Search

Abstract Background Deprescribing of potentially inappropriate medications is recommended for older adults and may improve health outcomes and quality of life in persons living with Parkinson disease (PD). Patient attitudes, beliefs, and preferences play a crucial role in the success of deprescribing interventions. We aimed to examine the attitudes and beliefs about medication burden and deprescribing among persons living with PD. Methods We administered a survey to participants of Fox Insight, a prospective longitudinal study of persons living with PD. The survey included the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire and additional questions about adverse drug effects. We used logistic regression models to explore potential predictors of treatment dissatisfaction and willingness to deprescribe. Results Of the 4945 rPATD respondents, 31.6% were dissatisfied with their current medications, and 87.1% would be willing to deprescribe medications. Male sex was associated with a greater willingness to deprescribe (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.37–1.93). A greater belief that the medication burden was high or that some medications were inappropriate was associated with treatment dissatisfaction (aORs 3.74, 95% CI 3.26–4.29 and 5.61, 95% CI 4.85–6.50), and more willingness to deprescribe (aORs 1.74, 95% CI 1.47–2.06 and 2.87, 95% CI 2.41–3.42). Cognitive impairment was the adverse drug effect participants were most concerned about when prescribed new medications to treat nonmotor symptoms. Conclusions Persons with PD are often dissatisfied with their overall medication load and are open to deprescribing. Medications that are associated with cognitive impairment might be prioritized targets for deprescribing interventions in this population.

Background: Deprescribing of potentially inappropriate medications is recommended for older adults and may improve health outcomes and quality of life in persons living with Parkinson disease (PD). Patient attitudes, beliefs, and preferences play a crucial role in the success of deprescribing interventions. We aimed to examine the attitudes and beliefs about medication burden and deprescribing among persons living with PD. Methods: We administered a survey to participants of Fox Insight, a prospective longitudinal study of persons living with PD. The survey included the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire and additional questions about adverse drug effects. We used logistic regression models to explore potential predictors of treatment dissatisfaction and willingness to deprescribe. Results: Of the 4945 rPATD respondents, 31.6% were dissatisfied with their current medications, and 87.1% would be willing to deprescribe medications. Male sex was associated with a greater willingness to deprescribe (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.37–1.93). A greater belief that the medication burden was high or that some medications were inappropriate was associated with treatment dissatisfaction (aORs 3.74, 95% CI 3.26–4.29 and 5.61, 95% CI 4.85–6.50), and more willingness to deprescribe (aORs 1.74, 95% CI 1.47–2.06 and 2.87, 95% CI 2.41–3.42). Cognitive impairment was the adverse drug effect participants were most concerned about when prescribed new medications to treat nonmotor symptoms. Conclusions: Persons with PD are often dissatisfied with their overall medication load and are open to deprescribing. Medications that are associated with cognitive impairment might be prioritized targets for deprescribing interventions in this population. [ABSTRACT FROM AUTHOR]

Generic and heart failure-specific measures do not capture unique aspects of living with a ventricular assist device (VAD). Using state-of-the-science psychometric measurement methods, we developed a measurement system to assess post-ventricular assist device adjustment and health-related quality of life (HRQOL). Patients were recruited from 10/26/16-2/29/20 from 12 U.S. VAD programs. We created a dataset of participants (n = 620) enrolled before left (L)VAD implantation, with data at 3- or 6- months post-implantation (group1 [ n = 154]), and participants enrolled after LVAD implantation, with data at one timepoint (group 2 [ n = 466]). We constructed 5 item banks: 3 modified from existing measures and 2 new measures. Analyses included item response theory (IRT) modeling, differential item functioning tests for systematic measurement bias, and indicators of reliability and validity. Of 620 participants, 56% (n = 345) were implanted as destination therapy, 51% (n = 316) were <12 months post-implantation, mean age = 57.3 years, 78% (n = 485) male, 70% (n = 433) White, 58% (n = 353) married/partnered, and 58% (n = 357) with >high school education. We developed 5 new VAD item banks/measures: 6-item VAD Team Communication; 12-item Self-efficacy Regarding VAD Self-care; 11-item Being Bothered by VAD Self-care and Limitations; 7-item Satisfaction with Treatment; and 11-item Stigma. Cronbach's alpha reliability ranged from good (≥0.80) to excellent (≥0.90) for item banks/measures. All measures, except VAD Team Communication, demonstrated at least moderate correlations (≥0.30) with construct validity indicators. These measures meet IRT modeling assumptions and requirements; scores demonstrate reliability and validity. Use of these measures may assist VAD clinicians to inform patients about VADs as a treatment option and guide post-VAD interventions. [ABSTRACT FROM AUTHOR]

