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Satisfaction Scores (satisfaction + score)
Kinds of Satisfaction Scores Selected AbstractsFate of the infrapatellar branch of the saphenous nerve post total knee arthroplastyANZ JOURNAL OF SURGERY, Issue 9 2005Dinshaw Mistry Background:, The infrapatellar branch of the saphenous nerve is a known cause of morbidity following knee surgery. The incidence of sensory changes following total knee arthroplasty, and its effect on patient satisfaction with arthroplasty surgery remain undocumented. Our aim was to document the incidence of infrapatellar nerve palsy following total knee arthroplasty and its effect on patient satisfaction. Methods:, Between 1 January 2002 and 31 December 2003 all patients attending outpatients clinic for primary total knee joint arthroplasty were prospectively tested for sensory defects. Patients were then assessed postoperatively and satisfaction was measured using the British Orthopaedic Satisfaction Score and a visual analogue scale. Results:, Thirty-one patients satisfied inclusion criteria of which 21 agreed to participate. One patient was excluded later in the study leaving 20 patients. Seventy per cent of patients had sensory changes in the area supplied by the infrapatellar branch of the saphenous nerve. Patient satisfaction scores did not correlate to the presence of a sensory deficit. Two patients stated that the sensory deficit was a significant factor in their dissatisfaction with their arthroplasty surgery. Conclusions:, Sensory changes due to damage to the infrapatellar branch of the saphenous nerve during total knee joint arthroplasty is a common occurrence and can interfere with patient satisfaction. Patients should be informed of this risk in the preoperative discussion. [source] The tension-free vaginal tape in older womenBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2004Emmanuel Karantanis Objective To evaluate peri-operative morbidity, continence outcome and patient satisfaction in older women (,65 years) compared with younger women undergoing tension-free vaginal tape. Design Case controlled study. Setting Tertiary Urogynaecology Unit. Sample Women undergoing tension-free vaginal tape for urodynamic stress incontinence between July 1999 and July 2002 were included. Those with detrusor overactivity, voiding difficulty at urodynamics or requiring concomitant prolapse surgery were excluded. Methods Older women were case matched to a younger cohort for BMI, parity, mode of anaesthesia and whether it was a primary or secondary continence procedure. Main outcome measures Operative morbidity and continence outcome were assessed at six weeks. After a minimum six months follow up, patient satisfaction and continence outcome were assessed using the Genitourinary Treatment Satisfaction Score (GUTSS). Results The median hospital stay was one day and overall urinary tract infection rate was similar in both groups. Post-operative voiding difficulty rates were 3% in older versus 15% in younger women (P= 0.09). At six weeks, 65% of older versus 79% of younger women were dry (P= 0.2). At a median of 12 months, 15 (45%) of older versus 24 (73%) of younger women had no urinary symptoms (P= 0.05). Median GUTSS scores for satisfaction with continence outcome were lower for older 90% compared with 100% in younger women (P= 0.003). Conclusions Tension-free vaginal tape is an effective continence intervention in older women but has a lower continence satisfaction rate compared with younger women. [source] Cancer patients' satisfaction with communication, information and quality of care in a UK regionEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2005R. DAVIDSON bsc, abps. consultant clinical psychologist , dphil., msc (clin. psych.) Effective patient,professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. This study identifies patient satisfaction with regard to various aspects of communication and perceived quality of care. A well-validated questionnaire was administered to 435 cancer patients throughout Northern Ireland during a 3-month period. Northern Ireland can be regarded as a typical UK region in terms of cancer service configuration. The cohort consisted of patients with breast, colorectal, lung, prostate, gynaecological and gastric cancers. There was a 78% response rate. Satisfaction scores were individually calculated for various aspects of care, particularly diagnosis, treatment, follow-up and overall care. Non-parametric analysis examined the interaction between satisfaction scores and primary tumour site, age and gender. While overall satisfaction scores were relatively high, there was considerable variation. Of particular note was the interaction between perceived satisfaction and quality of care, communication, tumour site and age. Key findings are that there are a number of issues with regard to information and communication which can be clearly improved within Northern Ireland cancer services. The paper concludes that patient,professional communication should be tailored to meet individual need. [source] Use of Patient and Hospital Variables in Interpreting Patient Satisfaction Data for Performance Improvement PurposesAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2004Elise E. Lessing PhD Satisfaction scores of 349 patients being discharged from a state psychiatric hospital were examined in relation to available norms for the instrument used and selected patient and hospital variables. Mean item scores fell within the less-than-satisfied category on both total and factor scores. Regression analyses indicated minimal effects of patient attributes. Two hospital factors (restraint rate on patient's unit and accessibility of psychosocial groups) significantly predicted satisfaction, with the former having an unexpected positive relationship to satisfaction. Clinicians were able to use the survey data to improve care, but patients' tendency toward undifferentiated positive or negative responding hindered the prioritizing of change efforts. [source] Medium-term outcome of fundoplication after lung transplantationDISEASES OF THE ESOPHAGUS, Issue 8 2009P. R. Burton SUMMARY Gastroesophageal reflux disease (GERD) in lung transplant recipients has gained increasing attention as a factor in allograft failure. There are few data on the impact of fundoplication on survival or lung function, and less on its effect on symptoms or quality of life. Patients undergoing fundoplication following lung transplantation from 1999 to 2005 were included in the study. Patient satisfaction, changes in GERD symptoms, and the presence of known side effects were assessed. The effect on lung function, body mass index, and rate of progression to the bronchiolitis obliterans syndrome (BOS) were recorded. Twenty-one patients (13 males), in whom reflux was confirmed on objective criteria, were included, with a mean age of 43 years (range 20,68). Time between transplantation and fundoplication was 768 days (range 145,1524). The indication for fundoplication was suspected microaspiration in 13 and symptoms of GERD in 8. There was one perioperative death, at day 17. There were three other late deaths. Fundoplication did not appear to affect progression to BOS stage 1, although it may have slowed progression to stage 2 and 3. Forced expiratory volume-1% predicted was 72.9 (20.9), 6 months prior to fundoplication and 70.4 (26.8), six months