Self-disclosure and marital satisfaction.

Examined the effect of self-disclosure on marital satisfaction in couples and also introduced attitude similarity as a possible predictor of marital satisfaction. 51 couples (mean age 30.6 yrs) completed 5 test instruments, including a self-disclosure scale, 2 marriage satisfaction scales, an attitude survey, and a demographic questionnaire. Results (1) revealed high reciprocity between spouses on most measures, (2) found a consistent positive relationship between self-disclosure and marital satisfaction, (3) substantiated self-disclosure as a significant predictor of marital satisfaction, and (4) demonstrated that attitude similarity had a strong positive relationship to marital satisfaction. Findings provide a firm basis for self-disclosure and attitude similarity as important predictors of marital satisfaction. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Satisfaction of ostomy patients

INTRODUCTION: This study looks at the degree of satisfaction colostomy patients feel in regards to their perception of the health care that they receive, whether they think that their physicians care could improve and the level of the medical staffs professional experience. METHOD AND MATERIAL: The study was performed in the Area Hospitalaria de Valme (Sevilla). With a population of 350,000 possible patients of which 215 have an ostomy, 55 of these took part in the study. 215 questionnaires were mailed to the ostomy patients with paid return mail enclosed. The survey was based on Lickerts attitude scale and had six items to respond to, using an evaluation of zero to five. This method is sufficiently valid and has been used in other studies such as project CORCH. RESULTS: First, averages were obtained for all items and variables. Second, a patient profile was obtained regarding sex and age. Third, a correlation of the three study variables was compared against variables of a global index of satisfaction. DISCUSSION: In contrast with the global index, the satisfaction of the patients in the study is very high (3.93 out of a possible 5). 45% of these patients perceive that the medical treatment that they receive could improve but that the professional experience of the medical staff is acceptable (62%).     

Minimally invasive esophageal surgery

OBJECTIVE: This study aimed to assess patient satisfaction and change in functional status after surgery for epiretinal membrane (ERM), rhegmatogenous retinal detachment (RRD), and complex retinal detachment (CRD). This study also aimed to determine whether objective measures of vision are predictive of subjective improvement after surgery. DESIGN: The study design included patient interviews and retrospective chart review. PARTICIPANTS: Participants were those patients who underwent surgery for ERM, RRD, or CRD by one surgeon at the Bascom Palmer Eye Institute between January 1, 1993, and December 31, 1994. INTERVENTION: Patient satisfaction and patients' perceptions of the impact of surgery on their functional status were assessed by telephone interviews conducted by one interviewer at least 6 months after surgery. MAIN OUTCOME MEASURES: Responses to patient satisfaction survey and subjective change in patients' functional status were measured. RESULTS: Of 187 eligible patients, 146 (78.1%) could be contacted and all agreed to participate. Ninety patients (61.6%) reported improved functioning after surgery in 2 or more of the 5 activities investigated. Twenty-one patients (14.4%) reported worse postoperative vision than expected, but only 5 patients (3.4%) thought surgery had not been worthwhile. One hundred forty-three patients (97.9%) reported adequate explanation of surgery and its expected results. Patients with preoperative study eye visual acuity between 20/40 and 20/200 were most likely to improve in two or more activities. Lower preoperative worse eye vision and better final study eye vision were associated with a greater likelihood of satisfaction after surgery. Diagnostic category was not predictive of change in functional status or patient satisfaction. CONCLUSIONS: There is a high rate of patient satisfaction and improved functional status after surgery for ERM, RRD, and CRD, even among patients with good fellow eye vision.     

The dynamics of daily events and well-being across cultures: When less is more.

The authors examined cultural and individual differences in the relation between daily events and daily satisfaction. In a preliminary study, they established cross-cultural equivalence of 50 daily events. In the main study, participants in the United States, Korea, and Japan completed daily surveys on the 50 events and daily satisfaction for 21 days. The multilevel random coefficient model analyses showed that (a) the within-person association between positive events and daily satisfaction was significantly stronger among Asian American, Korean, and Japanese participants than among European American participants and (b) the within-person association between positive events and daily satisfaction was significantly weaker among individuals high in global life satisfaction than among those low in global life satisfaction. The findings demonstrate a weaker effect of positive events on daily well-being among individuals and cultures high in global well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Otoplasty. Clinical protocol and long-term results

