Patient satisfaction: an indicator of quality in disablement services centres. (1/188)

OBJECTIVES: To develop a patient satisfaction system for disablement services centres and to report on how the initial findings have been used in audit to improve their quality of care and services. DESIGN: Interview survey of randomly selected users attending in three centres: Birmingham (centre X), Oxford (centre Y), and Cambridge (centre Z) to establish core topics for developing a patient satisfaction questionnaire with incorporation into a computer patient satisfaction system (PATSAT) to enable collation of responses to the questionnaire. A pilot of the questionnaire was undertaken in the centres to assess the sensitivity of the questionnaire, which was subsequently used as part of clinical audit process during June 1991 and April 1992 in centre X and the patient satisfaction system used to monitor changes in routine practice. PATIENTS: 123 amputees in the development phase, selected by cluster sampling, and 1103 amputees in the pilot study. MAIN MEASURES: Satisfaction scores for components of the service. RESULTS: The questionnaire included 16 core topics contributing to quality of care and services, including comfort of limbs, appointments, interpersonal aspects of care, a system of support and counselling, and organisation. The pilot survey demonstrated high satisfaction scores for aspects of interpersonal care, organisation, and physical surroundings of the centres and lower satisfaction for counselling services, comfort of the limb and the number of alterations made before the limb was considered acceptable. During the audit in centre X these results prompted changes to care and services which produced significant improvements in satisfaction. CONCLUSIONS: The early results suggest that the questionnaire, coupled with PATSAT software system, enable users' views to be expressed, collated, and fed back to staff; the information provided has already prompted change, and the system is sufficiently sensitive to measure changes in satisfaction with the service.  (+info)

Stem length and canal filling in uncemented custom-made total hip arthroplasty. (2/188)

We reviewed 60 custom-made femoral components of two different lengths : 125 mm (group A) and 100 mm (group B), in order to investigate the relationship between stem length and canal filling in uncemented custom-made total hip arthroplasty. There were no statistical differences between the two groups in age, gender, height, body weight, canal flare index, or bowing angle of the femur. Postoperatively there was no statistical difference between the two groups in the proximal canal filling, but significant difference in the distal canal filling (75.5% vs 85.8% on the anteroposterior view and 76.0% vs 82.5% in the lateral view, P<0.001). The distal canal filling inversely correlated with the ratio of the proximal portion and the distal portion of the stem curvature on the lateral view (lateral curve ratio of the stem, P=0.002). We conclude that superior filling at both the proximal and the distal levels can be obtained by using 100-mm custom made components with a small lateral curve ratio.  (+info)

Computer assisted implantation of the femoral stem in THA - an experimental study. (3/188)

Fourteen femoral stems were implanted either manually by an experienced surgeon or by a robot in fresh human cadaveric femora. The neck-shaft angle, the anteversion, the length of the femoral neck and the gap between stem and bone was measured in each specimen. Implantation by robot showed higher precision in reconstructing the true anatomic situation as well as providing a better press fit.  (+info)

Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. (4/188)

In total hip replacement, orientation of the cup is critical to the stability of the prosthesis. A new method to determine the angle of planar anteversion is described. A simple mathematical formula uses the measurements taken from anteroposterior radiographs to calculate the planar anteversion without reference to tables or charts. An experimental study in vitro has shown the efficacy of the formula in giving results which are within a clinically acceptable range.  (+info)

Extensible endoprostheses of the humerus after resection of bone tumours. (5/188)

We carried out extensible endoprosthetic replacement of the proximal or total humerus in 18 children aged between six and 12 years, after resection of primary bone tumours mainly for osteosarcoma and Ewing's sarcoma. In 11 patients we performed 44 lengthening procedures, with an average of two per child annually and a mean total extension of 29.9 mm per patient. We were able to achieve lengthening of the operated limb with few complications and a mean functional rating of 79.3% according to the Enneking system. Progressive lengthening of these prostheses does not adversely affect the overall function of the arm, and superior subluxation of the head of the prosthesis has not been a problem.  (+info)

A prospective study of changes in aneurysm and graft length after endovascular exclusion of AAA using balloon and self-expanding endograft systems. (6/188)