post-fundoplication, P= 0.33. Body mass index decreased significantly in the 6 months following fundoplication (23 kg/m2 vs. 21 kg/m2, P= 0.05). Patients were satisfied with the outcome of the fundoplication (mean satisfaction score 8.8 out of 10). Prevalence of GERD symptoms decreased significantly following surgery (11 of 14 vs. 4 of 17, P= 0.002). Fundoplication does not reverse any decline in lung function when performed at a late stage post-lung transplantation in patients with objectively confirmed GERD. It may, however, slow progression to the more advanced stages of BOS. Reflux symptoms are well controlled and patients are highly satisfied. Whether performing fundoplication early post-lung transplant in selected patients can prevent BOS and improve long-term outcomes requires formal evaluation. [source] Medical rhinoplasty with hyaluronic acid and botulinum toxin A: a very simple and quite effective techniqueJOURNAL OF COSMETIC DERMATOLOGY, Issue 3 2008Alessio Redaelli MD Summary Objective, The management of nasal deformities, and in particular those with "plunging" tip, has always been a typical area of interest in surgery. In the author's experience many of these problems can be successfully approached with a new medical technique, which consists of using only hyaluronic acid for the correction of nasal angles and botulinum toxin for patients with hyperactivity of the depressor septi nasi muscle. The present study aims to illustrate this new technique and evaluates safety and results. Materials and methods, Ninety-five patients were treated between January 2006 and July 2007. The average age of the patients was 42.7 years. In 45% of the cases, botulinum toxin was employed. In all of the cases, the treatment was conducted with hyaluronic acid (24 mg/mL), the same substance used for face rejuvenation. The amount varied from 0.6 to 1.4 mL. Results Results were evaluated using a definitive graduated score calculated by patient's and doctor's satisfaction score (range, 1,10) and by photographs' score at time 0, after 30 days, and after 180 days. It ranged from 8 to 10 (average of 9.1). No significant side effects were reported. Conclusion, The medical rhinoplasty for a "plunging" nose is a simple and very effective technique with immediate results. It can be used in those cases where patients are reluctant to undergo surgery, or as primary indication in the correction of minor nose defects. Results are satisfactory and no side effects have been reported so far. Results will last for a long time. [source] Feasibility and Acceptability of Providing Nurse Counsellor Genetics Clinics in Primary CareNURSING & HEALTH SCIENCES, Issue 2 2006Greta Westwood Increasing referrals to specialist genetics services have precipitated a review of models of service delivery in the United Kingdom. Little is known about whether a change in clinic location is feasible or acceptable for the patients seen. We consider the feasibility of genetics service development and delivery in primary care and develop a questionnaire to evaluate acceptability and cost to patients. Between July 2003 and May 2004, 64 primary care appointments with a genetics nurse counsellor were offered to patients referred and registered with selected general practices. 45 (79%) patients attended their appointment and 34 (77%) returned their follow-up questionnaire. Total mean satisfaction score was high and patients were most satisfied with the information and affective domains of the appointment. 48% of patients seen by the genetics nurse counselor remained in primary care. Patients were satisfied with the travel time and distance to clinic and patient clinic costs were limited. This study shows that patients do attend genetics nurse counselor clinics in primary care, and are satisfied with the new location. A large cluster randomized controlled trial is now being conducted to obtain a controlled comparison of acceptability to patients of attending clinics in primary vs. secondary care settings. [source] From rural beginnings to statewide roll-out: Evaluation of facilitator training for a group-based diabetes prevention programAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2010Clare Vaughan Abstract Objective:,To evaluate the approach used to train facilitators for a large-scale group-based diabetes prevention program developed from a rural implementation research project. Participants:,Orientation day was attended by 224 health professionals; 188 submitted the self-learning task; 175 achieved the satisfactory standard for the self-learning task and attended the workshop; 156 completed the pre- and post-training questionnaires. Main outcome measures:,Two pre- and post-training scales were developed to assess knowledge and confidence in group-based diabetes prevention program facilitation. Principal component analysis found four factors for measuring training effectiveness: knowledge of diabetes prevention, knowledge of group facilitation, confidence to facilitate a group to improve health literacy and confidence in diabetes prevention program facilitation. Self-learning task scores, training discontinuation rates and satisfaction scores were also assessed. Results:,There was significant improvement in all four knowledge and confidence factors from pre- to post-training (P < 0.001). The self-learning task mean test score was 88.7/100 (SD = 7.7), and mean assignment score was 72.8/100 (SD = 16.1). Satisfaction with training scores were positive and ,previous training' interacted with ,change in knowledge of diabetes prevention program facilitation' but not with change in ,confidence to facilitate.' Conclusions:,The training program was effective when analysed by change in facilitator knowledge and confidence and the positive mean satisfaction score. Learning task scores suggest tasks were manageable and the requirement contributed to facilitator self-selection. Improvement in confidence scores in facilitating a group-based diabetes prevention program, irrespective of previous training and experience, show that program-specific skill development activities are necessary in curriculum design. [source] Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care OrganizationBIRTH, Issue 1 2003Arden Handler DrPH ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source] Results from different patient populations using combined therapy with alprostadil and sildenafil: predictors of satisfactionBJU INTERNATIONAL, Issue 4 2000J.H. Mydlo Objective To evaluate the outcome of combined therapy (using intraurethral alprostadil and oral sildenafil) in private and clinic patients with erectile dysfunction, and thus assess predictors of satisfaction. Patients and methods In all, 360 men were treated for erectile dysfunction using single and/or combined therapy, comprising 214 private-practice and 166 clinic patients. Responses were evaluated using the International Index for Erectile Function (IIEF) questionnaire before and after treatment. Serum testosterone levels, education and socio-economic status were also assessed. Group 1a consisted of 33 private patients and Group 1b of 24 clinic patients who tried the maximum dose of intraurethral alprostadil monotherapy initially, followed by the maximum dose of sildenafil monotherapy, and remained dissatisfied. Group 2a consisted of 32 private patients and group 2b of 31 clinic patients who tried the maximum dose of sildenafil