OBJECTIVE: To evaluate the long-term results after otoplasty on prominent ears. DESIGN: Between 1988 and 1993, ear protrusion was measured preoperatively and postoperatively in pediatric patients undergoing otoplasty by means of a standard protocol based on the Frankfort horizontal line. Patients were asked to return for follow-up measurements a minimum of 1 year after surgery. At the time of follow-up, a patient satisfaction survey was completed by the patients and their families. SETTING: The Hospital for Sick Children, Toronto, Ontario, a tertiary care children's hospital. PARTICIPANTS: Thirty-one of 51 patients returned for follow-up an average of 3.7 years after surgery. RESULTS: One third of ears returned to their original position, one third of ears stayed in a position equal to the immediate postoperative position, and one third of ears had final positions between the preoperative and post-operative positions. At the superior rim, an average of 58% of the operative medialization was lost. Good to excellent ear-to-ear symmetry was obtained in 78% of patients who returned for follow-up. Retrospective chart review showed a revision surgery rate of 3%; stitch granulomas were removed in 9% of patients. The patient satisfaction survey found that 85% of patients were happy or very happy with their ears. CONCLUSIONS: With time, a substantial loss of correction can be expected in most (but not all) patients who undergo otoplasty, particularly at the upper pole. Overall, patients and their families are happy with the results of otoplasty surgery.     

Health-related quality of life after epilepsy surgery: a Swedish multicenter study

PURPOSE: To investigate health-related quality of life (HRQOL) in relation to seizure outcome as part of a multicenter follow-up of epilepsy surgery in Sweden. METHODS: A battery including the SF-36 Health Survey and the Hospital Anxiety and Depression scale (HAD) was distributed to all patients older than 16 years. Mean follow-up time was 4 years (range, 2-13 years) and response rate, 91% (103 of 113 patients). HRQOL data were related to seizure frequency and severity (Chalfont Seizure Severity Scale). RESULTS: Seventy-six percent considered their global health to be better than it was before surgery. Degree of improvement in seizure control correlated with improved satisfaction with health (Spearman's r = 0.44). Higher SF-36 scores (higher HRQOL ratings) correlated with percentage reduction of seizure frequency for all scales and was strongest for perception of general health (Spearman's r = 0.46). When the patients were divided into four categories [A, completely seizure free (n = 29); B, seizure free with aura (n = 18); C, > or =75% reduction in seizure frequency (n = 24); and D, <75% reduction in seizure frequency (n = 32)], a strong positive association was found between higher SF-36 scores (with the exception of physical functioning) and better seizure control. Health-related limitations in role performance differentiated best between the outcome categories. For patients with > or =75% reduction in seizure frequency, low seizure severity correlated with higher HRQOL ratings for scales measuring social function, vitality, and mental health. Depression levels (HAD scale scores) were on average low. Anxiety (HAD) increased significantly from A to D. CONCLUSIONS: HRQOL seems to be scored as a continuum in relation to seizure frequency. Seizure severity measures give complementary information.     

Relationship of work to nonwork.

Explored the relationship between work and nonwork experiences in a survey of 139 employees from an electronics firm and a broadcasting company. Respondents were asked to describe both work and nonwork according to dimensions employed in the Job Diagnostic Survey. Measures of physical and psychological stress developed by M. Patchen (1970) and measures of nonwork and job satisfaction based on the Faces scale were also obtained. Absenteeism data were derived from company records. A positive relationship was found between work and nonwork summary scores, supporting a spillover model of the work–nonwork relationship. Results indicate that the nonwork score was more highly related to stress and absenteeism than was the work score. However, the work score was more highly related to job satisfaction, and the nonwork score more highly related to nonwork satisfaction. The influence of nonwork factors on job-related responses is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determination of the minimal clinically significant difference on a patient visual analog satisfaction scale

OBJECTIVE: To determine the minimal clinically significant difference (MCSD) on a visual analog patient satisfaction scale. METHODS: The authors prospectively collected patient satisfaction evaluations during a clinical trial assessing the effect of introducing personal television sets on overall patient satisfaction from their ED encounters. Patient satisfaction was assessed with 2 scales: a 100-mm visual analog scale (VAS) (0 = least satisfied, 100 = most satisfied) and a 7-point categorical scale ("terrible," "mostly dissatisfied," "mixed," "partially satisfied," "mostly satisfied," "pleased," and "delighted"). The differences between the mean VAS scores of "delighted" and "pleased" patients, and between "pleased" and "mostly satisfied" patients were used to determine the MCSD on the VAS. Reliability of each of the scales was determined. RESULTS: 181 patients were evaluated. Mean age was 41 years; 59% were female. On a subset of 19 patients, the VAS yielded an interobserver correlation of 0.93. The kappa measurement of agreement on the categorical scale was 0.77. The mean difference between "delighted" and "pleased" patient VAS satisfaction scores was 6.8 mm (95% CI, 1.3-12.3 mm). The mean difference between "pleased" and "mostly satisfied" patient VAS satisfaction scores was 10.7 mm (95% CI, 5.5-15.8 mm). CONCLUSION: The MCSD in patient satisfaction scores measured with a 100-mm VAS was approximately 7-11 mm. Future studies evaluating differences in patient satisfaction should be designed to detect this difference.     

Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.     

Microdecompression and uninstrumented single-level fusion for spinal canal stenosis with degenerative spondylolisthesis

STUDY DESIGN: A retrospective review was completed on 21 patients who had a "least invasive" (one or two level) microdecompression and uninstrumented single-segment lumbar fusion for spinal canal stenosis with degenerative spondylolisthesis. OBJECTIVE: To determine whether a "least invasive" approach to lumbar spinal canal stenosis and degenerative spondylolisthesis would yield acceptable results. SUMMARY OF BACKGROUND DATA: The prevailing surgical technique for symptomatic spinal canal stenosis with degenerative spondylolisthesis is a wide midline decompression and instrumented fusion. METHODS: On an average of 38 months postoperatively, 21 patients were personally assessed on four scores: 1) their overall satisfaction with the outcome of surgery, 2) an analog back and leg pain scale, 3) a functional evaluation scale, and 4) Ferguson (upshot) anterior-posterior lumbosacral and lateral flexion-extension radiographs. RESULTS: The overall satisfactory outcome on all four scales was 16 (76%) of 21. Twenty of twenty-one patients had relief of their claudicant leg pain; the overall fusion rate was 18 (86%) of 21. Two of three patients with a pseudarthrosis had a successful outcome on the patient-oriented outcome (1, 2, and 3) scales (excluding the radiograph scale), and one was a failure. One patient with a solid fusion was a failure because of continuing back pain. One patient with a solid fusion was a failure because of continuing leg pain. The overall satisfactory outcome on the nonradiographic scales was 18 of 21, for an 86% patient satisfaction rate. CONCLUSIONS: In this retrospective study, a "least invasive" surgical approach to lumbar degenerative spondylolisthesis with spinal canal stenosis causing claudicant leg pain produced acceptable results.     

Sexual functioning among breast cancer, gynecologic cancer, and healthy women.

Determined the specific type of sexual functioning deficits and the relationship between global sexual satisfaction and adjustment in 2 related life areas (marital relationship and body image) for 2 groups of cancer patients at high risk for sexual difficulties. The 2 groups included 16 27–67 yr old females with Stage 2 breast cancer and 16 31–65 yr old females with gynecologic cancer. These Ss were compared to 16 healthy female outpatients (controls). Measures included the Sexual Activities scale from the Derogatis Sexual Functioning Inventory, a modified version of the Dyadic Assessment Scale (marital adjustment), a global sexual evaluation, and a body-image scale. Analyses revealed that the aspects of sexual functioning for breast-cancer and gynecologic-cancer Ss that differed from those of controls were the frequency of sexual behaviors and the level of sexual arousal. Whereas Ss' evaluations of their current sexual life had no relationship to their marital-adjustment ratings, analyses suggested that body-image disruption may be a prevalent problem for gynecologic cancer patients. Data suggest that cancer diagnosis and treatment are instrumental in producing reductions in sexual activity and arousability. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of patient satisfaction with outpatient medical care.

Patient satisfaction data for 2,226 patients (average age 55.8 yrs) in the Medical Outcomes Study were used to determine the dimensions of satisfaction with medical care, the relation between direct and indirect methods of assessing global satisfaction with care, and the extent to which visit-specific and global satisfaction with one's medical care covary. Results supported the multidimensionality of satisfaction ratings but showed substantial covariation among some dimensions. Direct and indirect methods of assessing global satisfaction with care also covaried markedly. Global satisfaction was significantly, albeit modestly, correlated with visit-specific satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness and cost-benefit analysis of using methotrexate vs Goeckerman therapy for psoriasis. A pilot study