Introduction: Patient satisfaction with mental health services has for several decades been considered an important component when evaluating service quality. It is often assessed in the context of monitoring quality of care, developing or evaluating newly implemented interventions or changes in practice. Because of this, patient satisfaction questionnaires are often added to longer questionnaire batteries, and shorter questionnaires are preferred to prevent respondent fatigue and non-compliance and to secure easy implementation. However, most studies use unvalidated patient satisfaction measures, making comparisons between studies difficult. Validation studies of short patient satisfaction measures are therefore warranted. Methods: The primary aim was to examine the construct validity and internal reliability of the Client Satisfaction Questionnaire-4 (CSQ-4) in a Norwegian outpatient mental health setting. A total of 467 patients were recruited from an outpatient psychiatric care clinic in Central Norway. The secondary aim was to examine an earlier proposed cutoff for classifying dissatisfied patients in this new population. A principal component analysis was conducted to evaluate factor structure, correlation analyses were conducted to test for predicted relationships, and Cronbach's alpha was calculated to examine internal reliability. Results: The CSQ-4 showed a clear unidimensional structure with one factor explaining 80% of its variance. Its internal reliability was very high, with a Cronbach's alpha of 0.92. As hypothesised this study found no statistically significant sex differences in satisfaction and no statistically significant association between age and satisfaction. Positive changes in symptoms during treatment and higher post-treatment functional impairment were associated with higher patient-reported treatment satisfaction scores, which indicates good construct validity. Conclusion: This is the first study to evaluate the CSQ-4 in a psychiatric population. The CSQ-4 demonstrated good structural validity and internal reliability and was correlated with outcome variables in terms of symptom change and post-treatment functioning. In sum, this indicates that the CSQ-4 is a good short alternative for evaluating patient satisfaction in routine outpatient mental health care. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) is one of the most effective forms of therapy of severe psychiatric conditions. ECT is often perceived negatively by the general public, however the negative perspective of ECT is in contrast with a real perspective of ECT by patients themselves and their relatives. In this study we have observed patients (N=67) and their relatives - mostly family members (N=50), who have been treated with ECT at the Department of Psychiatry, First Faculty of Medicine and General University Hospital in Prague. Both groups have filled a questionnaire after finishing the treatment (series of ECT), which evaluated the effectivity, awareness, and possible pressure to undergo the treatment. Part of the questionnaire was also to evaluate side effects and willingness to repeat ECT again in the future, if indicated. Most of the patients (over 80%) were content with the treatment, they considered it effective, and they were not afraid to undergo ECT again, despite approximately one third of the group reporting to experience some form of mild adverse effects. Patients' relatives had also similarly positive attitude towards ECT, which was used to treat their close ones. Positive feedback from patients themselves and their relatives can help to reduce the stigmatization of ECT, which can help future patients. [ABSTRACT FROM AUTHOR]

Copyright of Long-Term Care Nursing / Pielegniarstwo w Opiece Dlugoterminowej is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Validated measures of patient-reported experiences are essential for assessing and improving the quality of mental health services and interventions. In Norwegian mental healthcare settings, the Client Satisfaction Questionnaire (CSQ-8) is increasingly being used for this purpose, but the validity and reliability of the Norwegian translation have not been investigated. Methods: We examined the factor structure and internal consistency of a digitally administrated Norwegian translation of the CSQ-8 in a sample of 338 patients recruited from outpatient treatment. The relationship between satisfaction scores and the change in symptom severity during treatment, measured by the Patient Health Questionnaire-4, was also investigated. Results: The Norwegian CSQ-8 showed a clear unidimensional structure with one factor explaining 74% of the variance. Internal consistency was very high, with a Cronbach's alpha of 0.95. Satisfaction showed a small-to-moderate negative relationship with change in symptom severity. Satisfaction scores were negatively skewed, and the presence of ceiling effects is discussed. Conclusion: Our results support the use of the Norwegian CSQ-8 as a valid and reliable measure of satisfaction with mental healthcare services. Further studies are needed to determine the test-retest reliability of the questionnaire, its sensitivity to change, and to assess its propensity to ceiling effects. [ABSTRACT FROM AUTHOR]

Patient's satisfaction with treatment is a fundamental indicator of the quality of medical care, which is especially important for assessing the effectiveness of therapy for musculoskeletal pain in rheumatic diseases (RD).Objective: to determine satisfaction of patients with RD with pain relief therapy and to analyze the factors influencing the subjective assessment of analgesic therapy.Patients and methods. Anonymous survey of 1040 patients (age 55.8±14.0 years, 76.8% were women) with RD, rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis, systemic connective tissue diseases and gout, was carried out. The presence of pain and its therapy, satisfaction with treatment, and patient's opinion about the reasons of low pain relief effectiveness were assessed. The dependence of the presence of dissatisfaction with treatment on a number of demographic and clinical factors was analyzed.Results and discussion. 71.5% of patients experienced pain in one or more joint areas and/or in the back. 70.6% of patients used non-steroidal antiinflammatory drugs (NSAIDs), 1.6% – paracetamol, 40.0% – non-drug modalities and methods of alternative medicine. 15.6% of the respondents were completely satisfied with the treatment, 64.0% were partially satisfied, and 20.4% were completely dissatisfied. The main subjective reasons for the insufficient effectiveness of analgesic therapy were: fear of taking prescribed medications due to possible complications (45.4%), low effectiveness of drugs (15.7%), insufficient attention of doctors (20.3%). Male gender, body mass index >30 kg/m2 , severe pain, pain in several areas, and the diagnosis of OA were statistically significantly associated with treatment dissatisfaction. In contrast, patients with RA showed greater satisfaction with treatment.Conclusion. Most patients with RD are dissatisfied with the results of pain therapy. Educational work with patients and a personalized approach to prescribing analgesic therapy is needed.

Low back pain is a highly disabling health condition that generates high costs for patients and healthcare systems. For this reason, it is considered a serious public health problem worldwide. This pilot study aimed to assess the feasibility of a future randomized controlled trial (RCT) by evaluating adherence to treatment, contamination between groups, satisfaction with treatment, and understanding of the exercise instructions provided by the physiotherapist. Additionally, we sought to identify and implement necessary modifications to the exercise protocol for better suitability in older people. We conducted a prospective, registered pilot RCT comparing an 8-week group-based exercise program with a waiting list in older people (≥60 years old) with chronic low back pain. Sixty participants were recruited through social media, pamphlets, and invitations at community referral centers. The study demonstrated the feasibility of a full RCT. Participants reported high satisfaction with the treatment (i.e., 100% indicated willingness to return for future services) and a high understanding of the exercise instructions (i.e., 81.8% reported "very easy" comprehension). Adherence to the exercise program exceeded the average reported for group exercise interventions in older adults (i.e., 82.58%). Dropout was associated solely with preexisting physical activity levels. The exercise protocol was successfully adapted to better suit the needs of the older adult population. This pilot RCT demonstrates the feasibility of a full-scale RCT to evaluate the effectiveness of group exercise in improving pain intensity and disability in older adults with chronic low back pain. The implemented adjustments to the exercise protocol and overall study approach strengthen the methodological foundation and expected accuracy of the future RCT.

