Factors Influencing Patient Satisfaction after Microvascular Decompression for Hemifacial Spasm: A Focus on Residual Spasms

2021 ◽  
pp. 1-9
Author(s):  
Jeong-A Lee ◽  
Doo-Sik Kong ◽  
Soo Jung Kim ◽  
Seunghoon Lee ◽  
Sang-Ku Park ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Surgical Outcomes ◽  
Social Life ◽  
Interpersonal Relationship ◽  
Psychological Problem ◽  
Satisfaction Score ◽  
Patient Satisfaction Score ◽  
Significant Difference

<b><i>Introduction:</i></b> Patients with hemifacial spasm (HFS) experience improvement in symptoms after microvascular decompression (MVD); however, patient satisfaction is sometimes low. This study aimed to analyze the relationship between residual spasms and patient satisfaction, identify factors affecting satisfaction, and investigate the degree of improvement in spasms which result in patient satisfaction after surgery. <b><i>Methods:</i></b> 297 patients who completed a questionnaire after MVD for HFS between March 2020 and June 2020 were included. Information on surgical outcomes and patient satisfaction was collected using the questionnaire, and their relationships were analyzed. <b><i>Results:</i></b> Among the 297 patients, the mean residual spasm percentage and patient satisfaction score were negatively correlated with 14.0% and 8.8 points, respectively. In addition to residual spasms, discomfort caused by persistent spasms, psychological problem-solving, better social life, and interpersonal relationship improvement were associated with satisfaction. There was no significant association between the presence of complications and satisfaction. There was no significant difference in the satisfaction score at up to 30% residual spasm, and the patients with 0–30% residual spasm had a satisfaction score of 7 points or higher. <b><i>Conclusion:</i></b> Residual spasms and discomfort from residual spasms decreased patient satisfaction after MVD for HFS. It is then necessary to perform accurate surgical resolution to improve surgical outcomes and provide adequate management to reduce postoperative discomfort and anxiety, and ultimately to enhance satisfaction. Residual spasms of up to 30% compared with the preoperative severity can be considered a good outcome when evaluating surgical outcomes.

scholarly journals Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

2017 ◽  
Vol 6 (7) ◽  
pp. 2836
Author(s):  
Ashima Taneja ◽  
Kamaldeep Arora ◽  
Isha Chopra ◽  
Anju Grewal ◽  
Sushree Samiksha Naik ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Epidural Analgesia ◽  
Comparative Study ◽  
Satisfaction Score ◽  
Epidural Group ◽  
Patient Satisfaction Score ◽  
Vaginal Deliveries ◽  
Group A ◽  
Group B

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group.

scholarly journals COMPARING THE EFFECTS OF BUPIVACAINE AND ROPIVACAINE INSTILLATION FOR POST OPERATIVE ANALGESIA IN PATIENTS UNDERGOING LUMBER SPINE SURGERY: A PROSPECTIVE RANDOMISED DOUBLE BLIND STUDY

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Shashikant Sharma ◽  
T. Prabhakar ◽  
Usha Shukla ◽  
Shagufta Naaz
Keyword(s):  
Heart Rate ◽  
Patient Satisfaction ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Respiratory Rate ◽  
Visual Analogue Score ◽  
Study Groups ◽  
Satisfaction Score ◽  
Patient Satisfaction Score ◽  
Surgeon Satisfaction