monotherapy initially, followed by the maximum dose of alprostadil monotherapy, and were also dissatisfied. These two groups of 65 private and 55 clinic patients then underwent combined therapy. Results The mean ( sd) score for erectile function was 24.1 (2) for combined therapy (a 123% improvement), and 19.8 (1.8) (83% improvement) and 15.2 (1.6) (41% improvement) for sildenafil and alprostadil monotherapies (P < 0.05 for both patient groups). The men also reported an improvement in their satisfaction with intercourse. However, at 18 months, 60 of the 65 private patients but only 40 of the 55 clinic patients continued with combined therapy; thus, the discontinuation rate was three times greater among clinic than among private patients. Furthermore, the private patients had an overall improvement in the satisfaction score of 128%, compared with 51% for the clinic patients. Conclusion Although there were no significant differences in erectile function improvement within the two satisfied combined therapy groups, the differences in overall satisfaction and long-term withdrawal rates suggests that other factors beside motivation must be involved for success, e.g. education, persistence, realistic expectations, and certain psychological factors. Combined therapy should be considered for those patients who have a suboptimal response to monotherapy and refuse or are not candidates for surgical options. Generally, those patients with a higher education, greater persistence and more realistic expectations were more satisfied with combined therapy. [source] Long-term outcomes of revisional surgery following laparoscopic fundoplicationBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2009P. J. Lamb Background: A small proportion of patients who have laparoscopic antireflux procedures require revisional surgery. This study investigated long-term clinical outcomes. Methods: Patients requiring late revisional surgery following laparoscopic fundoplication for gastro-oesophageal reflux were identified from a prospective database. Long-term outcomes were determined using a questionnaire evaluating symptom scores for heartburn, dysphagia and satisfaction. Results: The database search found 109 patients, including 98 (5·6 per cent) of 1751 patients who had primary surgery in the authors' unit. Indications for surgical revision were dysphagia (52 patients), recurrent reflux (36), mechanical symptoms related to paraoesophageal herniation (16) and atypical symptoms (five). The median time to revision was 26 months. Outcome data were available for 104 patients (median follow-up 66 months) and satisfaction data for 102, 88 of whom were highly satisfied (62·7 per cent) or satisfied (23·5 per cent) with the outcome. Patients who had revision for dysphagia had a higher incidence of poorly controlled heartburn (20 versus 2 per cent; P = 0·004), troublesome dysphagia (16 versus 6 per cent; P = 0·118) and a lower satisfaction score (P = 0·023) than those with recurrent reflux or paraoesophageal herniation. Conclusion: Revisional surgery following laparoscopic fundoplication can produce good long-term results, but revision for dysphagia has less satisfactory outcomes. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Patient-centered outcome of immediately loaded implants in the rehabilitation of fully edentulous jawsCLINICAL ORAL IMPLANTS RESEARCH, Issue 10 2009Melissa Dierens Abstract Introduction: Edentulism often involves functional, esthetic, phonetic and psychological problems. Objectives: To evaluate patient-centered outcomes of full-arch screw-retained rehabilitation on immediately loaded implants. Material and methods: Fifty patients treated with Astra TechÔ implants answered self-administered questionnaires on a visual analogue scale (VAS) 100 mm scale or with multiple-choice or open questions: at baseline, 1 week, 3 or 6 months and 1 year. Changes of VAS in time were analyzed using mixed models for repeated measures, adjusting for gender, age and jaw; comparison of cross-sectional parameters between jaws was performed with the Mann,Whitney U- or ,2 -test, all at the 0.05 significance level. Results: The median calculated general satisfaction score increased from 40.25 (mean=40.9; SD=23.82; range=0,95) at baseline to 98.25 (mean=95.3; SD=6.68; range=74,100) after 1 year. Overall comfort, eating comfort, speaking comfort and perceived esthetics improved significantly within 1 week after surgery and immediate provisionalization. This did not change significantly until the final bridge was installed after 3 months (mandible) or 6 months (maxilla), when a further significant improvement was demonstrated. The most common postoperative complication was swelling, especially in the maxilla. The importance of one-stage surgery and immediate loading was rated very high by patients before treatment, especially in the mandible. The main reason for choosing fixed prosthetics was eating comfort. Phonetics and esthetics were more important in the maxilla than in the mandible. Conclusion: Immediate full-arch rehabilitation yeilds an instant significant improvement in general patient satisfaction and self-perceived factors related to comfort, function and esthetics. Eating comfort is the main concern for the patient and shows the highest improvement. Postoperative complications are limited and patients considered immediate loading important. [source] Comparison of a Long-Pulse Nd:YAG Laser and a Combined 585/1,064-nm Laser for the Treatment of Acne Scars: A Randomized Split-Face Clinical StudyDERMATOLOGIC SURGERY, Issue 11 2009SEONG UK MIN MD BACKGROUND Nonablative laser is gaining popularity because of the low risk of complications, especially in patients with darker skin. OBJECTIVE To compare the efficacy and safety of a long-pulse neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and a combined 585/1,064-nm laser for the treatment of acne scars. MATERIALS AND METHODS Nineteen patients with mild to moderate atrophic acne scars received four long-pulse Nd:YAG laser or combined 585/1,064-nm laser treatment sessions at fortnightly intervals. Treatments were administered randomly in a split-face manner. RESULTS Acne scars showed mild to moderate improvement, with significant Echelle d'évaluation clinique des cicatrices d'acné (ECCA) score reductions, after both treatments. Although intermodality differences were not significant, combined 585/1,064-nm laser was more effective for deep boxcar scars. In patients with combined 585/1,064-nm laser-treated sides that improved more than long-pulse Nd:YAG laser-treated sides, ECCA scores were significantly lower for combined 585/1,064-nm laser treatment. Histologic evaluations revealed significantly greater collagen deposition, although there was no significant difference between the two modalities. Patient satisfaction scores concurred with physicians' evaluations. CONCLUSION Both lasers ameliorated acne scarring with minimal downtime. In light of this finding, optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response. [source] Cancer patients' satisfaction with communication, information and quality of care in a UK regionEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2005R. DAVIDSON bsc, abps. consultant clinical psychologist , dphil., msc (clin. psych.) Effective patient,professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. This study identifies patient satisfaction with