Background: The satisfaction with life and, in particular, with treatment in Parkinson's disease (PD) is understudied. Objective: To explore a new 7-item rating tool assessing satisfaction with life and treatment (SLTS-7) in PD. Methods: In this cross-sectional, multi-center study, including patients screened for advanced therapies, psychometric characteristics of the SLTS-7 were analyzed. An exploratory factor analysis identified the underlying factorial structure of the SLTS-7. Results: 117 patients were included, and the data quality of the SLTS-7 was excellent (computable data 100%), and acceptability measures satisfied standard criteria. Besides the global assessment (item 1), the exploratory factor analysis produced item 2 (physical satisfaction) as an independent item and two factors among the remaining items: items 3–5 (psycho-social satisfaction), and items 6 and 7 (treatment satisfaction). Cronbach's alpha was 0.89, indicative of high internal consistency. The SLTS-7 total score correlated moderately with motor symptoms and weakly with non-motor symptoms total scores. SLTS-7 showed the highest correlations with the European Quality of Life with 5 items (EQ-5D) visual analog scale (0.43–0.58, p < 0.01), indicating a moderate convergent validity. The SLTS-7 significantly increased with higher non-motor symptoms burden levels (p = 0.002). Conclusion: Life satisfaction in PD covers three specific aspects, namely physical, psycho-social, and treatment satisfaction. The new SLTS-7 is a valid, reliable, and easy-to-use tool to assess satisfaction with life and treatment in patients with PD screened for advanced therapies. Longitudinal studies analyzing the effect of advanced PD treatment on life and treatment satisfaction are warranted. [ABSTRACT FROM AUTHOR]

Saul Alcaraz,1 Carme Viladrich,2 Joan Trujols,1,3 Núria Siñol,1 José Pérez de los Cobos1,3,4 1Addictive Behaviors Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; 2Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; 3Biomedical Research Networking Center on Mental Health (CIBERSAM), Madrid, Spain; 4Department of Psychiatry and Legal Medicine, School of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain Purpose: The aim of the present study was to test a structural equation model of patient satisfaction with different key facets of methadone maintenance treatment (MMT). In this model, the three dimensions of patient satisfaction with methadone as a medication (ie, personal functioning and well-being, anti-addictive effect on heroin, and anti-addictive effect on non-opioid substances) were expected to predict satisfaction with the basic interventions delivered by the staff of treatment centers to implement MMT.Patients and methods: A sample of 210 heroin-dependent patients, resistant to MMT treatment (mean age =41.66 years, SD =6.50; 75.7% male), participated voluntarily in this study. Preliminary analysis based on exploratory structural equation modeling supported the expected three-factor measurement model of the scale to assess satisfaction with medications for addiction treatment – methadone for heroin addiction. Moreover, the 15 items measuring staff’s basic interventions were shown to be compatible with the expected single-factor measurement model. Then, both measurement models were included in a structural model.Results: Results of this model show that patient satisfaction with the compatibility of methadone with personal functioning and well-being, as well as with the anti-addictive effects of methadone on non-opioid substances, predicts satisfaction with basic interventions conducted at methadone treatment centers (β=0.191 and β=0.152, respectively).Conclusion: Our results provide further understanding regarding patient satisfaction with MMT, which could help professionals to better understand patient perspective and experience during MMT. Keywords: exploratory structural equation modeling, satisfaction with medication, satisfaction with treatment, treatment quality, methadone non-responders

Background: Maintenance of stable glycemic control is an important prerequisite of effective treatment of patients with type 1 diabetes mellitus (DM). The ultra-long-acting basal insulin degludec allows for reduction of glycemic variability and for a substantial reduction in the rates of hypoglycemia with equivalent glycemic control. Evaluation of the impact of this novel insulin on diabetes-dependent quality of life and patient satisfactions with the treatment is necessary for comprehensive assessment of treatment efficacy.Aim: To study changes of glycated hemoglobin (HbA1c), rates of hypoglycemia, diabetes-dependent quality of life and treatment satisfaction in patients with type 1 DM, who have been switched to insulin degludec.Materials and methods: This open 12-week observational comparative study included 25 patients with type 1 DM (median age, 36 [20; 63] years), who were switched to insulin degludec in combination with a ultra-short insulin analogue. The control group included 21 patients with type 1 DM (median age, 40 [23; 63] years), who continued their treatment with a long-acting insulin analogue glargine. At baseline and at week 12 after switching to insulin degludec, we assessed HbA1c level, mean insulin dose, depression score, diabetes-dependent quality of life and patient satisfaction with the treatment with the use of the Russian versions of the diabetes-specific questionnaires “Audit of Diabetes-Dependent Quality of life” (RuADDQoL), and “Diabetes Treatment Satisfaction Questionnaire” (DTSQ), respectively.Results: At 3 months, there was a significant reduction of the HbA1c levels in the main and the control groups to 7.57% (Ме 7.5 [7.1; 8.4]; р=0.03) and 8.18% (Ме 7.8% [7.4; 8.7]; р=0.04), respectively. The mean reduction of this parameter under treatment with degludec was slightly higher than under treatment with glargine (0.73 vs 0.57%, respectively), at 3 months the difference being statistically significant (p=0.034). To achieve an equivalent glycemic control, the mean daily dose of insulin degludec was reduced by 26%. Switching to insulin degludec was associated with a significant reduction in non-severe hypoglycemia rates by 45% (р