As it is a comparative study of Bupivacaine and Ropivacaine therefore Ropivacaine is a long-acting amide local anaesthetic with a potentially improved safety profile when compared to bupivacaine . Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Subject and Methods:  90 patients, who belongs to American society of Anesthesiologist grade I & II of age 18-65 years randomized into three groups (n=30). All three groups received propofol bolus 0.75mg/kg IV followed by IV infusion at 0.025 mg/kg/min. group A received Nalbuphine 50 μg/kg IV bolus, group B fentanyl 1.5 μg/kg IV bolus and group C received Dexmedetomidine infusion 1 μg/kg given over 10 min as bolus followed by 0.1 mg/kg/hr IV infusion for maintenance. Ramsay sedation score and Visual analogue scale measured for sedation and analgesia respectively at 10 minute interval for 1st hour of surgery then every 30 minutes upto the end of surgery. Desired RSS was defined 3-5. Intraoperative hemodynamic variables viz. Heart Rate (HR), Respiratory Rate (RR), Mean Arterial Pressure (MAP) and SPO2 were recorded every 10 min till the end of surgery. Recovery was assessed using Modified Aldrete Score in the recovery room. Time to achieve Aldrete recovery score of 10 was recorded. Patient satisfaction score and Surgeon satisfaction score were noted using a 7-point Likert verbal rating scale. Results: The groups were comparable with respect to demographic parameters. Ramsay sedation was significantly higher in Dexmedetomidine group (P<0.05) than Nalbuphine and fentalyl group, while Visual analogue score was comparable in all three study groups (p>0.05). Heart rate and Mean arterial pressure both significantly decreased in Dexmedetomidine group from the baseline during study period (p<0.05). Respiratory rate and SPO2 were comparable in all three groups. In this study MAP was never <60 mmhg, SPO2 was never <94% and Respiratory rate was never <12 bpm. Time to achieve modified alderate score in Dexmedetomidine (0.93±2.33 min) was significantly least as compare to Nalbuphine (1.80±2.65) & Fentanyl group (3.50±4.76) (p=0.016). Patient satisfaction score in Dexmedetomidine was significantly higher (6.53±0.44) (p=0.005). Surgeon satisfaction score in Dexmedetomidine was also significantly higher (6.73±0.52) (p=0.000). Two patients in Dexmedetomidine group had episode of bradycardia which was managed with injection Atropine 0.6 mg effectively Conclusion: From these observations and analyses of the present study, it can be inferred that: ❖ Sedation in Dexmedetomidine was acceptable when used for MAC for middle ear surgeries. ❖ Visual analogue score was similar in all three study groups. ❖ Heart rate & Mean arterial pressure in Dexmedetomidine was lower than baseline value. ❖ Changes in Respiratory rate and SPO2 were similar in all three study groups. ❖ Time to achieve Modified alderate score of 10 in group Dexmedetomidine was least, suggesting quicker recovery from anesthesia. ❖ Patient and surgeon satisfaction score in Dexmedetomidine was significantly higher. Keywords: Dexmedetomidine, Nalbuphine, Bupivacaine, Ropivacaine

scholarly journals Lumbar canal stenosis: analyzing the role of stabilization and the futility of decompression as treatment

2019 ◽  
Vol 46 (5) ◽  
pp. E7 ◽  
Author(s):  
Atul Goel ◽  
Shashi Ranjan ◽  
Abhidha Shah ◽  
Abhinandan Patil ◽  
Ravikiran Vutha
Keyword(s):  
Patient Satisfaction ◽  
Nodal Point ◽  
Satisfaction Score ◽  
Spinal Instability ◽  
Fixation Technique ◽  
Patient Satisfaction Score ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Spinal Segments

OBJECTIVEThe authors report their current experience with their previously published novel form of treatment in 70 cases of lumbar canal stenosis. The treatment consisted of only fixation of the spinal segments by the transarticular screw fixation technique. No bone, ligament, osteophyte, or disc resection was done for spinal canal and neural foraminal decompression. The proposed treatment is based on the concept that vertical instability that results in telescoping of the facets on physical activity forms the nodal point of pathogenesis of lumbar canal stenosis.METHODSDuring the period June 2014 to May 2018, 70 patients presenting with the classically described symptoms of lumbar canal stenosis were treated surgically by only fixation of involved spinal segments. Apart from clinical and radiological guides, instability was diagnosed on the basis of physical observation of the status of articulation by direct manipulation of bones of the region. The operation involved transarticular insertion of 2 or 3 screws for each articulation. The Oswestry Disability Index and visual analog scale were used to assess the patients before and after surgery and at follow-up. Additionally, a personalized patient satisfaction score was used to assess the outcome of surgery.RESULTSClinical symptomatic recovery was observed in all patients in the immediate postoperative period. During the average follow-up period, 100% of patients had varying degrees of symptomatic relief. The patient satisfaction score suggested that all patients were very satisfied with the surgical procedure. The transarticular fixation technique provided strong spinal segment fixation and a reliable ground for bone arthrodesis. No patient needed any additional modality of treatment or reoperation for recurrence of symptoms.CONCLUSIONSSpinal instability is the nodal point of pathogenesis of spinal degeneration–related lumbar canal stenosis. Only fixation of the involved spinal segments is necessary—decompression by bone or soft-tissue resection is not necessary.

