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Background and objective: The aim of this study was to evaluate the utility of two items in vocal fold paresis and paralysis screening after thyroid and parathyroid surgery: patient self-assessment of voice using the Voice Handicap Index and computer-based acoustic voice analysis using the Multi-Dimensional Voice Program. Methods: This was a prospective study of 181 patients who underwent thyroid or parathyroid surgery over a 1-year study period (2017). Preoperatively, all patients underwent laryngoscopic vocal fold inspection and acoustic voice analysis, and they completed the Voice Handicap Index questionnaire. Postoperatively, all patients underwent laryngoscopy prior to hospital discharge; 2 weeks after the surgery, they completed the Voice Handicap Index questionnaire a second time. Two weeks postoperatively, patients with vocal fold paresis or paralysis and 20 randomly selected controls without vocal fold paresis or paralysis underwent a follow-up acoustic voice analysis. Results: Fourteen patients had a new postoperative vocal fold paresis or paralysis. Postoperatively, the total Voice Handicap Index score was significantly higher (p = 0.040) and the change between preoperative and postoperative scores was greater (p = 0.028) in vocal fold paresis or paralysis patients. A total postoperative Voice Handicap Index score > 30 had 55% sensitivity, and 90% specificity, for vocal fold paresis or paralysis. In the postoperative Multi-Dimensional Voice Program analysis, vocal fold paresis or paralysis patients had significantly more jitter (p = 0.044). Postoperative jitter > 1.33 corresponded to 55% sensitivity, and 95% specificity, for vocal fold paresis or paralysis. Conclusions: In identifying postoperative vocal fold paresis or paralysis, patient self-assessment and jitter in acoustic voice analysis have high specificity but poor sensitivity. Without routine laryngoscopy, approximately half of the patients with postoperative vocal fold paresis or paralysis could be overlooked. However, if the patient has no complaints of voice disturbance 2 weeks after thyroid or parathyroid surgery, the likelihood of vocal fold paresis or paralysis is low.

Availability of surgical site infection (SSI) surveillance rates challenges clinicians, healthcare administrators and leaders and the public. The purpose of this report is to demonstrate the consequences patient self-assessment strategies have on SSI reporting rates. We performed SSI surveillance among patients undergoing general surgery procedures, including telephone follow-up 30 days after surgery. Additionally we undertook a separate validation study in which we compared patient self-assessments of SSI with surgeon assessment. Finally, we performed a meta-analysis of similar validation studies of patient self-assessment strategies. There were 22/266 in-hospital SSIs diagnosed (8.3%), and additional 16 cases were detected through the 30-day follow-up. In total, the SSI rate was 16.8% (95% CI 10.1–18.5). In the validation survey, we found patient telephone surveillance to have a sensitivity of 66% (95% CI 40–93%) and a specificity of 90% (95% CI 86–94%). The meta-analysis included five additional studies. The overall sensitivity was 83.3% (95% CI 79–88%), and the overall specificity was 97.4% (95% CI 97–98%). Simulation of the meta-analysis results divulged that when the true infection rate is 1%, reported rates would be 4%; a true rate of 50%, the reported rates would be 43%. Patient self-assessment strategies in order to fulfill 30-day SSI surveillance misestimate SSI rates and lead to an erroneous overall appreciation of inter-institutional variation. Self-assessment strategies overestimate SSIs rate of institutions with high-quality performance and underestimate rates of poor performance. We propose such strategies be abandoned. Alternative strategies of patient follow-up strategies should be evaluated in order to provide valid and reliable information regarding institutional performance in preventing patient harm.

