scholarly journals Effects of a medical second opinion programme on patients’ decision for or against knee arthroplasty and their satisfaction with the programme

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Martin Weigl ◽  
Jens Pietzner ◽  
Rebecca Kisch ◽  
Alexander Paulus ◽  
Volkmar Jansson ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Elective Surgery ◽  
Quality Criteria ◽  
Treatment Decision ◽  
Evaluation Study ◽  
Second Opinion ◽  
Before And After ◽  
The Right ◽  
Health Insurance Funds

Abstract Background German social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurances. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty. Methods The largest statutory health insurance funds in Bavaria offered patients who had been recommended to have knee arthroplasty the opportunity to partake in a second opinion programme which consisted of an in person presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit. Results A total of 141 (66%) of 215 patients who presented for a second opinion participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. After receiving the second opinion 28 of 56 (41%) undecided patients preferred knee arthroplasty, 14 no knee arthroplasty, 14 remained undecided. Four of 46 patients with a preference for “arthroplasty” changed their decision to “no arthroplasty”, five of 35 patients from “no arthroplasty” to “arthroplasty”. The patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). They rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) (best:1; worst:6). Logistic regression analyses showed that the recommendation of the second opinion physician for joint arthroplasty was associated with the guideline criteria radiological severity of osteoarthritis (p = 0.001) and knee-joint-specific quality of life (p = 0.041). Conclusion The second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The association of guideline criteria to the second recommendation suggests a high quality of the second opinion. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.

Outcomes of a medical second opinion programme before knee arthroplasty: A prospective cohort study

2020 ◽  
Author(s):  
Martin Weigl ◽  
Jens Pietzner ◽  
Rebecca Kisch ◽  
Alexander Paulus ◽  
Volkmar Jansson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Knee Arthroplasty ◽  
Statutory Health Insurance ◽  
Elective Surgery ◽  
Quality Criteria ◽  
Treatment Decision ◽  
Evaluation Study ◽  
Second Opinion ◽  
The Right

Abstract Background: German social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurance. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty.Methods: The largest statutory health insurance funds in Bavaria offered patients to whom knee arthroplasty was recommended participation in a second opinion programme with personal presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit.Results: A total of 141 (66%) of 215 second opinion patients participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. The frequency of undecided patients decreased from 41% to 12%. After the second opinion, the patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). Logistic regression analyses showed that higher radiological severity of osteoarthritis on the Kellgren/Lawrence scale (p = 0.001) and lower knee-joint-specific quality of life on the KOOS questionnaire (p = 0.041) were associated with the recommendation for knee arthroplasty by the second opinion physician. The patients rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) on a scale from 1 to 5.Conclusion: The second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The results of this study suggest that a second opinion may improve adherence to guidelines for indications of knee arthroplasty. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.

scholarly journals Satisfação com os Cuidados Anestésicos num Hospital Central

2014 ◽  
Vol 27 (1) ◽  
pp. 33 ◽  
Author(s):  
Ana Catarina Moura ◽  
Maria Amélia Ferreira ◽  
Joselina Barbosa ◽  
Joana Mourão
Keyword(s):  
Elective Surgery ◽  
Quality Criteria ◽  
Three Dimensions ◽  
Mean Values ◽  
Global Satisfaction ◽  
Assess Patient Satisfaction ◽  
High Satisfaction ◽  
The Mean ◽  
Psychometric Quality