PURPOSE: Longitudinal shrinkage of aneurysms post-endovascular repair, employing unvalidated measurement techniques has been held to account for endograft disruption. In this study we record changes in aneurysm length, diameter and volume using the gold standard of calibrated spiral CT angiography (SCTA). METHOD: From 179 patients with AAA scanned by SCTA, 68 were selected for endografting. Twenty-seven had PTFE home-made prostheses while 41 patients had Talent endografts. SCTA was performed on the fifth postoperative day and 6-monthly intervals thereafter. The distance between the lowest renal artery and the aortic bifurcation (VBL - vertical body length) and the luminal centre line length (LCL) were measured. Maximal sac diameters and volumes were recorded using 3DCT reconstruction. RESULTS: Significant increase was noted in VBL (3.2) mm for PTFE-treated patients accompanied by an increase in sac volume at day 5 (12.5 ml). No changes in LCL or maximal diameters were evident. At 1.5 years further lengthening of both VBL (6.4 mm) and LCL (9.3 mm) was unaccompanied by sac diameter/volume changes. Talent patients - no changes in VBL or LCL were evident. Volumes and maximal AP and transverse diameters showed marked shrinkage: AP -11. 2 mm; transverse -2.6 mm; volumes by -35.5 ml at 6 months. CONCLUSION: With PTFE increase in VBL but not graft length, without concurrent changes in maximal diameters at day 5, is commensurate with increase in sac volume; after 1.5 years graft lengthening overtakes aortic lengthening. In Talent patients VBL/graft length remained unchanged. There is no evidence for longitudinal aneurysmal contracture. Volumes and maximal diameters for the Talent endograft but not for PTFE show shrinkage.  (+info)

Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. (7/188)

Prosthesis-patient mismatch is present when the effective orifice area of the inserted prosthetic valve is less than that of a normal human valve. This is a frequent problem in patients undergoing aortic valve replacement, and its main hemodynamic consequence is the generation of high transvalvular gradients through normally functioning prosthetic valves. The purposes of this report are to present an update on the concept of aortic prosthesis-patient mismatch and to review the present knowledge with regard to its impact on hemodynamic status, functional capacity, morbidity and mortality. Also, we propose a simple approach for the prevention and clinical management of this phenomenon because it can be largely avoided if certain simple factors are taken into consideration before the operation.  (+info)

Prosthesis-patient mismatch affects survival after aortic valve replacement. (8/188)

BACKGROUND: Surgeons traditionally avoid the use of "small" aortic prostheses because of the potential for residual left ventricular outflow tract obstruction and persistent transvalvular gradients. This study examines the ratio between prosthetic valve size and the body surface area (BSA) of patients undergoing aortic valve replacement (AVR). We sought to determine the effect of potential "prosthesis-patient" mismatch on long-term survival. METHODS AND RESULTS: Follow-up was conducted on 2981 patients who underwent AVR with stented bioprostheses between 1976 and 1996. To account for differences between manufacturers' labeled valve sizes, we calculated the ratio between the prosthetic valve effective orifice area (EOA) and the patient's BSA (recorded for 2154 patients). The lowest decile in this cohort had a calculated EOA/BSA of <0.75 cm(2)/m(2) (Small group, n=227) compared with the control group (n=1927), in whom the EOA/BSA ratio was >0.75 cm(2)/m(2). Operative mortality was higher in the Small group (8% versus 5%, P:=0.03). Actuarial survival at 12 years was 50+/-5% in the Small group compared with 49+/-2% in the control group (P:=0.27). However, freedom from valve-related mortality was significantly lower in the Small group (75+/-5% versus 84+/-2%, P:=0.004). Cox regression analysis determined age and NYHA functional class to be the multivariate predictors of overall mortality, whereas advanced age and EOA/BSA <0.75 cm(2)/m(2) were found to be the predictors of valve-related mortality. CONCLUSIONS: Prosthesis-patient mismatch results in significantly higher early and late mortality after bioprosthetic AVR. We recommend careful selection of stented bioprostheses to ensure an adequate ratio of EOA to BSA. An EOA/BSA ratio of >0.75 cm(2)/m(2) may avoid residual left ventricular outflow tract obstruction and persistent transvalvular gradients. Careful prosthesis-patient matching will improve both early and late survival after AVR.  (+info)