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Patients usually fear fiberoptic bronchoscopy (FBS) and they report a low level of satisfaction after this examination. We evaluated the efficacy of acupuncture in decreasing patient anxiety before diagnostic FBS and in improving tolerance to the examination. In a prospective double-blind study, we enrolled 48 patients scheduled to undergo diagnostic FBS. Patients were randomly assigned to one of three groups. Group A (16 patients): standard FBS, with airway topic anesthesia; Group B (16 patients): standard FBS, with airway topic anesthesia and acupuncture treatment; Group C (16 patients): standard FBS, with airway topic anesthesia and sham acupuncture. EKG, non-invasive arterial pressure, and pulse oximetry were monitored on a routine basis. We evaluated patient anxiety before and after acupuncture and, at the end of FBS, the discomfort suffered during the examination by a 100-mm Visual Analog Scale (VAS).

Patient satisfaction in Group A was 50% worse than in Group B (p = 0.04). We observed a strong, even if not statistically significant, tendency toward a lower pre-FBS anxiety in Group B. Patients in group C had values very close to those recorded in group A. We observed no adverse event and no differences in cardio-respiratory parameters in these three groups; in particular, we did not observe a respiratory depression in Group B.

Acupuncture seems an effective resource for a Thoracic Endoscopic Room to improve patient tolerance to FBS.

Carpal tunnel decompression (CTD) is a common procedure amenable to procedure specific consent forms (PSCFs). These may help better inform patients and so increase patient satisfaction with the consent process. We assessed the use of a PSCF for CTD. The PSCF mentions eight complications of carpal tunnel surgery and alternative non-operative treatments.

Two groups of 40 patients each were compared prospectively. Patients in one group were issued with a PSCF prior to admission whereas those in the other group were not. After standard pre-operative consent, patients were interviewed prior to surgery and assessed for their awareness of complications and alternative treatment options. The patients who received a PSCF showed greater awareness of different complications and alternative treatments and reported greater satisfaction with the consent process. We conclude that using PSCFs is a very useful and inexpensive adjunct to improve patient awareness and satisfaction with the consent process.

Post-surgical pain is commonly experienced by patients, and traditional pain medication has limitations and side effects. Virtual reality (VR) is a computer-generated technology that simulates realistic environments, which distracts the patient’s attention and emotions, reduces pain, and improves rehabilitation by creating an immersive experience. The increasing affordability and quality of portable VR headsets, as well as the increasing utility of pain management, bode well for the exciting future of using VR for analgesia. VR was found to be effective as a complementary adjunct or alternative nonpharmacological analgesic to a range of acute and chronic pain treatments. The application of VR to post-surgical pain management can significantly reduce patients’ dependence on medications, as well as decrease the intensity and duration of pain. In this paper, a thorough literature review was conducted to systematically evaluate the use of VR in post-surgical pain management.

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients.

Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up.

Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH.

Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

Background: There has been increasing amounts of work on the use of telephone follow-up (TFU) in trauma and orthopaedics, but little direct work on its use in the follow-up of elective day case hand surgery. The aim of this study is to compare patient satisfaction with face-to-face follow-up (FFU) and TFU after elective day case hand surgery.

Methods: Sixty-four patients from an FFU and 61 patients from a TFU cohort were contacted by telephone at least 6 months after their last follow-up. A customized questionnaire with answers recorded on a Likert scale (0–10) was used to evaluate their satisfaction with the follow-up they received.

Results: Data from 48 patients from the FFU and 52 patients from the TFU cohorts were available for the analysis. There were no statistically significant differences in patient demographics between the two cohorts. Patient satisfaction was significantly greater in all domains of the questionnaire in the TFU cohort. Most patients from both cohorts (71% face-to-face, 86% telephone) said they would prefer TFU if they were to have the same procedure again.

Conclusions: Patients were more satisfied with TFU compared to FFU following elective day case hand surgery.

