'Physio's not going to repair a torn tendon': patient decision-making related to surgery for rotator cuff related shoulder pain

BACKGROUND

Rotator cuff related shoulder pain (RCRSP) is a common and disabling shoulder condition and surgical management is becoming more common. The rates and costs of surgical interventions have been on the rise. Understanding decision-making related to surgery and providing adequate information to people with RCRSP may improve patient-centred care and potentially reduce rates of surgery.

OBJECTIVES

To explore the decision-making processors of people who have undertaken surgery for RCRSP.

DESIGN

An in-depth thematic analysis.

METHOD

Interviews were conducted with patients from Melbourne who had had surgical management for RCRSP. Data were analysed using an inductive thematic approach.

RESULTS

Fifteen participants were recruited. Six key themes emerged: (1) Needing to get it done: "It was necessary to remedy the dire situation"; (2) Non-surgical treatment experience:" I knew that I'd done all I could"; (3) Mechanical problem:" Physio's not going to repair a torn tendon"; (4) Trust in medical professionals "If they told me that I needed to swallow a thousand spiders, I would have done it."; (5) Varied information sources "Dr Google played a big part in it"; (6) Organisational barriers "It was absolutely useless, my insurance."

CONCLUSION

Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment. While there was strong trust in highly trained surgeons, decision to undergo surgery also drew on questionable pathoanatomical beliefs and instances of inadequate patient information about treatment choices and risks that may be addressed by adopting a more patient-centred care approach.IMPLICATIONS FOR REHABILITATIONUnderstanding decision-making related to surgery and providing adequate information to people with rotator cuff related shoulder pain may improve patient-centred care.Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment.Decision to undergo surgery sometimes drew on questionable pathoanatomical beliefs.There was strong trust in highly trained surgeons but there were instances of inadequate patient information about treatment choices and risks.

Conceptual development of an information systems framework for improving continuity in epidemiological research

Lack of continuity is a problem for survey-based epidemiological research. Poor access to experience and inadequate retention of information means new projects seldom build on successful predecessors to the maximum possible extent. We have designed a data management framework which addresses this problem using a well-known information systems approach. Our ideas provide a means of storing data in a manner which reflects the original research concepts. This makes collected data accessible and understandable without reference to the questionnaire, and allows new questionnaires to be designed quickly and easily. Our framework provides a means for recording developmental, conceptual and other supporting information and documentation which is traditionally poorly conserved. We illustrate the components of the framework using a major Australian epidemiological project as a case study. Once the necessary software is developed, our framework will improve organisational memory within individual research units and has the potential to become a valuable support tool for survey-based research.

Management of congenital atresia of the external auditory canal

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Frontal basilar trauma: classification and treatment

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Combination of unilateral polydactyly, syndactyly, and clinodactyly with occipitocervical encephalocele and vertebral fusion

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The deep inferior epigastric rectus abdominis muscle and myocutaneous free tissue transfer: further applications for head and neck reconstruction

The rectus abdominis muscle and myocutaneous free tissue transfer is a well-recognized donor site for reconstruction of complex head and neck defects. Four composite deformities were successfully managed using this donor site. The rectus abdominis myocutaneous "sandwich" flap was used for closure of a pharyngocutaneous fistula and to provide intraoral lining and external coverage for a composite mandibular defect. The rectus muscle flap was used to obliterate a compound frontal sinus injury and an orbitomaxillary defect. All flaps were based on the deep inferior epigastric vascular pedicle.

Advancement-onlay: an improved technique of fronto-orbital remodeling in craniosynostosis

Eighteen patients with nonsyndromic craniosynostosis underwent fronto-orbital remodeling with an advancement-onlay technique. The mean age of the infants was 5 months (range = 2-11 months) when the procedure was performed for the following indications: unilateral coronal synostosis (n = 10); bilateral coronal synostosis (n = 3); metopic synostosis (n = 2); and multiple craniosynostoses (n = 3). The technique consists of (1) unilateral or bifrontal craniotomy, (2) superior orbital rim recontouring and advancement, and (3) frontal bone graft rotation and onlay. Posteriorly, the frontal bone graft is left "floating," while anteriorly, rigid fixation with microplates and screws has supplanted wire osteosynthesis. The use of rigid fixation prevents uncontrolled "float" of the forehead and eliminates the need for temporal struts. Follow-up time ranged from 6 to 60 months (mean = 2.6 years). There were no serious postoperative complications. Surgical results were good to excellent in 94% of cases and poor to fair in 6%. Only 1 patient with a Kleeblattschädel deformity required major revision, while another patient with trigonocephaly underwent a minor, extracranial recontouring procedure. Supraorbital rim and/or forehead recession suggestive of relapse or initial inadequacy of anterior projection occurred in 3 patients (17%). Residual, mild contour abnormalities of the forehead and/or temporal regions were found in 5 cases. To date, no gross disturbances in craniofacial growth related to our method of rigid fixation have been observed and no clinically detectable resynostosis has occurred.

Laryngeal modeling: theoretical, in vitro, in vivo

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Kawasaki disease in adults. An otolaryngologist's perspective

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The nerve-muscle pedicle. A visual, electromyographic, and histochemical study

The nerve-muscle pedicle was studied in dogs using visual, electromyographic, and histochemical means. All methods failed to show evidence of reinnervation. It would appear that the nerve-muscle pedicle operative procedure causes fibrosis and lateral displacement of the vocal cord with a subsequent improvement in the airway. It thus functions as a minimal arytenoidopexy.