regard to various aspects of communication and perceived quality of care. A well-validated questionnaire was administered to 435 cancer patients throughout Northern Ireland during a 3-month period. Northern Ireland can be regarded as a typical UK region in terms of cancer service configuration. The cohort consisted of patients with breast, colorectal, lung, prostate, gynaecological and gastric cancers. There was a 78% response rate. Satisfaction scores were individually calculated for various aspects of care, particularly diagnosis, treatment, follow-up and overall care. Non-parametric analysis examined the interaction between satisfaction scores and primary tumour site, age and gender. While overall satisfaction scores were relatively high, there was considerable variation. Of particular note was the interaction between perceived satisfaction and quality of care, communication, tumour site and age. Key findings are that there are a number of issues with regard to information and communication which can be clearly improved within Northern Ireland cancer services. The paper concludes that patient,professional communication should be tailored to meet individual need. [source] Maxillary obturators: The relationship between patient satisfaction and speech outcomeHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2003Jana M. Rieger PhD Abstract Background. Patient satisfaction with a maxillary obturator has been studied in relation to extent of surgical defect, sociodemographic characteristics, scores on mental health inventories, and psychosocial adjustment to illness scales. However, review of the literature reveals limited study of the relationship between patient satisfaction with an obturator and clinical speech outcome measures. The purpose of this study is to relate patient satisfaction scores obtained by questionnaire with those obtained by means of clinical speech measurements. Methods. Acoustical, aeromechanical, and perceptual measurements of speech were collected for 20 patients after receiving a definitive obturator. Patient satisfaction with their obturator was later measured with the Obturator Functioning Scale (OFS). Results. Results reveal that poorer aeromechanical speech results were associated with patient-reported avoidance of social events, whereas lower speech intelligibility outcomes were related to overall poorer perception of speech function on the OFS. Several background patient characteristics were significantly related to several responses on the OFS and to the aeromechanical assessment outcomes. Conclusions. Results from instrumental assessments of speech seem to be informative regarding not only speech outcome but also a patient's satisfaction with the obturator. Consideration of background patient characteristics is important when interpreting both clinically obtained and patient-perceived outcomes. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 000,000, 2003 [source] Girls with anorexia nervosa as young adults: Personality, self-esteem, and life satisfactionINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2006Inger Halvorsen MD Abstract Objective: The current study evaluated personality, self-esteem, and life satisfaction in former patients with different outcomes of childhood and adolescent-onset anorexia nervosa (AN). Methods: Forty-four female patients with AN were assessed 8.5 ± SD 3.4 years after treatment start with a clinical interview and questionnaires including the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale. Self-esteem and general life satisfaction in former patients were compared with women in a large population study. Results: Former AN patients with no eating disorder and normal eating attitudes at follow-up (n = 21 [48%]) had similar TCI profiles and self-esteem as samples from normal populations, whereas participants with poorer outcome had significantly lower TCI Self Directedness, self-esteem, and life satisfaction scores. Life satisfaction was reduced in all outcome groups and was strongly associated with self-esteem. Conclusion: Personality, self-esteem, and life satisfaction varied significantly between outcome groups. The results indicate that young patients with AN with a good outcome may have normal personality and self-esteem features in young adulthood. © 2006 by Wiley Periodicals, Inc., Int J Eat Disord, 2006 [source] Patient responses to an integrated service, initiated by community pharmacists, for the prevention of osteoporosisINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2008Dr. Judith A. Crockett project officer Objective This study aimed to develop, implement and evaluate an integrated service provided by pharmacists to consumers based on the results of a risk-assessment survey carried out by the pharmacist and testing of bone mineral density (BMD) by a radiographer. It also investigated whether measurement of BMD in the pharmacy increased the effectiveness of the service and pharmacist referral in terms of adherence to advice and uptake of referral compared with the same service offered without BMD testing. Setting Community pharmacists in urban and rural settings in New South Wales, Australia, delivered the service. Method The adherence to advice or referral given by 12 community pharmacists during 2003 to 217 participants about the prevention of osteoporosis following screening with either a BMD test plus risk-assessment questionnaire or a risk-assessment questionnaire only was compared. Key findings No significant between-group differences in adherence to advice or referral were found. However, participants valued the BMD service significantly more highly than the non-BMD service as measured by satisfaction scores. Conclusions Consumers were interested in receiving information about osteoporosis and their own risk of it and even greater interest in BMD testing in the pharmacy. There was no difference in uptake of referral or advice following either questionnaire only or questionnaire plus BMD testing. Low uptake of referral and advice overall by those deemed to be at high risk is of concern. Far greater education and encouragement for consumers to follow through is required. [source] Measuring job satisfaction of UK pharmacists: a pilot studyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2007Professor Karen Hassell chair in social pharmacy Objective To review the UK published literature on pharmacy job satisfaction, in order to describe and assess the strengths of their methods and the findings and to validate an existing instrument to measure work satisfaction, with a sample of locum pharmacists. Method A literature review of relevant databases was used to identify UK studies exploring any aspect of job, role, career or work satisfaction. A search of the grey literature was also undertaken. A satisfaction scale, the Warr-Cook-Wall scale, previously used with general practitioners (GPs), was adapted and administered to a sample of locum pharmacists (n = 175, response rate = 75%). Validity and reliability analyses were undertaken in SPSS v13. Key findings Three articles, two reports, one thesis abstract and one conference abstract were identified through the search. The findings of the review indicate that the way in which pharmacist satisfaction has been measured to date renders it difficult to determine historical trends or make cross-sectoral comparisons. A Cronbach alpha coefficient of 0.90 was obtained for