<strong>Introduction:</strong> The satisfaction level with health care reflects the quality of care from the patient’s perspective. The aim of this study is to assess patient satisfaction with anesthesia care in a Portuguese general hospital by using the “The Heidelberg Peri-anaesthetic Questionnaire”.<br /><strong>Material and Methods:</strong> The questionnaire was translated and tested based on psychometric quality criteria in a sample of 107 patients who underwent elective surgery as inpatients at Hospital de São João. The global satisfaction and for each dimension of care were calculated. We analyzed the differences between patients with different levels of satisfaction, identifying potential confounding factors.<br /><strong>Results:</strong> The Portuguese version of the questionnaire has 32 items distributed in three dimensions: ‘staff’, ‘discomfort’ and ‘fear’. The mean values of satisfaction for each dimension were 83.4%, 66.8% and 65.9%, respectively. The internal consistence was demonstrated by a Cronbach’s alpha coefficient ranging from 0.776 to 0.875 in the three dimensions. Satisfied and dissatisfied patients differed in the three dimensions, but to a lesser degree in ‘staff’. In the multivariate analysis we found significant influence of gender in the ‘discomfort’ dimension.<br /><strong>Discussion: </strong>The questionnaire has good psychometric characteristics. The domain ‘staff’ includes three domains of the source questionnaire.<br /><strong>Conclusions:</strong> Its application revealed high satisfaction levels regarding the staff. Dissatisfaction was mainly seen in the “fear” and “discomfort” dimensions, the latter being significantly lower in males.

Effects of pre- or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis

2008 ◽  
Vol 21 (3) ◽  
pp. 161-169 ◽  
Author(s):  
Georgios Evgeniadis ◽  
Anastasia Beneka ◽  
Paraskevi Malliou ◽  
Savvas Mavromoustakos ◽  
Georgios Godolias
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Therapeutic Exercise ◽  
Before And After ◽  
Total Knee

scholarly journals Patient-reported Quality of Life Before and After Total Knee Arthroplasty: A Prospective Multicentre Cohort Study

2021 ◽  
Author(s):  
Jinghui Chang ◽  
Manru Fu ◽  
Peihua Cao ◽  
Changhai Ding ◽  
Dong Wang
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Family Income ◽  
Knee Function ◽  
Targeted Interventions ◽  
Patient Reported ◽  
Before And After ◽  
Total Knee

Abstract Background: To identify patients’ self-reported health-related quality of life (HRQoL) before and after total knee arthroplasty (TKA) and determine factors contributing to any heterogeneity in HRQoL. Methods: This prospective multicentre study included 404 patients with knee osteoarthritis who underwent TKA between 1 April and 30 December 2019 and in whom HRQoL was assessed preoperatively and at 7 days and 1, 3, and 6 months postoperatively. Sociodemographic characteristics were assessed using a general information questionnaire; disability, using the Knee Injury and Osteoarthritis Outcome Score; pain, using the visual analogue scale (VAS) score; and HRQoL, using the European Quality of Life Five Dimension Five Level (EQ-5D-5L) score. Potential heterogeneity and factors influencing longitudinal changes in HRQoL were analysed using a growth mixture model.Results: The mean EQ-5D-5L score improved from 0.69 preoperatively to 0.90 at 6 months postoperatively. Two types of longitudinal heterogeneity were identified: (1) a group of patients with a small and slow improvement in HRQoL and (2) a group of patients who showed marked and rapid improvement in HRQoL. The main characteristics of the latter group were a monthly family income >2000 yuan, exercising for approximately 30 min daily, and better knee function at baseline. Baseline knee function and change in knee function were significantly associated with the percentage change in HRQoL.Conclusions: HRQoL improved considerably after TKA. However, there was some heterogeneity in the changes in HRQoL depending on certain patient characteristics. Targeted interventions should focus on these differences to optimise the outcomes of TKA.

Health and quality of life before and after hip or knee arthroplasty

1995 ◽  
Vol 10 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Pekka Rissanen ◽  
Seppo Aro ◽  
Pär Slätis ◽  
Harri Sintonen ◽  
Pekka Paavolainen
Keyword(s):  
Quality Of Life ◽  
Knee Arthroplasty ◽  
Before And After

Sedentary Behavior in Patients With Knee Osteoarthritis Before and After Total Knee Arthroplasty: A Systematic Review