Hospital malnutrition is an under-recognized issue that leads to a variety of adverse outcomes, especially for older adults. Food/fluid intake (FFI) monitoring in hospital can be used to identify those who are improving and those who need further treatment. Current monitoring practices such as calorie counts are impractical for all patients and a patient-completed tool, if valid, could support routine FFI monitoring. The aim of this research was to determine whether the patient-completed My Meal Intake Tool (M-MIT) can accurately represent FFI at a single meal.Cross-sectional, multi-site.Four acute care hospitals in Canada.120 patients (65+ yrs, adequate cognition).Participants completed M-MIT for a single meal. Food and fluid waste was visually estimated by a research dietitian at each hospital. Sensitivity (Se), specificity (Sp) and overall agreement were calculated for both food and fluid intake by comparing M-MIT and dietitian estimations to determine criterion validity of M-MIT. Patient and research dietitian comments were used to make revisions to the M-MIT.Using a cut-point of ≤50% intake, Se was 76.2% and 61.9% and Sp was 74.0% and 80.5% for solid and fluids respectively (p0.001). M-MIT identified a greater proportion of participants (37.2%) as having low FFI (≤50%) than dietitians (25.0%), as well as a greater proportion identified with low fluid intake (28.3% vs. 24.6%). Modest revisions were made to improve the tool.This study has demonstrated initial validity of M-MIT for use in older patients with adequate cognition. Use of M-MIT could promote FFI monitoring as a routine practice to make clinical decisions about care.

Introduction : We report on one surgeon’s clinical experience with the 2 and 4 corner Raz bladder suspension performed for the treatment of stress urinary incontinence (alone or associated with cystocoele repair) in a consecutive patient cohort between 2003 and 2012 reporting short and longer term results. Materials and Methods : We performed a retrospective study of consecutive patients who underwent a 2 or 4 corner Raz bladder suspension by one surgeon (EHA ) to treat stress urinary incontinence over a period of time from Jan 1 2003 -Sept 2012. 3 month and longer term outcomes was determined by patient self assessment including validated questionnaires. Results : 98.7% of 82 patients reported no stress incontinence at 3 months Longer term follow-up was available on 48 (65%) patients. Of those lost to follow up, 8 were deceased. Mean age was 66.1 years. Mean follow up was 48.2 months (range 4-111months). 21 of the 48 (44%)patients were beyond 48 months. 41 of 48 (85%) patients were either delighted, pleased or mostly satisfied. 42 of 48 patients (87.5 %) had 50 % or more improvement. Pad use of 2.6 decreased to 0.9 pads with P value less than 0.0001. Conclusion : The Raz bladder suspension has good short and longer term results in relieving stress incontinence in addition to low morbidity and lower costs without the use of any mesh product.

A questionnaire for patient self-assessment of shoulder function was designed. It was based on the internationally accepted Rowe score.Explanations and photographs were added to the various parameters to make them easier to understand for the patients. A total of 95 patients completed the assessment form. The validity was tested by a correlation analysis comparing the questionnaire with the original score.The questionnaire demonstrated a reproducible and significant (p0.001), very high correlation (r0.9) in the overall results and a moderate to very high correlation within single parameters (r0.68).Based on these results, it can be concluded that a valid and reproducible assessment of the original score is possible with the new questionnaire. Self-evaluation allows reliable assessment which is not dependent on the examiners or location, resulting in a higher number of patients reachable for follow-up studies.

Background Shoulder outcome scores that include range of motion (ROM) and apprehension signs are limited by the need for direct involvement of the physician. Patient-reported outcome measures are patient centered and self-administered, and they can help physicians track the patient's progress between office visits and for long-term follow-up once the patient has been discharged. Methods Thirty consecutive patients completed a form before their 6-month follow-up after surgery on the labrum or capsule as a result of instability or pain related to instability. The form included bilateral ROM, apprehension, and instability episodes. The same parameters were measured by the physician during the visit. The patient's and physician's responses were compared. The primary outcome was the percentage agreement with exact and approximate agreement. Results Exact agreement was moderate for forward elevation at 56.6%; fair for abduction and external rotation at 90° at 24.5% and 34%, respectively; and poor for internal rotation at 90° and external rotation with the arm at the side at 2.6% and 12%, respectively. Approximate agreement within a range of positive or negative 20° range was very good for forward elevation (94%), abduction (92%), and external rotation at 90° (87%); moderate for external rotation with the arm at the side; and fair for internal rotation at 90°. There was 70% agreement regarding apprehension, 93% regarding subluxation events, and 100% regarding redislocation events. Conclusion Some measures of shoulder ROM showed a moderate to high level of agreement between patient-reported measurements and the physician's measurements. This method for short- and long-term follow-up could potentially replace routine clinic visits.