Introduction . Atopic dermatitis is a frequent chronic skin disease in children. The major clinical manifestations include itching and dryness of the skin. The pathomechanism of skin changes results from an interaction of genetic and environmental factors as well as impairments of skin barrier function and immune response. Despite chronic treatment the disease is characterized by exacerbation and remission periods and lowers the quality of life of patients and their families. Objective. To evaluate treatment satisfaction in children with atopic dermatitis, identify components of medical care which contribute to treatment satisfaction, and evaluate the relationship between satisfaction and adherence to a doctor’s recommendations. Material and methods. One hundred and nineteen children (6 months to 12 years old, mean age 4.9 years) with atopic dermatitis were enrolled in the study. The doctor performed physical examinations and history taking and filled in questionnaires evaluating the course and exacerbation of the disease, the type of administered therapy and diagnostics. The patients’ parents completed two questionnaires: a questionnaire assessing satisfaction with the therapy (the type of recommended therapy, adherence to recommendations, contact with the doctor, obtained information, degree of psychological support, role of parents in taking decisions regarding the therapy) and a quality of life questionnaire. Results. The authors observed that 56% of parents were dissatisfied with the administered treatment, and 40% failed to adhere to at least one therapeutic recommendation. Parents of children with mild atopic dermatitis significantly more often stop using emollients. It was also observed that lack of treatment satisfaction in children with severe atopic dermatitis whose parents are insufficiently educated contributes to decreased adherence. The authors identified independent factors of lack of treatment satisfaction: failure to obtain enough psychological support (OR = 20.00), failure to obtain reliable information on the disease (OR = 5.91), failure to actively get engaged in the treatment procedure (OR = 5.31), dissatisfaction with the contact with the doctor (OR = 4.9), dissatisfaction with the diagnostics (OR = 4.93) and severe course of the disease (OR = 2.82). Conclusions . Elimination of risk factors of dissatisfaction with the treatment might potentially improve the adherence to chronic treatment in atopic dermatitis.

Treatment satisfaction, which refers to the positive appraisal of process and outcome attributes of a treatment, is a prominent indicator of quality care. Although it is known that participant, treatment, and outcome factors influence treatment satisfaction, it remains unclear which factors contribute to satisfaction with each process and outcome attribute. In this study, we examined the extent to which participant (age, gender, education, race, employment), treatment (type of therapy, method of assignment to therapy), and outcome (self‐reported improvement in outcome) factors contribute to satisfaction with the process and outcome attributes of therapies for insomnia. This study consists of a secondary analysis of data obtained from a partially randomized preference trial in which persons with chronic insomnia (N = 517) were assigned to treatment randomly or by preference. Four types of behavioral therapies were included: sleep hygiene, stimulus control therapy, sleep restriction therapy, and multi‐component therapy. Self‐reported improvement in insomnia and satisfaction were assessed with validated measures at post‐test. Multiple regression analysis was used to examine which factors influenced satisfaction with each treatment attribute. The findings showed that treatment and outcome, more so than participant, factors influenced satisfaction with the process and outcome attributes of the behavioral therapies for insomnia. Future research on satisfaction should explore the contribution of treatment (type and preference‐matching) and outcome factors on satisfaction to build a better understanding of treatment attributes viewed favorably. Such understanding has the potential to inform modifying or tailoring treatments to improve their acceptance to participants and optimize their effectiveness. [ABSTRACT FROM AUTHOR]

Aims: The clinical management and care of patients with an implantable cardioverter defibrillator (ICD) has shifted from face-to-face in-clinic visits to remote monitoring. Reduced interactions between patients and healthcare professionals may impede patients' transition to adapting post-implant. We examined patients' needs and preferences for information provision and care options and overall satisfaction with treatment.Methods and Results: Patients implanted with a first-time ICD or defibrillator with cardiac resynchronization therapy (n = 389) within the last 2 years at Odense University Hospital were asked to complete a purpose-designed and standardized set of questionnaires. The level of satisfaction with information provision was high; only 13.1% were dissatisfied. Psychological support for patients (39.9%), their relatives (43.1%), and deactivation of the ICD towards end of life (47.8%) were among the top five topics that patients reported to have received no information about. The top five care options that patients had missed were talking to the same healthcare professional (75.2%), receiving ongoing feedback via remote monitoring (61.1%), having a personal conversation with a staff member 2-3 weeks post-implant (59.6%), having an exercise tolerance test (52.5%), and staff asking how patients felt while hospitalized (50.4%). Patients with a secondary prevention indication and cardiac arrest survivors had specific needs, including a wish for a psychological consult post-discharge.Conclusion: Despite a high satisfaction level with information provision, particular topics are not broached with patients (e.g. device activation) and patients have unmet needs that are not met in current clinical practice. [ABSTRACT FROM AUTHOR]