2018 ◽  
Vol 26 (4) ◽  
pp. 671-681 ◽  
Author(s):  
Emmanuel Frimpong ◽  
Joanne A. McVeigh ◽  
Rebecca M. Meiring
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Sedentary Behavior ◽  
Knee Arthroplasty ◽  
Risk Of Bias ◽  
Before And After ◽  
Total Knee ◽  
Appraisal Tool

Objective:The objective of this systematic review is to integrate the available evidence on changes in sedentary behavior (SB) in patients with knee osteoarthritis after total knee arthroplasty (TKA).Methods:A systematic literature search from January 2002 to October 31, 2017, was performed for studies assessing objectively and/or subjectively measured SB following TKA. The Scottish Intercollegiate Guidelines Network Methodology appraisal tool was used to critically appraise the methodological quality of the included studies.Results:Ten studies reporting on SB with a total of 1,028 participants were included in the review. Three studies reported changes in SB with two showing a reduction in SB and one (with high risk of bias) an increase in SB after TKA. Seven studies showed no change in SB following TKA.Conclusion:Currently, there is insufficient evidence which suggests that SB time improves following TKA. Detailed assessments of SB after TKA are needed.

scholarly journals CRITERIA FOR PROVISIONAL RESTORATIONS USED IN PREPARATION FOR COMPREHENSIVE ORTHODONTIC AND ORTHOPEDIC REHABILITATION

2019 ◽  
Vol 16 (32) ◽  
pp. 647-655
Author(s):  
Adil MAMEDOV ◽  
Natalia MOROZOVA ◽  
Alexey YUMASHEV ◽  
Andrey DYBOV ◽  
Denis NIKOLENKO
Keyword(s):  
Orthodontic Treatment ◽  
Quality Criteria ◽  
Color Stability ◽  
Stable Fixation ◽  
Orthodontic Appliance ◽  
Orthopedic Rehabilitation ◽  
Before And After

There are substantial differences in the criteria within the framework of the comprehensive orthodontic and orthopedic rehabilitation of patients with malocclusions and associated defects of hard tooth tissues. The purpose of this article is to analyze the modern criteria for the fabrication and quality of provisional restorations based on data from the literature regarding the traditional rehabilitation of patients with defects of hard tooth tissues and edentulism. A total of 32 patients were subjected to either orthopedic or orthodontic treatment. The results demonstrated that before and after treatment, indices were deduced based on the following scales: OHIP-14-RU, IOTN, and FDI. The quality criteria for the provisional restorations in patients with malocclusions and associated defects of hard tooth tissues in comprehensive orthodontic and orthopedic rehabilitation were formulated. It was concluded that provisional restorations should be characterized based on a number of parameters including color stability, stable fixation of the orthodontic appliance, and high retention to tooth stumps.

scholarly journals STUDI PENGOLAHAN LIMBAH CAIR PENYAMAKAN KULITDI PT BUDI MAKMUR KECAMATAN GEDONG KUNING YOGYAKARTA TAHUN 2014

2015 ◽  
Vol 34 (1) ◽  
pp. 1-10
Author(s):  
Sri Rejeki Indah Astiani ◽  
Djamaluddin Ramelan
Keyword(s):  
Field Data ◽  
Liquid Waste ◽  
Leather Industry ◽  
Produce Water ◽  
Before And After ◽  
Result Show ◽  
More Care ◽  
The Right ◽  
Water Waste

PT Budi Makmur is one of the made leather industry that located in Yogyakarta. It processing a raw leather which from goat leather that processed into wolves, shoes, etc. PT Budi Makmur also produce water waste that flows to the river and if the waste is not produced in the right way, the waste will be very dangerous for the ecosystem in that river.The aim of this research are to know the process of the liquid waste producing leather tanning, the parameter of the liquid waste before and after through the producing process (COD, BOD, TSS dan pH) , and the condition of the liquid waste producing leather tanning.The kind of this research is descriptive. The research done by collecting the field data an laboratorium, and then analyzed and compared with the existing theory and quality of the liquid waste producing leather tanning.The result show that the source of the waste produce from the leather tranning. Liquid waste that produced is about 8.000-12.000 gallon per 1.000 wet leather pond that produced. The quality of the influent is BOD 1.946mg/lt, COD 1965mg/lt, TSS 1.774mg/ltd and pH 7.50. The quality of the effluent is BOD 98.61mg/lt, COD 100mg/lt, TSS 1130mg/lt and pH 7,49. The step of the liquid waste processing are: filtering ink, equalitation ink, sedimentation, aeration and active mud.The writer conclude that PT Budi Makmur has already optimal to decrease the content that contained in the leather-liquid waste producing but the effluent that is produced still exceed the exsisting standart quality. The suggestion to PT Budi Makmur is to more care about the liquid waste producing.