the job satisfaction scale, indicating that the job satisfaction scale is a satisfactory and reliable tool for use with this group of pharmacists. In terms of substantive findings, these suggest that locum pharmacists in general derive high levels of job satisfaction and higher levels than those reported by GPs. Conclusion Limited evidence is available regarding pharmacists' job satisfaction in the UK. The review highlights the need for a universal, multifaceted measure of satisfaction. The findings of this study suggest that the Warr-Cook-Wall satisfaction scale has very high reliability and is suitable for use with pharmacists without any further amendments. Although the study suggests relatively high satisfaction scores in this group of pharmacists, it would be instructive to determine the applicability of the job satisfaction measure and to explore the satisfaction levels of pharmacists in a wide range of roles and sectors, to determine relative levels of satisfaction. [source] Evaluating Migrant Integration: Political Attitudes Across Generations in Europe,INTERNATIONAL MIGRATION REVIEW, Issue 1 2010Rahsaan Maxwell This article engages debates about migrant integration by analyzing political trust and satisfaction in 24 European countries. The evidence suggests that first-generation migrants have the most positive attitudes, while native-origin and second-generation migrant-origin individuals have similar political trust and satisfaction scores. To explain these outcomes, I focus on the importance of subjective integration factors related to the stages of migration. I claim that first-generation migrants, who have gone through the disruptive process of changing countries, will have lower expectations and be more likely to have positive evaluations of the host society. In comparison, native-origin and second-generation migrant-origin individuals have been raised in the same society and are likely to share perspectives toward that society's political institutions. [source] The use of light-emitting diode therapy in the treatment of photoaged skinJOURNAL OF COSMETIC DERMATOLOGY, Issue 3 2007FACCS, FRACGP, Fabien Baez MBBS, MAACS, MCPSA Summary Background, Light-emitting diode (LED) therapy is an increasingly popular methodology for the treatment of sun damage. Combination use of light wavelengths reported to stimulate collagen synthesis and accelerate fibroblast,myofibroblast transformation may display a composite rejuvenative effect. Objective, To clinically assess reduction in sun damage signs following a 5-week course of LED therapy and to assess subject's perception of the treatment. Methods, Thirteen subjects with wrinkles or fine lines in the periorbital and nasolabial region and those presenting Glogau scale photodamage grade II,III received nine 20-min duration light treatments using the OmniluxÔ LED system. The treatments combined wavelengths of 633 and 830 nm at fluences of 126 and 66 J/cm2, respectively. Sun-damage reduction was assessed at 6, 9, and 12 weeks by clinical photography and patient satisfaction scores. Results, The majority of subjects displayed "moderate" (50%) or "slight" (25%) response to treatment at investigator assessment. Treatment of the periorbital region was reported more effective than the nasolabial region. At 12-week follow-up, 91% of subjects reported improved skin tone, and 82% reported enhanced smoothness of skin in the treatment area. Conclusion, Good response to LED therapy has been shown in this modest sample. Larger trials are needed to assess optimum frequency of light treatments and overall treatment time. [source] Elucidation and decisional risk in a multi-criteria decision based on a Choquet integral aggregation,a cybernetic frameworkJOURNAL OF MULTI CRITERIA DECISION ANALYSIS, Issue 5-6 2005J. Montmain Abstract The authors are developing multi-criteria Decision-making support systems (DMSS) for project teams in charge of selecting a technical solution among alternatives. They propose a cybernetic framework to emphasize the link between decision-making (DM) and knowledge management processes in such projects. These DMSSs rely on the tracking of the accompanying knowledge production of long-term decisional processes by a collective with many actors. Based on knowledge-production management, this paper explains how to design decisional risk evaluation, monitoring and control aids and traceability functions for strategic choices and logical argumentation. The DMSS is seen as a recommender system for the project manager. Each possible solution involved in the decision-making process (DMP) is evaluated by means of a set of criteria. The evaluation results from an interpretation of the knowledge items in terms of satisfaction scores of the solutions according to the considered criteria. Aggregating these partial scores provides a ranking of all the possible solutions by order of preference. As criteria are sometimes interacting, the aggregation has to be based on adapted operators, i.e. Choquet integrals. Evaluating possible solutions by the knowledge contained in the knowledge base (KB) opens the way to automating the argumentation of the project team's decisions: the argumentation principle underlying this approach is based naturally on coupling a knowledge dynamical management system (KDMS) with the DMSS. The DMSS also evaluates the decisional risk that reflects the eventuality of a wrong selection due to the insufficiency of available knowledge at a given time in order to adopt a reliable solution. Decisional risk assessment corresponds to sensitivity analyses. These analyses are then exploited to control the decisional risk in time: they enable to identify the crucial information points for which additional and deeper investigations would be of great interest to improve the stability of the selection in the future. The knowledge management of a collective project is represented as a control loop: the KDMS is the actuator, the risk accompanying the decision is the controlled variable and is strongly linked to the entropy of the KB managed by the KDMS. Each of the three phases,intelligence, design, choice,of the DMP is identified to a function of the control loop: actuator, process and regulator. This cybernetic framework for decision has its origin in knowledge management activities for a great-scale project,the EtLD project of the French Atomic Commission (CEA) that concerns the management of high-level long-life radioactive waste in France. Copyright © 2007 John Wiley & Sons, Ltd. [source] Co-Bedding Versus Single-Bedding Premature Multiple-Gestation Infants in IncubatorsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2003CNAA associate professor, Jacqueline Fowler Byers PhD Objective: To compare the physiological stability and behavioral effects of co-bedding with those of single-bedding premature multiple-gestation infants in incubators as well as the psychological effects on their parents. Design: Prospective, randomized, repeated measure. Participants: Convenience sample of 16 infants and 8 parents in the co-bedded group, and 21 infants and 11 parents in the control group. Interventions: Infants in the study group were co-bedded in incubators. Main Outcome Measures: Baseline and posttesting for parental state anxiety, maternal attachment, and parental satisfaction measures; infant sleep-wake synchronicity; physiological measures; and stress cue measures