Background: In a patient population with a limited life expectancy, malignant pleural effusion can significantly impact quality of life (QoL). Different treatment options are available, each with its own effect on QoL. T o date, satisfaction with treatment options has not been evaluated. Purpose: T o evaluate QoL and satisfaction with treatment using patient-reported outcomes for four different treatment strategies. Design: A prospective, cohort study that compared four treatment options: indwelling pleural catheter (IPC); video assisted thoracic surgery (VATS) and IPC; chest tube and talc slurry; and VATS talc poudrage. Setting: A total of 104 participants were treated across four acute care teaching hospitals in a large Canadian city. Measurements: Patient-reported outcomes were assessed using functional assessment of chronic illness therapy--palliative (FACIT--PAL), London Chest Activity of Daily Living scale and FACIT--treatment satisfaction questionnaires. Results: No significant difference was identified between the four treatments based on patient-reported outcomes. VATS talc poudrage provided the most durable improvement. At the 6-week post-treatment time point, the highest patient satisfaction was noted in patients who received VATS and talc pleurodesis, lowest satisfaction in patients with chest tube and talc pleurodesis; however, the differences were not statistically significant (p=0.20). VATS and talc pleurodesis had the highest scores at 6 weeks for recommendation of treatment to others; however, the comparison with other treatment groups was not statistically significant (p=0.22). For FACIT -PAL, total scores when analysed as one group, there was a statistically significant increasing trend (indicating improvement) (p<0.0001). Breathlessness, measured using the London Chest Activity of Daily Living scale, indicated a statistically decreasing trend, suggesting an improvement (p=0.0003). There was no statistically significant difference in trends over time between the four treatment groups. Conclusions: While all treatment options addressed the patients' symptoms and relieved dyspnoea, an IPC offered effective treatment with minimal discomfort and time in hospital yet still high satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of Dermatology Review / Przeglad Dermatologiczny is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inadequately controlled postoperative pain (POP) subjects individuals to complications which may be fatal or leading to prolonged hospital stay. Complications from inadequately controlled POP may alleviate the existing shortage of hospital human resource for health in health facilities in developing countries. The burden and challenges of POP management at health facilities in Tanzania is not known. This study was therefore carried out to evaluate postoperative pain management and patient satisfaction with care given at Kilimanjaro Christian Medical Centre (KCMC). This descriptive prospective hospital based study, was conducted at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania from August 2011 to March 2012. POP and patients' satisfaction with pain relief scores were assessed using pain and satisfaction numerical rating scales. Pain assessment was done at 24 hours and 48 hours after operation. Satisfaction was assessed on 48 hours post surgery. All adult patient aged 18 years and above whom were operated in general surgery ward, KCMC and accepted by signing consent were involved in the study. Patients suffering from nervous system were excluded from the study. A total number of 124 patients were recruited and participated in the study. Sixty-five (52.4%) were males and 59 (47.6%) females. Mean age (SD) years 40.9 ± 15.4. The largest percentage of individuals had mild pain both at rest (45.2%) and during movement (44.4%). Patients whose analgesia was administered intravenously were more likely to be satisfied with POP management than those given intramuscular analgesics (P= 0.028). Analgesia used in combination increased significantly the proportion of pain free individuals 48 hours postoperative compared to 24 hours postoperative (P= 0.003). In conclusion, the postoperative pain management is still a challenge in our centre as nearly half of the patient had mild pain in the first 48 hours post surgery. [ABSTRACT FROM AUTHOR]

Participants with symptoms of depression received either eight sessions of therapist-delivered email cognitive behaviour therapy (eCBT; n=37), or eight sessions of computerised CBT self-administered treatment (cCBT; n=43). At post-treatment participants completed a questionnaire to determine what they found satisfying about their online treatment. Quantitative and qualitative analysis was employed to report outcomes. A sample of 25 participants(eCBT n=10; cCBT n=15) completed the satisfaction questionnaire. Both groups were satisfied with accessing and using an online treatment and that they had self-control over their treatment. Perceived anonymity was important for the eCBT group. For the cCBT group they found the treatment user-friendly, engaging and also a source of learning. Both groups disliked that the online treatment could at times be complicated and impersonal. [ABSTRACT FROM AUTHOR]

Introduction. This study evaluates the functional outcomes and satisfaction of an initial series of 47 patients after radical perineal prostatectomy performed in our department. Material and methods. The first set of 47 consecutive patients underwent perineal prostatectomy during 2008 and 2009. Continence, sexual outcomes, and satisfaction of the treatment were evaluated using a self-reporting questionnaire, which was mailed to all patients after 15 to 33 months of follow-up. 26 patients (55.3%) returned a completed form and participated in the study. Additionally, final outcomes were compared to results reported elsewhere. Results. Amid respondents, 91.7% were satisfied with the chosen treatment and 8.3% regret the previous decision. 38.5% patients reported any urine leakage, 15.4% drip up to 100 ml a day, and only one patient (3.8%) was totally incontinent. 76.9% men report a decline in prior sexual function. Six patients (23.1%) patients have any degree of spontaneous erections and undertake sexual activity. However, as erectile outcomes are adjusted to nine nerve-sparing cases, 66.7% have spontaneous erections and 55.5% undertake sexual activity, but only 40% of them describe their sexual function as satisfying. Conclusions. Our survey demonstrates that, because of short operating time, fast recovery, low postoperative pain score, early patient mobilization and feeding, and a small (8-10 cm) and inconspicuous skin incision, radical perineal prostatectomy fully deserves to be recognized as a low-morbidity procedure. The perineal approach provides a quality of life and patients satisfaction rate comparable to trendy, highly equipped procedures and emerges as an attractive alternative to them. Even novice "perineal surgeons" may achieve favorable results. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patients’ satisfaction with methadone maintenance treatment (MMT) is a key measure of treatment quality. The main objective of the present study is to identify independent factors that contribute significantly to satisfaction with MMT. Method: Participants were a representative sample of methadone-maintained patients (n =123) from the region of La Rioja. Satisfaction with MMT was assessed with the Verona Service Satisfaction Scale for Methadone Treatment (VSSS-MT), and mental health status with the General Health Questionnaire-28 (GHQ-28). Multivariate linear- and logistic-regression analyses were performed to identify variables independently associated with satisfaction with MMT. Results: Multiple linear regression analysis revealed that the variables independently associated with VSSS-MT total score were number of hours per week that the centre dispensed methadone (β =0.193), number of patients per centre (β =0.233), perceived frequency of receiving information about methadone dose changes (β =0.246), perceived influence on these changes (β =0.194), and Social Dysfunction subscale of GHQ-28 (β =−0.179). Multivariate binary logistic regression showed that the variables independently associated with the likelihood of being satisfied with MMT were number of years of education completed (OR=0.835), number of patients per centre (OR=1.009), perceived frequency of receiving information about methadone dose changes (OR=1.571), and Social Dysfunction subscale of GHQ-28 (OR=0.748). Conclusions: Patients from larger centres, who perceive themselves as participating to some extent in treatment decisions, and showing lower deterioration in social functioning are more likely to be satisfied with MMT. [Copyright &y& Elsevier]

