prostheses failed to determine prosthesis superiority. Bioprostheses of specific manufacturers contribute sub-optimal hemodynamics in small sizes. Two trials showed lack of superiority between aortic stented and stentless bioprostheses. Autografts, not allografts, are indicated for children because of structural valve deterioration of allografts. Atrial ablation surgery with concomitant mitral valve reconstruction/replacement is safe and efficacious with at least two energy sources. Minimally invasive aortic valve replacement does not provide superior results to conventional surgery. Patient-managed anticoagulation provides the most favourable thromboembolic and hemorrhagic rates with mechanical prostheses. Prosthesis sewing cuff impregnation with a bactericidal agent to reduce the incidence of prosthetic valve endocarditis was stopped because of increased incidence of major paravalvular leak requiring reoperation.

SUMMARY

Randomized clinical trials, although limited in number, have provided advancement of the standard of care. Randomized clinical trials are indicated in the management of mild to moderate ischemic mitral regurgitation and evaluation of new transcatheter technologies to conventional surgery.

[The task of the HNO specialist by Hearing Aid fitting. Part 1: indications, special diagnostic tests, prescription]

The first part of the article deals with the indication of fitting, which mainly is given when the communication is impaired, not only in dialogue with one person, but also in conversation with several persons and in noisy surrounding. Yet, the healthy insurances cover only the expenses if the guidelines on relief-aid are considered, which are exactly listed in this article. Bevor starting the fitting of an Hearing Aid, special diagnostic tests are necessary, such as pure tone audiogram, speech audiogram including dB(opt), freefield measurement in noise, and several retrocochlear tests, as well as tinnitus determination and masking with narrow-band and broad-band noise. Most important is the correct filling in the form "Ohrenärztliche Verordnung einer Hörhilfe", including the necessity of renewal. In addition, it is necessary to accentuate the need of trying out several Hearing Aids and to let the patient know that digital Hearing Aids will not be covered by the health insurance.

An in-vitro investigation of the accuracy of fit of Procera and Empress crowns

The current study aimed to investigate the accuracy of fit and the reproducibility of inner crown profile for two types of high strength ceramics, IPS Empress and Procera. Procera and Empress crowns with four different morphologies were cemented to dies using zinc phosphate dental cement. Vertical and horizontal sections were made through each of the crown/die preparations and images of the vertical sections were compared for curvature reproduction by alignment using image processing. Measurements were made on horizontal sections to determine cement layer thickness. Alignment of the crowns using image analysis identified quantifiable variations in the inner surface profile compared with the outer surface of the die. The largest differences occurred from the cusp tips to the occlusal adaptation area and differences in surface profile were less pronounced for Procera than Empress crowns. Marginal gap varied independently of ceramic or internal crown shape from 7-529 microm for Procera and 26-548 microm for Empress. IPS Empress has a superior ability to reproduce the inner surface profile of the crown morphologies investigated compared with Procera. The reduced reproduction of surface profile was associated with an increased cement thickness at the occlusal contact area that may inadvertently lead to failure of the crowns functional characteristics.

[Check of hearing aid fitting]

A qualified hearing aid fitting is only possible if the ENT doctor not only prescribes the device, but also conscientiously checks the comparative adjustments made by the hearing aid acoustician. In deciding, which of the tested hearing aids achieves the best and most appropriate improvement of hearing, the physician should first thoroughly study the acoustician's fitting protocol, which contains comparative results of all devices tested. The subjective satisfaction of the patient with his hearing aid can be determined in a detailed conversation or with a special questionnaire. The examination of the otoplastic is as necessary as the improvement of speech discrimination under free field conditions, especially with additional noise. With in situ measurement, the individual transmission characteristics of the hearing aid and the otoplastic are tested in a few minutes. Conscientious control of the fitted hearing aid is only possible with loudness scaling. The scaling function shows clearly whether the fitted aid has adequate amplification, is not too loudly adjusted, and whether the field of pleasant hearing has been considered.

A picture of amputees and the prosthetic situation in Haiti

PURPOSE

The purpose of this study is to present the situation of Haitian amputees and to outline some of the major barriers in Haiti that prevent people from receiving prosthetic treatment.

METHOD

Interviews were conducted with amputees throughout Haiti using a 42-question questionnaire. Additionally, interviews were conducted with traditional healers, health care workers, and leaders of handicap associations. Each interview was manuscripted and the data were subsequently coded and analysed in the USA.

RESULTS

There are three full-time prosthetic shops and two part-time prosthetic shops in Haiti, all of which are severely limited in the scope of services they are able to provide amputees due to insufficient supplies and inadequately trained personnel. Only 25% of the 164 amputees interviewed had ever had a prosthetic limb. Typically prosthetic treatment is inaccessible and unaffordable for amputees, which prevents many from seeking treatment. The most common cause of amputation in Haiti is infection, followed by motor vehicle accidents.

CONCLUSION

There must be additional cooperation between Haitian patients, doctors, traditional healers, prosthetists, and government officials in order to provide more adequate prosthetic care. Prosthetic treatment in Haiti can be successful with cooperation of different entities, proper rehabilitation therapy, adequately trained personnel, and development of culturally appropriate limbs.

A self-report outcome measure for the evaluation of hearing aid fittings and services

OBJECTIVE

To design, optimise and validate an outcome measure for the evaluation of adult hearing aid fittings.