PURPOSE: To compare topical tetracaine 0.5% alone and with intracameral lidocaine 1% as a local anesthetic agent in phacoemulsification with intraocular lens (IOL) implantation. SETTING: The Toronto Hospital-Western Division, Toronto, Canada. METHODS: Fifty-nine consecutive patients (60 eyes) having phacoemulsification with implantation of a foldable acrylic IOL (AcrySof) were randomized into 1 of 2 groups: The intracameral balanced salt solution (BSS) group received topical tetracaine 0.5% plus intracameral BSS; the intracameral lidocaine group received topical tetracaine 0.5% with preservative-free intracameral lidocaine 1%. The patients' subjective experience of pain was measured at 4 points during surgery using a 4-point pain scale. Patient and surgeon satisfaction with the anesthesia used was measured using a 5-point satisfaction scale. Central endothelial cell counts were obtained preoperatively and 1 month postoperatively. Best corrected visual acuity (BCVA) was measured preoperatively and 1 hour, 1 day, 1 week, and 1 month postoperatively. RESULTS: The mean pain score after phacoemulsification was significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.63 +/- 0.7 [SD] and 0.23 +/- 0.4, respectively, P < .019). The mean pain score at the end of surgery was also significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.60 +/- 0.6 and 0.21 +/- 0.4, respectively; P < .014). The surgeon satisfaction score was significantly lower for the intracameral BSS group than for the intracameral lidocaine group (3.90 +/- 1.2 and 4.73 +/- 0.8, respectively; P < .0007). There was no difference in patient satisfaction between the intracameral BSS and intracameral lidocaine groups (4.60 +/- 0.6 and 4.70 +/- 0.8). Endothelial cell loss 1 month postoperatively was similar between the 2 groups (6.1% +/- 8% and 6.7% +/- 6%). Ninety-seven percent of patients (29/30) in each group noted BCVA improvement from preoperatively. The rate of potential visual acuity recovery was similar in both groups. CONCLUSION: Topical tetracaine 0.5% with intracameral lidocaine was safe and effective in patients having phacoemulsification with IOL implantation. The advantage of using intracameral lidocaine 1% over a placebo was a significant decrease in the patients' subjective experience of pain and in the surgeon's satisfaction with the anesthesia used. None of the other parameters measured in this study differed significantly between the 2 groups.     

Orthopaedic surgery in hemophilic patients with human immunodeficiency virus

Patients registered at the author's hemophilia center between 1982 and 1994 were studied to establish whether major orthopaedic surgical procedures accelerate the fall of CD4 lymphocyte counts of patients with hemophilia who are infected with the human immunodeficiency virus, and whether patients who had surgery had different rates of development of acquired immune deficiency syndrome or death when compared with patients who did not have surgery. The patients were divided into four groups: Group 1, 22 patients who were human immunodeficiency virus positive undergoing orthopaedic surgery; Group 2, 89 patients who were human immunodeficiency virus positive not undergoing orthopaedic surgery; Group 3, 18 patients who were human immunodeficiency virus negative undergoing orthopaedic surgery; and Group 4, 135 patients who were human immunodeficiency virus negative not undergoing orthopaedic surgery. There was no significant difference between the rates of decline of CD4 lymphocyte counts for patients who were human immunodeficiency virus positive who underwent surgery when compared with human immunodeficiency virus positive patients who did not undergo surgery, nor was there any significant difference between the two human immunodeficiency virus negative groups. There were no significant differences in the rate of development of acquired immune deficiency syndrome or mortality rates between patients who had surgery and those who did not.     

Benefit Finding in Multiple Sclerosis and Associations With Positive and Negative Outcomes.

This study examined the direct and stress-buffering effects of benefit finding on positive and negative outcomes. A total of 502 people with multiple sclerosis completed a questionnaire at Time 1 and, 3 months later, at Time 2 (n=404). Measures of illness were collected at Time 1, and number of problems, stress appraisal, benefit finding, subjective health, and negative (global distress, negative affect) and positive (life satisfaction, positive affect, dyadic adjustment) outcomes were measured at Time 2. Factor analyses showed the Benefit Finding scale to have 2 dimensions: Personal Growth and Family Relations Growth. Hierarchical regressions showed that after controlling for the effects of demographics, illness, problems, and appraisal, benefit finding showed strong direct effects on the positive outcomes. Benefit finding did not have a direct effect on distress or subjective health but had a weak association with negative affect. Family Relations Growth had a stress-buffering effect on distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress management in the health care setting: Matching interventions with patient coping styles.

Forty-six patients about to undergo preprosthetic oral surgery were presented with either a problem-focused, emotion-focused, or mixed-focus stress management intervention. The mixed-focus intervention produced the best overall response to surgery; the emotion-focused intervention produced the lowest adjustment levels. The Krantz Health Opinion Survey Information scale was the best overall predictor of response to surgery in conjunction with treatments. Better adjustment and satisfaction and lower self-reported pain were obtained when high information-preference subjects were given a problem-focused intervention and when low information-preference subjects were given an emotion-focused intervention; responses were relatively poor when mismatches occurred. Differences in relative use of problem- to emotion-focused coping as measured by the Ways of Coping Checklist were unrelated to adjustment or satisfaction, but differences in problem-focused coping were the best predictors of pain response in conjunction with treatments. Preoperative anxiety level was inversely related to adjustment and satisfaction and was directly related to pain, with the affective-unpleasantness component of pain primarily accounting for this association. (PsycINFO Database Record (c) 2010 APA, all rights reserved)