( Headache 2011;51:590-601) The objective of the nationwide EXPERT survey carried out in France in 2005 was to compare satisfaction with treatment with treatment effectiveness in migraine patients consulting general practitioners (GPs) for migraine, and to establish an instrument to easily evaluate the adequacy of acute treatment of migraine. Many migraine patients feel satisfied with their current acute treatment of migraine whereas objective evaluation reveals poor treatment effectiveness. A total of 2108 GPs included 11,274 migraine patients. Satisfaction with treatment was evaluated using a 4-point verbal scale and a 10-cm visual analog scale (VAS). Treatment effectiveness was assessed by the 4-item questionnaire designed by the French Medico-Economic Evaluation Service (ANAES) and the French Society for the Study of Migraine Headache (SFEMC). In total, 5224 patients (49.8%) stated that they were satisfied with their treatment. Mean VAS score was 5.1. Only 17% of patients (1789/10,539) gave positive responses at the 4 questions of the ANAES/SFEMC questionnaire. VAS score was high for patients satisfied with their treatment and with good treatment effectiveness. Two VAS thresholds were determined using receiver operating characteristic curves that allowed easy identification, with high sensitivity and specificity, of patients satisfied/dissatisfied with their current treatment and with good/poor treatment effectiveness. Based on EXPERT data, this instrument showed that only 16% of patients using triptans (597/3719) were dissatisfied and reported poor treatment effectiveness, whereas treatment was inadequate for 63% of those using aspirin or nonsteroidal anti-inflammatory drugs (1882/2992), 74% of those using paracetamol or other analgesics (2229/2998), and 53% of those using ergotamine (253/474). The new instrument should allow easy identification in general practice of the patients receiving an effective or ineffective acute treatment of migraine and thus facilitate the implementation of treatment guidelines for migraine. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and tolerability of a contraceptive vaginal ring and transdermal patch in the treatment of endometriosis-associated pain. Design: Patient preference cohort study. Setting: Academic center. Patient(s): Two-hundred and seven women with recurrent moderate or severe pelvic pain after conservative surgery for symptomatic endometriosis. Intervention(s): Continuous, 12-month treatment with a vaginal ring supplying 15 mcg of ethinyl E and 120 mcg of etonogestrel per day or a transdermal system delivering 20 mcg of ethinyl E and 150 mcg norelgestromin per day. Main Outcome Measure(s): Satisfaction with treatment. Result(s): One-hundred and twenty-three women preferred the ring, and 84 preferred the patch. Forty-four ring users (36%) and 51 patch users (61%) withdrew. Thirty-six of 79 subjects (46%) in the ring group and 14 of 33 (42%) in the patch group shifted from continuous to cyclic use because of irregular bleeding. Pain symptoms were reduced by both treatments, with the ring being more effective than the patch in patients with rectovaginal lesions. According to an intention-to-treat analysis, 88 of 123 ring users (72%) and 40 of 84 patch users (48%) were satisfied with the treatment received. Conclusion(s): Patients who preferred the ring were significantly more likely to be satisfied and to comply with treatment than those who chose the patch. Both systems were associated with poor bleeding control when used continuously. [Copyright &y& Elsevier]

Objective: To assess individualized satisfaction with migraine treatment, patient expectations, importance rankings, treatment outcomes, and overall satisfaction were combined using a four-part conceptual model. This article describes the measurement properties of the Migraine Treatment Satisfaction Measure (MTSM) using participants from a randomized controlled trial evaluating a Headache Management Program (HMP). Methods: Participants completed the first two parts of the MTSM upon enrollment and the final two parts at 6 months. Internal consistency reliability was computed within each of the four modules. Discriminant validity was ascertained using Migraine Disability Assessment Survey (MIDAS), Patient Health Questionnaire-9, and MSFB scores. Convergent validity was established by hypothesized positive correlations between MTSM scores, Medical Outcomes Study Short-Form (SF-36), MIDAS, and Migraine Symptom Frequency Bother (MSFB). Results: In total, 124 participants (mean age 45.4 years, 75% women, 59.7% Caucasian) enrolled. Internal consistency for expectations, importance rankings, outcomes, and satisfaction measures was 0.83, 0.95, 0.86, and 0.95, respectively. As the severity of depression increased, MTSM scores decreased significantly. ANOVA between MTSM scores and symptom bothersomeness and symptom frequency tertiles showed a significant decrease in satisfaction in the moderate-to-severe groups. MTSM scores showed expected associations with MSFB scores (−0.301; P < 0.01), MIDAS (−0.267; P < 0.01), general health (0.253; P < 0.05), mental health (0.217; P < 0.05), and vitality subscales of SF-36 (0.214; P < 0.05). Patients in the HMP reported significantly higher MTSM scores (43.2 vs. 31.4; P < 0.001). Patients on triptans reported a significantly higher satisfaction compared to patients on analgesics (39.5 vs. 32.9; P < 0.05). Conclusion: The MTSM is a valid and reliable patient-reported outcome that can be used to evaluate differences in treatment satisfaction associated with migraine therapies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The activity of cytochrome P-450 enzyme 2D6 (CYP2D6) could be related to heroin-dependent patient satisfaction with methadone maintenance treatment. We sought to compare satisfaction with the usual methadone treatment in patients who are ultrarapid, extensive or poor metabolizers, according to CYP2D6 genotyping. Methods: Two hundred and five heroin-dependent patients filled out the Verona Service Satisfaction Scale for methadone maintenance treatment (VSSS-MT), before CYP2D6 genotyping. Results: VSSS-MT overall scores were comparable in the poor metabolizer (N =9) and extensive metabolizer (N =185) groups, although they were higher in poor metabolizers and extensive metabolizers taken together than in the ultrarapid metabolizers (N =11) (p <0.003). Likewise, ultrarapid metabolizers scored higher than the rest of the sample on the VSSS-MT Basic Interventions subscale (p <001). Regarding this subscale, no poor metabolizers felt dissatisfied, and ultrarapid metabolizer males (N =7) reported lower satisfaction than ultrarapid metabolizer females (N =4) (p <0.022). Ultrarapid metabolizer genotype accounted for 4.2% of the variance on the VSSS-MT total scores, and 5.0% on the Basic Intervention scores. Conclusion: Heroin-dependent patients who are CYP2D6 ultrarapid metabolizers according to genotyping present deficient satisfaction with methadone maintenance treatment. [Copyright &y& Elsevier]