Background Patient-derived self-assessment potentially minimizes loss of valuable outcomes data, conserves medical resources, and benefits patients by saving valuable time out of work and travel expenses. The purpose of this study was to determine the physician-patient correlation of a patient-derived outcomes questionnaire that assesses range of motion (ROM) and strength after shoulder arthroplasty. Methods One hundred twenty consecutive patients completed a home-based questionnaire before their 1-year postoperative visit after shoulder arthroplasty. The questionnaire contained demographic information such as age, gender, type of surgery, education level, and income. Diagram-based questions, in which patients were asked to identify the image representing their own active shoulder ROM in various planes, were included. Patients were asked to perform a strength examination using premeasured zip-lock bags filled with water that correspond to predetermined weights up to 2.72 kg. The κ statistics were used to assess the degree of agreement between the patient's self-assessment and the clinician's measures. Results The κ statistics indicated moderate clinician-patient agreement (0.5-0.59) on items related to ROM and substantial to almost perfect agreement (0.62-0.92) on items related to strength (forward flexion and abduction). A majority of patients (>88%) correctly estimated their ROM within 1 grade of the clinician's measurement. Patients tended to err toward overestimating their ROM. Conclusions This patient-derived questionnaire provides a moderate to high level of agreement with clinician assessment. This assessment questionnaire may be an important tool in facilitating both clinical and research follow-up of patient outcomes after shoulder arthroplasty.

Before their first appointment at a pulsed dye laser clinic, 76 patients with a variety of vascular abnormalities completed a pretreatment assessment pack containing personal and demographic questions and the SF-36 Health Questionnaire, a self-report instrument for assessment of health status. These patients continued to receive laser treatment at approximately 3-monthly intervals. At 3 months and again at 6 months after their initial visit, the patients were sent postal follow-up packs containing the SF-36 Questionnaire and questions requesting information on: (a) opinions of the treatment itself; (b) the result in terms of clearance of coloration and (c) effect of treatment result on everyday life. The response rate to the follow-up questionnaire was 71% at 3 months and 60% at 6 months. Of the eight dimensions of health measured by the SF-36 Health Questionnaire, only mental health was found to be significantly improved at 6 months after initiation of treatment, and this improvement was dependent on gender, pertaining only to women. Information gained from the patients' perceptions of their treatment showed that opinions of the service delivery and advice and information offered were good. Overall, at the 6 month follow-up period, 83% of responders were satisfied with the treatment result, and the majority were pleased with its effect on their everyday life.

Between 1991 and 1994, 74 patients received total hip replacements with metal on metal articulation. The results of these patients with 74 hips who had a 6-month to 4-year (average, 2.2 years average) followup are reported. Patients were prospectively evaluated by the Harris hip score, a patient self assessment form, and radiographs. The average postoperative Harris hip score was 91. Patient self assessment forms showed that 95% of the patients scored their results as excellent or good. No patient had revision for loosening, but 1 underwent revision surgery for recurrent dislocation. Serial radiographs have not revealed loosening or osteolysis. Wear could not be measured radiographically. Twenty-seven of the patients had bilateral total hip replacements with 1 hip being metal on polyethylene; the patients could not detect any difference between the 2 hips. The satisfactory short term results from the contemporary metal on metal articulation investigated in this study are encouraging and warrant continued study.