scholarly journals Assessment of general well-being before and after treatment for morbidities among inmates of a destitute centre of north Karnataka: a pre and post evaluation study

2017 ◽  
Vol 4 (11) ◽  
pp. 4282
Author(s):  
Sachin Desai ◽  
Chandra S. Metgud
Keyword(s):  
Well Being ◽  
The Elderly ◽  
Evaluation Study ◽  
Female Inmates ◽  
Age Group ◽  
Post Evaluation ◽  
Appropriate Treatment ◽  
Before And After ◽  
Morbid Conditions

Background: The destitute centre was established in 1992, 14th August; situated in Karnataka with a built up area is 29 acres and has 33 males and 17 female inmates. The patients here can be classified as having psychiatric illness, destitute with general co morbid conditions and wandering tramps with normal mentation. The study was done to know the morbidity profile among the inmates of destitute centre and to assess the change in the quality of life before the morbidity assessment and after medication and treatment.Methods: It was a pre-post evaluation study done from August 2012 to December 2012. All of the 50 resident inmates of the destitute centre were evaluated before and after clinical examination and treatment with General Well Being Scale (GWBS).Results: Among the total inmates, 06 (12%) were in age group 20-29 years, 11 (22%) belonged to 30-39 years, 10 (20%) belonged to 40-49 years, 09 (18%) each belonged to 50-59 and 60-69 years age group respectively, 04 (8%) belonged to 70-79 years and 01 (2%) of the elderly belonged to age ≥80 years of age. 38 (76.0%) were males and 12 (24%) were females. Majority of the inmates i.e. 42 (84.0%) belonged to broken families, about 4(8.0%) elderly belonged to problem families. 18 (36.0%) consumed tobacco, about 07 (14.0%) were either smoking or consuming alcohol, about 02 (4.0%) had both alcohol and smoking habits.Conclusions: 74% of them had psychiatric comorbidities and these were likely to cause significant functional impairment. Appropriate treatment helped 5 (10%) individuals to be shifted to rehabilitation center.

Preventing seclusion in psychiatry

2013 ◽  
Vol 21 (7) ◽  
pp. 766-773 ◽  
Author(s):  
Yolande Voskes ◽  
Martijn Kemper ◽  
Elleke GM Landeweer ◽  
Guy AM Widdershoven
Keyword(s):  
Quality Of Care ◽  
Psychiatric Hospital ◽  
Care Ethics ◽  
Evaluation Study ◽  
Good Care ◽  
First Case ◽  
Intervention Protocol ◽  
Healthcare Practice ◽  
The Right

In this article, an intervention aimed at improving quality of care to prevent seclusion in psychiatry by focusing on the first five minutes at admission is analyzed from a care ethics perspective. Two cases are presented from an evaluation study in a psychiatric hospital. In both cases, the nurses follow the intervention protocol, but the outcome is different. In the first case, the patient ends up in the seclusion room. In the second case, this does not happen. Analyzing the cases from a care ethics perspective, we conclude that applying the intervention in the right way implies more than following the steps laid down in the protocol. It requires a new way of thinking and acting, resulting in new relationships between nurses and patients. Care ethics theory can help clarify what good care is actually about and keep in mind what is needed to apply the intervention. Thus, care ethics theory can be highly practical and helpful in changing and improving healthcare practice.

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