Background: Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples. Methods: Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes. Results: Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence. Satisfaction with treatment and affiliation with Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence. Conclusion: Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to document the satisfaction with pain management in a Spanish inpatient population and its relationship with pain ratings. Two hundred fifty inpatients of four departments were interviewed: Surgery, Orthopedics, Gynecology, and Internal Medicine. A 32-item questionnaire was used, and the main variables evaluated were pain severity, dissatisfaction with pain management and caregivers, and patient expectations regarding pain relief. Relationships among the variables were analyzed by means of Spearman''s correlation between item scores and regression analysis. Median satisfaction scores were consistent with “very satisfied.” Mean (SD) worst pain during the past 24 hours was 68.8 (27.5) on a 100mm visual analogue scale. “Dissatisfaction with Pain Management” correlated positively with “Dissatisfaction with Medical Staff” (0.42), and inversely with “Pain Now” (−0.41) and “Expected Pain Relief” (−0.38). Regression analysis showed that “Dissatisfaction with Pain Management” was dependent on “Pain Now,” “Least Pain,” and “Dissatisfaction with Medical Staff,” with statistically significant beta weight values of 0.277, 0.197, and 0.280, respectively. The study shows that patients were highly satisfied with pain management, even when they were in pain. Moreover, it establishes that patient dissatisfaction with treatment was highly related to the satisfaction with caregivers and pain intensity. [Copyright &y& Elsevier]

Copyright of Adicciones is the property of Sociedad Cientifica Espanola de Estudios sobre el Alcohol and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Desired adjustment of methadone dose, perceived participation in dosage regulation, and satisfaction with methadone treatment centres were assessed in a sample of opioid-dependent patients from the Valencia Region (eastern Spain). An independent interviewer asked 278 consecutively arriving patients to answer the survey, and 165 (59.4%) completed it. Adjustment of methadone dose was assessed with a −10 to +10 visual analogue scale (VAS-MD); participation in methadone dose regulation, with specific questions; and patient satisfaction, with the Verona Service Satisfaction Scale for methadone treatment (VSSS-MT). The methadone dose (mg/d) prescribed by physicians was (mean±S.D.) 68.0±30.4. Participants scored −1.0±4.7 on the VAS-MD, indicating a significant downward desired adjustment of methadone dose (95% CI of −1.73 to −0.30). Of the patients surveyed, approximately one-third were, overall, content with their participation in methadone dose regulation. Overall, participants felt slightly satisfied (VSSS-MT=3.5±0.6) with the centres. Patients treated with a methadone dose of &#60;60mg/d felt more satisfied than those treated with 60–100mg/d. Information about dose changes was the only continuous methadone dose variable related with satisfaction that was found in a multiple regression analysis, which accounted for only 2.0% of the variance in VSSS-MT overall scores. In conclusion, patients’ opinions on methadone dose and patient satisfaction are only very weakly related when methadone treatment is implemented as in the Valencia Region. [Copyright &y& Elsevier]

A survey was carried out to evaluate the satisfaction with methadone treatment centres of methadone-maintained opioid-dependent patients from Spain. Independent interviewers asked 505 consecutively arriving clients from 20 randomly selected centres (14 conventional centres, two bus units, and four prisons) to participate; 370 (73.3%) clients agreed to fill out the questionnaire, and 351 (69.5%) completed it. Satisfaction was assessed using the Verona Service Satisfaction Scale for methadone treatment (VSSS-MT). The prison sub-sample (n=43) was excluded from overall analysis because survey acceptance and satisfaction was very different in prisons than in the other centres. Mean overall satisfaction in the non-prison sub-sample (n=308) was 3.5 (S.D.=0.6) on a 1–5 point scale (1=terrible; 5=excellent). The percentage of these clients who felt dissatisfied (VSSS-MT scores: ≤3) and satisfied (VSSS-MT scores: >3) was, by category: overall satisfaction, 15.9% dissatisfied, 84.1% satisfied; basic interventions, 16.0% versus 84.0%; specific interventions, 45.4% versus 54.6%; social worker skills, 33.8% versus 66.2%; psychologist skills, 38.5% versus 61.5%. The number of hours per week that the centre dispensed methadone was the only variable able to predict satisfaction. This regression model accounted for only 2.5% of the variance in VSSS-MT overall scores. These results show that Spanish clients are slightly satisfied with conventional centres and bus units, although they fail to detect specific variables that are strongly related to that satisfaction. [Copyright &y& Elsevier]