DESIGN

A multi-dimensional subject-specific and situation-specific questionnaire (the Glasgow Hearing Aid Benefit Profile--GHABP) to assess initial disability, handicap, use, benefit, residual disability and satisfaction before and after hearing aid provision.

SUBJECTS

Hearing-impaired adults attending National Health Service clinics for the first time for whom amplification is an appropriate management option.

RESULTS

A self-report instrument of length compatible with the requirements of routine clinical practice which retains psychometric leverage. The GHABP demonstrates sensitivity to the technological content and rehabilitative context of interventions. The scale properties facilitate the use of the GHABP in decision-making for individual hearing-impaired patients.

CONCLUSION

An outcome measure such as the GHABP offers the various interested parties (purchasers, providers and patients) a tool for use in the evaluation of the effectiveness and cost effectiveness of existing services and future developments. Many of the design concepts embodied in the GHABP are applicable in other healthcare contexts.

Standardized rigid contact lens fitting protocol for keratoconus

Keratoconus is typically managed by a variety of rigid contact lens fitting techniques and lens designs. The two most fundamental fitting techniques are apical corneal touch (including divided or three-point touch) and apical clearance. In the course of designing a multi-center study of keratoconus patients, a standardized keratoconus fitting protocol was developed. All contact lens parameter options are uniform except for base curve and secondary curve radii, which are determined by interpretation of fluorescein patterns using the CLEK Study trial lens set and protocol. The initial trial lens's base curve is the average keratometric reading; sequentially steeper lenses are applied until definite apical clearance is observed. We have evaluated the feasibility of this standardized fitting protocol on 30 keratoconus patients. Our results suggest that we have developed a standardized contact lens fitting set and fitting protocol to simplify contact lens management in patients with mild to moderate keratoconus.

Micromotion, fit, and fill of custom made femoral stems designed with an automated process

This study presents an automated process for the design of custom made femoral stems. Two software programs have been developed to obtain the inner bone contours from computed tomography scan images and to design the optimal stem that can be inserted into the femur. This process requires only 2 hours of computer use, therefore reducing the price of the stem. It is also possible to control the amount of bone sacrifice necessary to facilitate the insertion of the stem. Micromotion for 6 specimens was measured using a special machine simulating the load supported by the hip joint during single-limb stance. Three prostheses were tested successively: anatomic cementless stem, custom made stem, and modified custom made stem in which the distal part was thinned out. To be stabilized, the anatomic prosthesis required a greater number of cycles than custom made stems associated with a more important total vertical migration. The micromotion of custom made prostheses was significantly less than that of the other prostheses. The fill of custom made stems also was measured, having a range from 93% to 100% (mean, 97.5%-98.8%) of the medullary canal. The metaphyseal fill was significantly linked with the vertical and rotational components of instability. These results showed that it was possible, using a computerized automated and controlled process, to obtain low price femoral stems well fitted to the medullary canal that provide an excellent primary stability.

Axial wall convergence of full veneer crown preparations. Documented for dental students and general practitioners

The convergence angle in 478 full crown preparations was assessed. Of these preparations, 351 had been performed by general practitioners and 127 by dental students. Groups of preparations performed on incisors, premolars, and molars were compared, as were preparations performed by dentists and students. Two different convergence angles were measured for each tooth, buccolingually and mesiodistally. The results showed a mean angle of 21 degrees. The mean values for premolars and molars differed significantly. When a comparison was made of preparations performed by students, a significant difference was found between premolars and molars. The same comparison for general practitioners showed a significant difference both for incisors compared with molars and for premolars compared with molars. A wide range was found for the convergence of the axial walls, especially for the preparations performed by general practitioners.

Patient satisfaction: an indicator of quality in disablement services centres

OBJECTIVES

To develop a patient satisfaction system for disablement services centres and to report on how the initial findings have been used in audit to improve their quality of care and services.

DESIGN

Interview survey of randomly selected users attending in three centres: Birmingham (centre X), Oxford (centre Y), and Cambridge (centre Z) to establish core topics for developing a patient satisfaction questionnaire with incorporation into a computer patient satisfaction system (PATSAT) to enable collation of responses to the questionnaire. A pilot of the questionnaire was undertaken in the centres to assess the sensitivity of the questionnaire, which was subsequently used as part of clinical audit process during June 1991 and April 1992 in centre X and the patient satisfaction system used to monitor changes in routine practice.

PATIENTS

123 amputees in the development phase, selected by cluster sampling, and 1103 amputees in the pilot study.

MAIN MEASURES

Satisfaction scores for components of the service.

RESULTS

The questionnaire included 16 core topics contributing to quality of care and services, including comfort of limbs, appointments, interpersonal aspects of care, a system of support and counselling, and organisation. The pilot survey demonstrated high satisfaction scores for aspects of interpersonal care, organisation, and physical surroundings of the centres and lower satisfaction for counselling services, comfort of the limb and the number of alterations made before the limb was considered acceptable. During the audit in centre X these results prompted changes to care and services which produced significant improvements in satisfaction.

CONCLUSIONS

The early results suggest that the questionnaire, coupled with PATSAT software system, enable users' views to be expressed, collated, and fed back to staff; the information provided has already prompted change, and the system is sufficiently sensitive to measure changes in satisfaction with the service.