during baseline and activity. Main Results: Repeated measures 5 (time) × 2 (group) analysis of variance found significant differences in infant daily weight, feeding amount, and high-activity heart rate. There was no difference in parental state anxiety, maternal attachment, and parental satisfaction scores by group, except for higher baseline parental satisfaction scores in the co-bedded group. Conclusions: This research demonstrated the safety of co-bedding multiple-gestation infants in incubators but did not find any significant clinical improvement in infant or parental outcomes with co-bedding. Neonatal intensive-care unit providers should educate staff and parents about the potential benefits of co-bedding and consider developing policies and procedures for co-bedding in both incubators and cribs. Co-bedding of multiple-gestation infants may be provided as an adjunctive developmental care strategy if parents desire this intervention. [source] Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unitJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2010F. VAROL TAS md Accessible summary ,,The views of patients and their relatives regarding the treatment are extremely important in mental health as well as in other medical disciplines. ,,In our study, consistent with the literature, the satisfaction levels of young people and their families regarding the service they got during their stay in the unit were determined to be high. ,,The questionnaire used in the survey was designed to allow for five domain-based subscales which were admission process, staff, environment/services, treatment interventions and treatment outcome. ,,The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that; the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. ,,The results of such studies help to improve the quality of treatment and the mental health service that children and adolescents and their families receive. Abstract The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit. [source] Veterans' perceptions of care by nurse practitioners, physician assistants, and physicians: A comparison from satisfaction surveysJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2010Dorothy Budzi DrPH (Quality Manager/Performance Improvement Coordinator) Purpose: To examine the differences in patient satisfaction with care provided by nurse practitioners (NPs), physician assistants (PAs), and physicians in the Veterans Health Administration (VHA) system. Data source: Secondary data was obtained from the VHA's Survey of Healthcare Experience of Patients (SHEP), a monthly survey designed to measure patient satisfaction. Descriptive statistics were calculated and categorical variables were summarized with frequency counts. Conclusions: Of the 2,164,559 surveys mailed to the veterans, 1,601,828 (response rate 64%) were returned. The study found that satisfaction scores increased by 5% when the number of NPs was increased compared to 1.8% when the number of physicians was increased and slightly increased or remained the same when the number of PAs was increased. Physician to PA/NP ratio was 7:3. Implications for practice: The VHA is the largest healthcare system and the single largest employer of NPs and PAs in the country. This study shows that a majority of the primary care clinic patients prefer to see NPs as compared with PAs and physicians. Besides clinical care, NPs focus on health promotion, disease prevention, health education, attentiveness, and counseling. Physicians and PAs should be educated on these characteristics to promote patient satisfaction and expected outcomes. [source] Predicting marital satisfaction: Social absorption and individuation versus attachment anxiety and avoidancePERSONAL RELATIONSHIPS, Issue 2 2007MAHNAZ R. CHARANIA The incremental validity of social absorption and social individuation in predicting relationship satisfaction beyond anxious and avoidant attachment was assessed in a sample of 400 heterosexual couples. Results indicated that the actor's and partner's social absorption scores and the absolute difference between the partners' social individuation scores made significant unique contributions to the actor's satisfaction in a model that included avoidant and anxious attachment. This model accounted for 49% of the variance in the actors' satisfaction scores. Satisfaction was high when both partners were predisposed toward behavioral interdependence but suffered when the partners were discrepant in their need to cognitively distinguish self and other. Possible explanations for these findings and their implications for marital satisfaction are discussed. [source] Latest news and product developmentsPRESCRIBER, Issue 8 2008Article first published online: 12 MAY 200 Glargine preferred to lispro as type 2 add-on Basal insulin glargine (Lantus) and insulin lispro (Humalog) at mealtimes improved glycaemic control equally well in patients with type 2 diabetes poorly controlled by oral agents, but patient satisfaction was greater with basal insulin (Lancet 2008;371:1073-84). The 44-week APOLLO trial, funded by Sanofi Aventis, was a nonblinded randomised comparison of basal and prandial insulin regimens added to oral treatment in 418 patients. It found similar reductions in HbA1C (,1.7 vs ,1.9 per cent respectively). Fasting and nocturnal glucose levels were lower with insulin glargine and postprandial levels were lower with insulin lispro. The basal regimen was associated with fewer hypoglycaemic events (5.2 vs 24 per patient per year), less weight gain (3.01 vs 3.54kg) and greater improvement in patient satisfaction scores. Treating hypertension cuts mortality in over-80s Treating hypertension in the over-80s reduces all-cause mortality by 21 per cent, the HYVET study has shown (N Engl J Med online: 31 March 2008; doi: 10.1056/NEJMoa 0801369). Compared with placebo, treatment with indapamide alone or with perindopril for an average of 1.8 years also reduced the incidence of fatal stroke by 39 per cent, cardiovascular death by 23 per cent and heart failure by 64 per cent. The incidence of stroke was reduced by 30 per cent but this was of borderline statistical significance. Fewer serious adverse events were reported with treatment than with placebo. New work for NICE The DoH has announced the 18th work programme for NICE. Seven public health interventions include preventing skin cancer, smoking by children and excess weight gain during pregnancy. Public health guidance will include the provision of contraceptive services for socially disadvantaged young people. Two new clinical guidelines are sedation in young people and management of fractured neck of femur. New technology appraisals may include eight therapies for cancer, two new monoclonal antibodies for psoriasis and rheumatoid arthritis, an oral retinoid for severe chronic hand eczema and methylnaltrexone for opioid-induced bowel dysfunction. Combinations no better against CV disease Taking ezetimibe and simvastatin (Inegy) does not appear to slow the progression of atherosclerosis more than high-dose simvastatin alone, say researchers from The Netherlands (N Engl J Med 2008;358: 1431-43). In patients with hypercholesterolaemia, there was no difference in regression or progression of atherosclerosis after two years' treatment with simvastatin 80mg per day alone or combined with ezetimibe 10mg per day. Adverse event rates were similar. In patients with vascular disease or high-risk diabetes, there was no difference between the ACE inhibitor ramipril 10mg per day or the ARB telmisartan (Micardis) 80mg per day as monotherapy, or their combination, in the risk of a composite outcome of cardiovascular death, MI, stroke and admission for heart failure (N Engl J Med 2008;358:1547-59). Combined treatment was associated with higher risks of hypotensive symptoms, syncope and renal dysfunction. Twice-daily celecoxib increases CV risk Taking celecoxib (Celebrex) twice daily carries a higher risk of cardiovascular events than the same total dose taken once daily, a metaanalysis suggests (Circulation 2008; doi: 10.1161/ CIRCULATIONAHA.108. 