1212 A Novel Approach to Alleviating Surgical Anxiety: QI Study in a Primary Care Government Centre

Aim Surgical Anxiety is a challenging problem in the peri-operative care of a patient often leading to poor surgical outcomes and repeated visits by the patient to the hospital. Despite being well documented, in practice, it still remains the most neglected and haphazardly adopted part of patient care. This study aimed to make the overall experience of surgery, safer and pleasant to the patient by instituting a novel, multimodal and easy to follow protocol. Method A self-made questionnaire formed the source for data collection from 43 patients listed for elective surgery in a government setup, throughout the duration of their admission and review period. Patient satisfaction rate was assessed by re-audits, post implementation of changes via a Plan-Do-Study-Act (PDSA) cycle. The ease of protocol administration and sustainability were assessed from staff via an audit and it was further simplified to ensure adoption was easy and patient satisfaction rate remained high as well. Results Initial audit showed only 49% (n = 21) of patient satisfaction rate at the time of admission. Significant variations of > 90% (n = 39) patient satisfaction rate was noted post implementation of changes after the first PDSA cycle. A second PDSA cycle was instituted to simplify the protocol and post audit >90% acceptance rate from staff were noted. Conclusions Shared Decision Making, Peer Support Groups, Adequate knowledge of the treating surgeon, the disease, treatment modalities and complications instituted via a proper protocol helped to alleviate surgical anxiety and prepare a positive patient for surgery.

275 Feasibility and Patient Satisfaction of Intra-Detrusor Botulinum Toxin (Botox) Injections Under Local Anaesthetic (LA) In the Outpatient Setting

Introduction Intra-detrusor Botox injections for overactive bladder has shifted to being performed under local anaesthetic rather than general anaesthetic to improve cost and efficiency. However, it may cause the patient pain and discomfort. We aim to assess the feasibility of LA Botox injections in the outpatient setting and to evaluate patient satisfaction. Method Our first cycle assessed whether patients would consider intra-detrusor Botox injections under local anaesthetic in the outpatient setting. Our services were then restructured to run LA Botox clinics. Our second cycle then assessed the patient satisfaction of these clinics using the client satisfaction questionnaire (CSQ-8) template. Results The first cycle showed that 70% (14/20) of patients would consider having outpatient Botox injections under LA. A potential annual saving of £88,434 was estimated. The second cycle showed a high patient satisfaction rate with an average CSQ-8 score of 30/32 in 16 patients who had Botox injections in the outpatient setting. 9 patients reported being “very satisfied” with our service and the remainder reported being “mostly satisfied” Conclusions LA Botox injections in the clinic setting has a high patient satisfaction rate and can provide considerable cost savings. Suitable patients should have LA intra-detrusor Botox injections in the outpatient setting where possible.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals: a retrospective analysis of 118 consecutive cases

Background To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during mid-term follow-up. Methods The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results The average operation time was 18 min (range, 10–30 min) and the average blood loss was 4 ml (range, 2–10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. One hundred eighteen patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. One hundred fifteen patients (97.5%) were able to crouch with knees close to each other after surgery. One hundred fourteen patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5 ± 10.6 before operation to 90.1 ± 5.2 at the last follow-up (p < 0.05). The patient satisfaction rate was 95.8%. Conclusion Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium-term effect.

Triple Arthrodesis for Equinovarus Foot using Ilizarov Technique: A Retrospective Study

Introduction: Equinovarus foot deformity is a significant problem in adolescents and its treatment remains challenging. Triple arthrodesis, even though an effective palliative tool in management of complex foot deformity, has its own limitations if it is done for acute deformity correction. Ilizarov technique offers gradual deformity correction, fusion and takes care of many known complications of acute correction. However, there are very few studies about effectiveness and functional outcome of triple arthrodesis for equinovarus deformity when done gradually with an Ilizarov fixator. Aim: To study the effectiveness of triple arthrodesis, performed with Ilizarov technique for equinovarus foot deformity in adolescents and adults and to evaluate the early functional outcome and patient satisfaction rate for this procedure. Materials and Methods: A retrospective analysis of 22 feet in 20 patients with equinovarus foot deformity between January 2015 and December 2018 was done. Patients underwent gradual deformity correction and triple fusion with Ilizarov fixator. Foot was assessed for any residual deformity and shortening. Functional outcome and patient satisfaction were assessed by Ankle Hind Foot Scale (AHFS) and Likert scale, respectively using paired t-test. Final analysis was done with Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Twelve males and eight females with mean age of 15.9±3.4 years fulfilled the inclusion criteria and were included for final analysis of results. Fusion rate was 86.1% with mean union time of 12.5 weeks. Mean AHFS improved from 61.27 before surgery to 76.9 which was statistically significant (p<0.0001). One or more complications were seen in 15 (68.1%) feet but were managed satisfactorily without any significant impact on final outcome. Patient satisfaction rate for the procedure was 80%. After a mean follow-up of 18.1 months, plantigrade foot with equal foot length was obtained in all patients. Conclusion: Triple arthrodesis with gradual deformity correction by Ilizarov technique effectively corrects equinovarus foot deformity and foot length discrepancy. Known complications of acute deformity correction can be avoided with equally good results. It corrects deformity and restores alignment of foot more accurately leading to a high patient satisfaction rate.

SAFETY OF INTRAOSSEOUS ANESTHESIA IN DENTISTRY.

The aim is to increase safety and efficiency of intraosseous anesthesia by automated injectors. Duration of intraosseous anesthesia depends on the concentration of epinephrine in the local anesthetic. Intraosseous analgesia has a high patient satisfaction rate in terms of efficiency and comfort – more than 97%.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals ： a retrospective analysis of 118 consecutive cases

Background: To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during mid-term follow-up. Methods: The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results: The average operation time was 18 min (range, 10-30 min) and the average blood loss was 4 ml (range, 2-10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. 118 patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. 115 patients (97.5%) were able to crouch with knees close to each other after surgery. 114 patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5±10.6 before operation to 90.1±5.2 at the last follow-up (p<0.05). The patient satisfaction rate was 95.8%. Conclusion: Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium-term effect.

The application of mobile phone APP in the follow-up management of hospital

Explore the application of mobile phone APP in the follow-up management of hospital in the information age, to build a harmonious doctor-patient relationship,improve the effective follow-up rate and promote the rehabilitation of patients. Methods: Compare and analyze the traditional telephone follow-up mode and the mode of mobile phone APP with telephone follow-ups . Results:In 2016,with telephone follow-ups only,the effective rate was 91.3%, the patient satisfaction rate was 92.6%.In 2017,besides telephone follow-ups, we used mobile phone APP,the effective follow-up rate got up to 96.2%,the satisfaction rate of patients got up to 98.1%. Conclusion: Compared with the traditional follow-up model, mobile phone APP follow-up model can improve the clinical follow-up service and the compliance of patients, help to reduce failures of follow-up.With mobile phone APP, it’s much more convenient and effective for doctors to communicate with patients,and it is better for the rehabilitation of patients with disease.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portal: a retrospective analysis of 118 consecutive cases

Background To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during medium and long-term follow-ups. Methods The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results The average operation time was 18 min (range, 10–30 min) and the average blood loss was 4 ml (range, 2–10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. 118 patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. 115 patients (97.5%) were able to crouch with knees close to each other after surgery. 114 patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5 ± 10.6 before operation to 90.1 ± 5.2 at the last follow-up (p < 0.05). The patient satisfaction rate was 95.8%. Conclusion Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium- and long-term effect.