One hundred three consecutive patients with primary glenohumeral degenerative joint disease completed standard questionnaires regarding their general health status (Short Form-36) and the function of their shoulder (Simple Shoulder Test). These patients' self-assessed health status indicated overall bodily pain, physical functioning, and physical role fulfillment scores that were significantly below those of population-based control groups. Self-assessed shoulder functions were likewise consistently below those of patients with normal shoulders. These deficits clearly indicated the problems that the patients desired to have resolved by treatment. The use of self-assessment questionnaires to routinely characterize patients with shoulder conditions is practical in the context of a busy practice. These data enable surgeons to understand the condition from the patient's perspective. This understanding should be central to the planning of treatment and to the evaluation of treatment effectiveness.

Contains fulltext : 69018.pdf (Publisher’s version ) (Closed access) The objective of this article was to investigate whether there were discrepancies between the physician interview and a patient's self-assessment questionnaire on the functional results after surgery for pelvic organ prolapse. Before their follow-up appointment, 79 patients were sent a validated urogynaecological questionnaire. At the follow-up visit, the physician interviewed the patients using a checklist with ten symptoms and scored the items as present or absent. Seventy-two patients (91.1%) attended the follow-up visit and had completed the questionnaire. There was poor to slight agreement between the interview score and the self-reported responses to the questionnaire on all items. This was illustrated by low kappa coefficients. The physician was more optimistic about the outcome of the operation than was justified according to the answers to a patient self-assessment questionnaire. We therefore recommend the use of validated questionnaires to evaluate surgical outcome because they provide a more realistic (objective) view of the functional results.

Background: In a previous study, the authors evaluated factors that contribute to patient satisfaction with breast reconstruction, using a comprehensive chart review and questionnaire. The results of part of this questionnaire, regarding patients' rating of the cosmetic result of their breast reconstruction, are presented in this article. Methods: The questionnaire was mailed to 267 patients, 214 questionnaires (80.1 percent) were returned, and 200 contained a response to the question rating the overall cosmetic outcome of breast reconstruction (Fig. 1). To conduct a statistical analysis, the data were collapsed into two smaller groups. An excellent or good result was considered a favorable outcome, while lower responses were unfavorable outcomes. Results: The outcome was rated as excellent by 82 patients, good by 76 patients, fair by 31 patients, and poor by 11 patients. A significant association was found between overall cosmesis and breast size, shape, or scars. Conclusion: It should not be assumed that patients' responses regarding satisfaction with reconstruction will reflect their specific feelings regarding cosmetic results.

Eighty-five consecutive patients referred to the Musculoskeletal Tumor Service completed a standardized short form questionnaire to evaluate their health status and function. Each patient completing the Short Form-36 questionnaire had a diagnosis of musculoskeletal neoplasm, including benign soft tissue and bone tumors, malignant soft tissue and bone tumors, and metastatic tumors. The results of this preliminary study show that the authors' patient population experienced health status and functional deficits in each of the eight Short Form-36 assessed domains. Data show that the most severe deficits were experienced by patients who had diagnoses of bone tumors and malignant tumors. This study shows that the Short Form-36 is a practical and effective method for documenting perceived deficits in health status in patients with musculoskeletal tumors. These data allow the physician to understand the presenting condition from the patient's perspective. This is an important and often neglected aspect of the overall assessment of the health of patient on presentation. An understanding of these deficits is critical for effective planning of treatment and evaluation of treatment effectiveness.

A randomised double-blind placebo-controlled trial of phenylethylmalonamide, the major metabolite of primidone was performed in eight patients with essential tremor. Phenylethylmalonamide was given in a daily dose of 400 mg for one week and 800 mg for a second week. The compound had no statistically significant effect on the amplitude of tremor assessed by an accelerometric method, tests of performance, clinical evaluation and patient self assessment. No side effects occurred. Serum levels of phenylethylmalonamide on a daily dose of 400 mg were 11-27 micrograms/ml and on 800 mg daily were 16-48.5 micrograms/ml.