Patient Reports of Satisfaction after Microvascular Decompression and Partial Sensory Rhizotomy for Trigeminal Neuralgia

Neurosurgery ◽  
2005 ◽  
Vol 56 (6) ◽  
pp. 1304-1312 ◽  
Author(s):  
Joanna M. Zakrzewska ◽  
Benjamin C. Lopez ◽  
Sung Eun Kim ◽  
Hugh B. Coakham
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Primary Group ◽  
Posterior Fossa Surgery ◽  
Ablative Surgery ◽  
Significant Difference ◽  
Primary Procedure

Abstract OBJECTIVE: There are no reports of patient satisfaction surveys after either a microvascular decompression (MVD) or a partial sensory rhizotomy (PSR) for trigeminal neuralgia. This study compares patient satisfaction after these two types of posterior fossa surgery for trigeminal neuralgia, because it is postulated that recurrences, complications, and previous surgical experience reduce satisfaction. METHODS: All patients who had undergone their first posterior fossa surgery at one center were sent a self-complete questionnaire by an independent physician. Among the 44 questions on four standardized questionnaires were 5 questions that related to patient satisfaction and experience of obtaining care. Patients were divided into those having their first surgical procedure (primary) and those who had had previous ablative surgery (nonprimary). RESULTS: Response rates were 90% (220 of 245) of MVD and 88% (53 of 60) of PSR patients. Groups were comparable with respect to age, sex, duration of symptoms, mean duration of follow-up, and recurrence rates. Overall satisfaction with their current situation was 89% in MVD and 72% in PSR patients. Unsatisfied with the outcome were 4% of MVD and 20% of PSR patients, and this is a significant difference (P &lt; 0.01). Satisfaction with outcome was higher in those undergoing this as a primary procedure. In the primary group, satisfaction was dependent on recurrence and complication/side effects status (each P &lt; 0.01), but this was not the case in the nonprimary group. Patients expressed a desire for earlier posterior fossa surgery in 73% of MVD and 58% of PSR patients, and this was highest in the primary group. The final outcome was considered to be better than expected in 80% of MVD and 54% of PSR patients, but 22% of the PSR group (P &lt; 0.01) thought they were worse off. CONCLUSION: Patients undergoing posterior fossa surgery as a primary procedure are most satisfied and PSR patients are least satisfied, partly because of a higher rate of side effects.

scholarly journals Persistent abnormal muscle response after microvascular decompression for hemifacial spasm

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Li Xu ◽  
Wu Xu ◽  
Jing Wang ◽  
Yulong Chong ◽  
Weibang Liang ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Muscle Response ◽  
Abnormal Muscle Response ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract To explore the causes of persistent abnormal muscle response (AMR) after microvascular decompression (MVD) for hemifacial spasm (HFS) and the clinical outcomes of these patients. MVDs performed in Nanjing Drum Tower Hospital in 2017 were retrospectively studied, and 326 patients with HFS were classified into two groups based on whether AMR disappeared or persisted following MVD. The clinical features, treatment efficacy and postoperative complications were compared between the two groups. 305 patients with disappeared AMR after decompression were classified as Group A. In Group B, the 21 patients exhibited persistent AMR after successful MVD. The preoperative duration of symptoms in Group B was significantly longer than that in Group A (P < 0.001), and no significant difference was identified between the two groups in terms of gender, side, age and offending vessels (P > 0.05). The immediate postoperative cure rate of Group A (88.9%)was significantly higher than that in Group B (28.6%, P < 0.001), furthermore, the two groups were not different in the long-term outcome and the incidence of surgical complications (P > 0.05). The long preoperative duration of HFS patients may account for persistent AMR after successful decompression, and it is more likely for these patients to get delayed cured, the long-term outcomes showed no difference compared to those in patients with disappeared AMR after MVD.

scholarly journals Association of pharmacy services with patient satisfaction in public and private tertiary care hospitals of Rawalpindi and Islamabad