The aim of this study was to compare two short-term treatments for alcohol-related problems. The study was performed at an outpatient clinic for substance misuse, and subjects (65 men and 28 women) were recruited through advertisements in the local newspaper. The subjects were randomized to either a four-session guided self-change group or a one-session advice group. Alcohol consumption, degree of alcohol dependence, negative consequences of drinking, and health-related quality of life were measured or assessed, respectively, by using the timeline follow-back technique, the Short Alcohol Dependence Data (SADD) questionnaire, The Drinker Inventory of Consequences questionnaire, and the Nottingham Health Profile questionnaire. Biological markers for high alcohol consumption [carbohydrate-deficient transferrin (CDT) and gamma-glutamyl transferase (γ-GT) levels] were analyzed. All assessments were made at baseline and at 9- and 23-month follow-up periods after treatment. Self-reported alcohol consumption was significantly reduced (P < .0001) in both treatment groups at the 23-month follow-up period, as were measures of alcohol dependence, negative consequences of drinking, and health-related quality of life, whereas no corresponding reduction was found in CDT or γ-GT values. No statistically significant differences in self-reported alcohol consumption were found between the two groups. Patient satisfaction was significantly higher with the four-session guided self-change treatment than with the one session of advice. This finding seems to indicate that individuals, although suffering from alcohol-related problems of relatively low severity, appreciate more time with a therapist. [Copyright &y& Elsevier]

In the present study, the equivalence of paper and pencil assessment versus computer assessment of two self-administered questionnaires was investigated by means of a randomized cross-over design. Therefore, 105 out-patients with diabetes were invited to participate; 76 patients completed both the computer and the paper and pencil version of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) in a randomized order, with a mean interval of 7 days. The scales showed high test-retest correlations and the means, dispersions, kurtosis and skewness were found to be approximately the same in both versions. In both modes of assessment, the depression and the energy scale proved to be sensitive for carry-over effects, resulting in better well-being scores at the second measurement. Almost all subjects reported that using the personal computer in the realization of a questionnaire was easy. It is concluded that the paper and pencil and the computerized versions of the WBQ and DTSQ can be considered equivalent. Therefore, the norms and cut-off scores obtained from paper and pencil assessments can be used in computerized versions of the WBQ and DTSQ and vice versa. [ABSTRACT FROM AUTHOR]

Copyright of Der Nervenarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

IntroductionDespite consistently high discontinuation rates due to withdrawal of consent (WOC) and insufficient therapeutic effect (ITE) in schizophrenia trials, insight into the underlying factors contributing to poor satisfaction with treatment and dropout is limited. A better understanding of these factors could help to improve trial design and completion rates., Methods: Using data from 1,136 trial participants with schizophrenia or schizoaffective disorder, we explored associations between predictor variables with (1) dropout due to WOC and ITE and (2) satisfaction with treatment among patients and investigators by means of hierarchic multiple regression analyses., Results: ITE was associated with poor clinical improvement, poor investigator satisfaction with treatment, and poor patient insight into their own disease, whereas WOC only showed a meaningful association with poor patient satisfaction with treatment. Investigator satisfaction with treatment appeared most strongly associated with Positive and Negative Syndrome Scale (PANSS) positive factor endpoint scores, whereas patient satisfaction with treatment was best predicted by the endpoint score on the PANSS emotional distress factor. The occurrence of severe side effects showed no meaningful association to satisfaction with treatment among investigators and patients, and neither did a patient's experienced psychopathology, nor their self-rating of functional impairment., Conclusions: Whereas trial discontinuation due to ITE is associated with poor treatment effectiveness, a patient's decision to withdraw from an antipsychotic trial remains unpredictable and may occur even when the investigator observes a global clinical improvement and is satisfied with the treatment.

The purpose of the study was to assess treatment effectiveness and satisfaction of patients with teeth hyperesthesia considering their mental state and compliance. Satisfaction and compliance of patients using for individual oral hygiene Sensodyne instant effect toothpaste and Sensodyne mouthrinse ('GlascoSmithKlein', UK) was evaluated using the methods of assessing personal response to the disease known as 'syndrome of psychosensory-anatomical and functional maladjustment' in 37 men aged 19 to 25 years suffering from hyperesthesia of the teeth without visible damage of dental hard tissues. It was established that before treatment patients with dental hyperesthesia were in a state of inadaptation. Professional oral hygiene and use of oral care products recommended by dentists resulted in a positive change in personal response to the disease. Patients remained in the state of adaptation throughout the entire study period (3 months). Patients were fully satisfied with the results of dental hyperesthesia treatment, since the values of the indicator of satisfaction with dental care at the end of the study reached 8.03 points. However, throughout the entire observation period patients compliance did not reach the required level. Patients usually followed the recommendations of the dentist in the amount of 25 to 50% of those recommended. Despite the patient's knowledge of the medical recommendations, the possibility of negative consequences if they were not fulfilled, they did not have the proper commitment to implement of medical prescriptions and did not voluntarily fully follow the treatment regimen and behavior recommended by the dentists. The results should be considered when treating patients with dental hyperesthesia.

Aims: The clinical management and care of patients with an implantable cardioverter defibrillator (ICD) has shifted from face-to-face in-clinic visits to remote monitoring. Reduced interactions between patients and healthcare professionals may impede patients' transition to adapting post-implant. We examined patients' needs and preferences for information provision and care options and overall satisfaction with treatment., Methods and Results: Patients implanted with a first-time ICD or defibrillator with cardiac resynchronization therapy (n = 389) within the last 2 years at Odense University Hospital were asked to complete a purpose-designed and standardized set of questionnaires. The level of satisfaction with information provision was high; only 13.1% were dissatisfied. Psychological support for patients (39.9%), their relatives (43.1%), and deactivation of the ICD towards end of life (47.8%) were among the top five topics that patients reported to have received no information about. The top five care options that patients had missed were talking to the same healthcare professional (75.2%), receiving ongoing feedback via remote monitoring (61.1%), having a personal conversation with a staff member 2-3 weeks post-implant (59.6%), having an exercise tolerance test (52.5%), and staff asking how patients felt while hospitalized (50.4%). Patients with a secondary prevention indication and cardiac arrest survivors had specific needs, including a wish for a psychological consult post-discharge., Conclusion: Despite a high satisfaction level with information provision, particular topics are not broached with patients (e.g. device activation) and patients have unmet needs that are not met in current clinical practice., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)