764530). The analysis of six placebo-controlled trials involving a total of 7950 patients taking celecoxib for indications other than rheumatoid arthritis found that the combined risk of cardiovascular death, myocardial infarction, stroke, heart failure or thromboembolic event increased with dose over the range 400-800mg per day. The risk was significantly greater with 200mg twice daily (HR 1.8) than 400mg once daily (HR 1.1). Patients at greatest baseline risk were at disproportionately increased risk from celecoxib. Long-term etanercept effective in AS An open-label study suggests that etanercept (Enbrel) remains effective in the treatment of ankylosing spondylitis in the long term (Ann Rheum Dis 2008;67:346-52). Of 257 patients who completed six months' treatment with etanercept and who entered the nonblinded extension study, 126 completed a total of 168-192 weeks' treatment. The commonest adverse events were injection-site reactions (22 per cent), headache (20 per cent) and diarrhoea (17.5 per cent). The annual rate of serious infections was 0.02 per person. Response and partial remission rates after 192 weeks were similar to those reported after 96 weeks. Metformin reduces risk Metformin reduces the risk of developing diabetes in individuals at increased risk, a meta-analysis suggests (Am J Med 2008;121:149-57.e2). The study included 31 mostly small, randomised, controlled trials involving a total of 4570 participants and lasting at least eight weeks (8267 patient-years of treatment). Metformin was associated with reductions in body mass (,5.3 per cent), fasting glucose (,4.5 per cent) and insulin resistance (,22.6 per cent); lipid profiles also improved. The odds of developing diabetes were reduced by 40 per cent,an absolute risk reduction of 6 per cent over 1.8 years. MHRA clarifies cough and colds advice Press reports mistakenly suggested that the MHRA had banned some cough and cold remedies when it issued new guidance on treating young children, the MHRA says. The Agency's advice followed a review of over-thecounter cough and cold medicines for children by the Commission on Human Medicines. Children under two are at increased risk of adverse reactions and should no longer be treated with products containing antihistamine (chlorphenamine, brompheniramine, diphenhydramine), antitussives (dextromethorphan, pholcodine), expectorants (guaifenesin, ipecacuanha) and decongestants (phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and xylometazoline). The MHRA said these products, which are classified as general sale medicines, should be removed from open shelves until available in new packaging that complies with the advice. They may still be supplied by a pharmacist for the treatment of older children. Coughs and colds should be treated with paracetamol or ibuprofen for fever, a simple glycerol, honey or lemon syrup for cough, and vapour rubs and inhalant decongestants for stuffy nose. Saline drops can be used to thin and clear nasal secretions in young babies. Parents are being urged not to use more than one product at a time to avoid inadvertently administering the same constituent drug twice. Perindopril brand switch Servier Laboratories is replacing its current formulations of perindopril (Coversyl, Coversyl Plus) with a new product that is not bioequivalent. The current Coversyl brand contains perindopril erbumine (also known as tert -butylamine). The new formulation contains perindopril arginine; it will be distinguished by new brand names (Coversyl Arginine, Coversyl Arginine Plus) and new packaging. Coversyl 2, 4 and 8mg tablets are equivalent to Coversyl Arginine 2.5, 5 and 10mg. Servier says the change is part of the simplification and harmonisation of global manufacturing; the arginine salt is already used in other countries and offers greater stability and a longer shelf-life. Both Coversyl and Coversyl Arginine will be in the supply chain for the next few weeks. Generic perindopril will continue to be the erbumine salt and prescriptions for generic perindopril are not affected. New from NICE Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical Guidance No. 63, March 2008 This clinical guideline focuses on additional aspects of care for women with gestational diabetes (88 per cent of cases) or pre-existing diabetes (of which about 40 per cent is type 2 diabetes) and their babies. To date, insulin aspart (NovoRapid) is the only drug in the guideline specifically licensed for use in pregnancy and NICE advises obtaining informed consent to implement its recommendations for using other insulins and oral hypoglycaemic agents. As with other guidelines, NICE begins by stressing the importance of patient-centred care and involving women in decisions about their treatment. The guideline is divided into six sections, dealing with consecutive periods of pregnancy. Preconceptual planning should include empowering women to help them reduce risks, optimising glycaemic control (after retinal assessment) and increasing monitoring intensity, and providing information about the effects of pregnancy on diabetes. Metformin may be recommended as an adjunct or alternative to insulin, but other oral hypoglycaemic agents should be replaced with insulin, although glibenclamide is an option during pregnancy. Isophane insulin is the preferred long-acting insulin; lispro (Humalog) and aspart are considered safe to use. ACE inhibitors and angiotensin-II receptor blockers should be replaced with other antihypertensive agents and statins should be discontinued. Recommendations for screening and treatment of gestational diabetes build on previous guidance (CG62). Drug treatment will be needed by 10-20 per cent , this includes insulin (soluble, aspart or lispro) and/or metformin or glibenclamide, tailored to individual need. Antenatal care includes optimising glycaemic control. Insulin lispro or aspart should be considered in preference to soluble insulin. If glycaemic control cannot be achieved with insulin injections, an insulin pump may be indicated. The guideline includes a timetable for appointments and the care that should offered after each interval. Recommendations for intrapartum care, which supplement those in CG55, include frequent monitoring of blood glucose. Neonatal care includes recommendations for monitoring and screening the infant and the management of hypoglycaemia. Postnatal care (supplementing CG37) involves adjusting maternal treatment to avoid hypoglycaemia and recommendations for returning to community care. Metformin and glibenclamide are the only oral agents suitable for breastfeeding women. Women with gestational diabetes need advice about glycaemic control and planning for future pregnancies. Lifestyle advice and measurement of annual fasting plasma glucose should be offered. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal No. 138, March 2008 The latest technology appraisal of asthma treatments covers inhaled steroids for adults and children over 12 with chronic asthma. It makes only two recommendations. First, the cheapest appropriate option is recommended. Second, when a steroid and a long-acting beta2-agonist are indicated, the decision to prescribe a combined inhaler or separate devices should take into account therapeutic need and likely adherence. Combined inhalers are currently less expensive than separate devices, though they may not remain so. When a combined inhaler is chosen it should be the cheapest. NICE concludes that, at equivalent doses, there is little difference in the effectiveness or adverse event profile of the available steroids or the fixed-dose combinations. According to specialist advice, choosing the best device for an individual remains the overriding concern. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Technology Appraisal No. 139, March 2008 NICE recommends continuous positive airway pressure (CPAP) for adults with moderate or severe obstructive sleep apnoea, and for those with a milder disorder if quality of life and functioning are impaired and alternative strategies such as lifestyle change have failed. Diagnosis and treatment is the responsibility of a specialist team. A CPAP device costs £250-£550 and lasts for seven years. Copyright © 2008 Wiley Interface Ltd [source] Does life satisfaction predict victimization experiences in adolescence?PSYCHOLOGY IN THE SCHOOLS, Issue 8 2008Kellie Martin Longitudinal relationships between adolescents' life satisfaction and peer victimization and prosocial experiences were assessed. A total of 417 students in Grades 6,8 completed the Multidimensional Students' Life Satisfaction Scale (MSLSS: Huebner, 1994) and the Children's Social Experience Questionnaire , Self Report (SEQ-SR: Crick & Grotpeter, 1996) on two occasions (Time 1 and Time 2), 1 year apart. The results revealed that Time 1 life satisfaction scores did not add to the prediction of Time 2 overt victimization scores but did add to the prediction of Time 2 relational victimization scores and prosocial experiences. Additionally, Time 1 overt victimization, relational victimization, and prosocial experiences did not significantly add to the prediction of Time 2 general life satisfaction. However, the predictive equations for Time 1 relational victimization and prosocial experiences approached significance, suggesting the possibility of bidirectional effects between life satisfaction and relational victimization and prosocial peer experiences. Most interestingly, lower levels of life satisfaction appeared to be a newly identified risk factor for two qualitatively distinct types of adverse peer relationships (relational victimization and lack of prosocial experiences). © 2008 Wiley Periodicals, Inc. [source] Atomised lidocaine for airway topical anaesthesia in the morbidly obese: 1% compared with 2%,ANAESTHESIA, Issue 1 2010C. Woodruff Summary Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in morbidly obese patients was evaluated using two doses of local anaesthetic. In this randomised, blinded prospective study, 40 ml of atomised 1% (n = 11) or 2% (n = 10) lidocaine was administered with high oxygen flow as carrier. Outcomes included time for intubation, patient tolerance to airway manipulation, haemodynamic parameters, the bronchoscopist's overall satisfaction, and serial serum lidocaine concentrations. Patients receiving lidocaine 1% had a longer mean (SD) time from the start of topicalisation to tracheal tube cuff inflation than those receiving lidocaine 2% (8.6 (0.9) min vs 6.9 (0.5) min, respectively; p < 0.05). Patients in the 1% cohort demonstrated increased responses to airway manipulation (p < 0.0001), reflecting lower bronchoscopist's satisfaction scores (p < 0.03). Haemodynamic responses to topicalisation and airway manipulation were similar in both groups. Peak plasma concentration was lower in the 1% group (mean (SD) 1.4 (0.3) and 3.8 (0.5) ,g.ml,1, respectively; p < 0.001). Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in the morbidly obese is efficacious, rapid and safe. Compared with lidocaine 1%, the 2% dose provides superior intubating conditions. [source] A comparison of dexmedetomidine and midazolam for sedation in third molar surgery,ANAESTHESIA, Issue 11 2007C. W. Cheung Summary This randomised, double-blind study compared dexmedetomidine and midazolam for intravenous sedation during third molar surgery under local anaesthesia. Sixty patients received either dexmedetomidine (up to 1 ,g.kg,1) or midazolam (up to 5 mg), which was infused until the Ramsay Sedation Score was four or the maximum dose limit was reached. Intra-operative vital signs, postoperative pain scores and analgesic consumption, amnesia, and satisfaction scores for patients and surgeons, were recorded. Sedation was achieved by median (IQR (range)) doses of 47 ,g (39,52 (25,76)) or 0.88 ,g.kg,1 (0.75,1.0 (0.6,1.0)) dexmedetomidine, and 3.6 mg (3.3,4.4 (1.9,5.0)) or 0.07 mg.kg,1 (0.055,0.085 (0.017,0.12)) midazolam. Heart rate and blood pressure during surgery were lower in dexmedetomidine group. There was no significant difference in satisfaction or pain scores. Midazolam was associated with greater amnesia. Dexmedetomidine produces comparable sedation to midazolam. [source] Study of Botulinum Toxin A in Neurogenic Bladder Due to Spina Bifida in ChildrenANZ JOURNAL OF SURGERY, Issue 4 2010Aniruddh V. Deshpande Abstract Background:, We report results of a pilot study investigating the safety and efficacy of Botulinum A toxin on urinary incontinence and bladder function in children with neurogenic bladder. Methods:, This was a prospective, non-randomized clinical trial. Seven children with median age of 16 years with spina bifida who had high storage pressures, poor bladder compliance and had failed treatment with anticholinergic medications were offered a single intra-detrusor injection of Botulinum A toxin. All subjects were on clean intermittent catheterization before and during the study. Follow-up videourodynamic studies were performed at 1 month, between 3 and 6 months, and at 9 months. Data were collected on safety and on subjective outcomes through validated questionnaires filled out by patients at each visit. Results:, In majority of the patients (5/7), the injection produced an increase in bladder compliance (P < 0.05) and an improvement in incontinence (P < 0.05) at 1-month follow-up. However, in two patients whose baseline bladder capacity was markedly reduced (<200 mL), the improvement was very minimal. The beneficial effects in bladder compliance and incontinence dissipated by 9 months. The changes in subjective outcomes (incontinence and satisfaction scores) did not parallel the changes in urodynamics through the study period. No side effects of Botulinum toxin were seen. Conclusion:, Botulinum A toxin injection produces beneficial urodynamics and clinical effects. These beneficial effects last for approximately 9 months. There is a poor correlation between improvement in the urodynamics and the subjective outcomes. Botulinum A toxin injection is a safe alternative treatment for patients with spina bifida and a neurogenic bladder. [source] | ||||||||||||||||||||||||||||||||||