2021 ◽  
Author(s):  
Urmah Mahrosh ◽  
Ayesha baber kawaish ◽  
Mateen Abbas
Keyword(s):  
Patient Satisfaction ◽  
Marital Status ◽  
Age Groups ◽  
Demographic Characteristics ◽  
Satisfaction Score ◽  
Pharmacy Services ◽  
Drug Availability ◽  
Public And Private ◽  
Significant Difference ◽  
Pharmacy Setting

Abstract Background The healthcare system in Pakistan is facing a shortage of human resources and appropriate and sustainable financial measures and therefore fails to provide optimum services to the population of Pakistan. Furthermore, research is limited in the healthcare institutes; therefore, there is a scarcity of information about patient satisfaction with pharmacists and pharmacy services in Pakistan. As evident from the inadequate information in the literature, patients’ opinions about the pharmacy services in Pakistan are important [1]. Therefore, the current study was designed to assess patient satisfaction with the pharmacy performance of the outpatient pharmacy and its variation with socio-demographic characteristics in twin cities of Pakistan (Rawalpindi and Islamabad). Method A cross-sectional study design was used to assess the patient satisfaction through convenience sampling technique. Minimum sample size of 250 respondents who visit pharmacy department of public and private hospital for pharmaceutical care were included in this study. A pre validated tool was used to assess the patient satisfaction. Data was clean coded and import into spss for analysis. Descriptive and inferential statistic was applied to calculate frequency, standard deviation, mean deviation and p value to find the association among different domain of patient satisfaction with different demographic characteristics of respondents. Result Current study shows overall patients were satisfied from pharmacy services provided by government and private hospitals. Furthermore patient satisfaction towards pharmacist medication advice was very good however patient satisfaction towards pharmacist approach was good while patient perception with pharmacy setting, drug availability and cost were underrated. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. No significant difference (p ≥ 0.05) was observed in pharmacy setting drug availability and cost with different gender, age groups and marital status of respondents. However Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with different level of education patients with less education had better satisfaction as compared to highly educated respondents. Furthermore Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with occupation. Self-employee and government employee had low satisfaction score while other had better satisfactory score. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. Females had better satisfactory score as compared to female. Younger age group had better satisfaction as compared to elderly. Patients belong to higher educational groups had better satisfaction toward pharmacist approach as compared to low qualification groups respondents. Furthermore No significant difference (p ≥ 0.05) was observed in pharmacist’s approach with marital status and number of visits Conclusion Current study concluded that overall patient had average satisfaction score. Patients shows a better satisfaction towards pharmacist behavior/ way of handling the patients, information provided by pharmacist regarding medicine. Patient had less satisfaction towards the location of pharmacy, Availability and affordability of medicine. Patient shows negative satisfaction regarding waiting area and counselling area at in door patient pharmacy. It has been observed that educated respondents shows high level of satisfaction towards pharmacist availability and information provided by the pharmacist.

Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression

2021 ◽  
Author(s):  
Hua Zhao ◽  
Jin Zhu ◽  
Yin-da Tang ◽  
Lin Shen ◽  
Shi-ting Li
Keyword(s):  
Elderly Patients ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Facial Palsy ◽  
The Elderly ◽  
Elderly Group ◽  
Effective Treatment Option ◽  
Younger Patients ◽  
Significant Difference ◽  
Csf Leakage

Abstract Objective The aim of the present study was to evaluate the efficacy and safety of microvascular decompression (MVD) for primary hemifacial spasm (HFS) in patients aged ≥70 years and to compare the outcome with a control cohort of younger patients(<70 years). Methods In this retrospective study, subjects were divided into two groups: an elderly group (patients who were ≥70 years) and a younger group. We compared demographic and clinical data, surgical outcome, MVD-related complications, and duration of operation and hospitalization after MVD between the two groups. Results At a mean follow-up of 32 ± 4.2 months, 188 elderly patients (90.4%) reported an effective outcome without need for any medication versus 379 (91.1%) of the younger cohort. There was no mortality in both cohorts. The prevalence of delayed facial palsy was 4.8% in the elderly group and 4.1% in the younger group. One (0.5%) patient in the elderly group and 3 (0.7%) patients in the younger group suffered cerebrospinal fluid (CSF) leakage. There was no significant difference between the two groups in terms of MVD-related complications, such as delayed facial palsy, hearing impairment, CSF leakage, and hematoma. Conclusions MVD is an effective treatment option in elderly patients with HFS as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD.

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