Level of Evidence: Level III (Therapeutic)

Background: Collagenase clostridium histolyticum has become a widely used treatment in the management of Dupuytren disease. The aims of this study are to assess the immediate success of treatment of Dupuytren contracture with collagenase injection, to measure long-term patient-rated outcomes, to determine whether the risk factors for the disease impacted outcomes and to report complications of collagenase treatment.

Methods: A prospective study was performed in a tertiary referral centre. Measurements were recorded pre-treatment, day 1 and day 90. Patient-rated outcome scores were measured using Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Michigan Hand Questionnaire (MHQ) at minimum 36 months post-injection.

Results: The study included 45 patients with 53 hands with a mean age of 65.7 years. The treatment was successful in 62% of patients with the greatest improvement in the metacarpal-phalangeal joint of the little finger. Diabetes, epilepsy, gender, alcohol intake and positive family history had no statistically significant predictive value on successful outcomes. Patient satisfaction at 41 months was high with mean MHQ score of 97.3.

Conclusions: Collagenase is effective in the treatment of Dupuytren contracture, with disease involving the little finger showing the greatest benefit. Risk factors for development of Dupuytren disease had no effect on successful outcome and long-term satisfaction rates are high.

Level of Evidence: Level III (Therapeutic)

The uncertainty, immediate hazards, severe consequences and broad impact of medical emergencies are far beyond the scope of ordinary medical treatment, calling for special attention. The importance of constructing hospital emergency management system has been increasingly reflected. The system not only needs the practical solution of hospital management at the present stage, but also the working direction of the hospital management in the future. In this paper, the emergency satisfaction survey was conducted on the patients in two first-class tertiary hospitals in Shanghai. The service satisfaction scores of a hospital with integrated traditional Chinese medicine (TCM) and Western medicine as well as a general hospital were $4.94\pm 0.32$ and $4.99\pm 0.14$, respectively. There was a significant difference in the service satisfaction scores between the two hospitals ($p<0.0001$). Poor network signal was a vulnerability problem in the dimension of medical auxiliary facilities in both hospitals, accounting for the highest proportion. For the dimension of medical building, the main vulnerability problems were wall cracking and uneven ground, accounting for a high proportion. In the dimension of medical process, the parking inconvenience of a hospital with integrated traditional Chinese and Western medicine was particularly serious, accounting for 81.7%. In the dimension of medical service, the vulnerability of “medical staff overwork” in a general hospital was more prominent, accounting for 39.10%, which was significantly higher than that in a hospital with integrated TCM and Western medicine. In terms of service attitude, the vulnerability of the two hospitals was represented as the poor service attitude of doctors, nurses and managers. In the medical safety dimension of the two hospitals, “lack of assistance in emergencies” and “hospital equipment failures” were the main vulnerability issues. From the perspective of patients, this paper analyzed the current vulnerability problems of the hospital, identified the actual and potential risks of hospital emergency management and put forward suggestions on adjusting the spatial layout, strengthening internal management and comprehensively improving employees’ emergency awareness and skills. This will provide a reference for the hospital’s emergency management system to make necessary adjustments to meet the practical needs.

Healthcare improvement relating to basic hospital service attributes is one of the most fundamental driving forces to uplifting in economic and social transition for developing countries in an emerging context. The purpose of this paper is to measure patients’ trio need satisfaction toward doctor service quality (DSQ), nurse caring quality (NCQ), and hospital environment quality (HEQ) and compare the effects of perceived, expected, and service quality gap on patient satisfaction. Multiple regression analysis was used to explain the patient satisfaction. The result shows that the perceived service quality (67.3%) and the service quality gap (50.8%) can better explain patient satisfaction than the expected service quality (3.0%). Both perception and gap model show that DSQ, NCQ, and HEQ are significant predictors of patient satisfaction, where NCQ is the most important dimension in explaining patient satisfaction. This study focuses on patient need satisfaction research by being one of the few empirical studies relating to the most basic hospital service quality attributes, contributing to the development of hospital service quality in a developing context of Bangladesh.