Analyzing Arabic Twitter-Based Patient Experience Sentiments Using Multi-Dialect Arabic Bidirectional Encoder Representations from Transformers

Healthcare organizations rely on patients’feedback and experiences to evaluate their performance and services,thereby allowing such organizations to improve inadequate services and address any shortcomings.According to the literature,social networks and particularly Twitter are effective platforms for gathering public opinions.Moreover,recent studies have used natural language processing to measure sentiments in text segments collected from Twitter to capture public opinions about various sectors,including healthcare.The present study aimed to analyze Arabic Twitter-based patient experience sentiments and to introduce an Arabic patient experience corpus.The authors collected 12,400 tweets from Arabic patients discussing patient experiences related to healthcare organizations in Saudi Arabia from 1 January 2008 to 29 January 2022.The tweets were labeled according to sentiment(positive or negative)and sector(public or private),and thereby the Hospital Patient Experiences in Saudi Arabia(HoPE-SA)dataset was produced.A simple statistical analysis was conducted to examine differences in patient views of healthcare sectors.The authors trained five models to distinguish sentiments in tweets automatically with the following schemes:a transformer-based model fine-tuned with deep learning architecture and a transformer-based model fine-tuned with simple architecture,using two different transformer-based embeddings based on Bidirectional Encoder Representations from Transformers(BERT),Multi-dialect Arabic BERT(MAR-BERT),and multilingual BERT(mBERT),as well as a pretrained word2vec model with a support vector machine classifier.This is the first study to investigate the use of a bidirectional long short-term memory layer followed by a feedforward neural network for the fine-tuning of MARBERT.The deep-learning fine-tuned MARBERT-based model—the authors’best-performing model—achieved accuracy,micro-F1,and macro-F1 scores of 98.71%,98.73%,and 98.63%,respectively.

Enhancing Quality of Patients Care and Improving Patient Experience in China with Assistance of Artificial Intelligence

Improving health of Chinese people has become national strategy according to the Healthy China 2030.Patient experience evaluation examines health care service from perspective of patients;it is important for improving health care quality.Applying artificial intelligence(AI)in patient experience is an innovative approach to assist continuous improvement of care quality of patient service.A nursing quality platform based on patient experience data which is empowered by AI technologies has been established in China for the purpose of surveillance and analysis of the quality of patient care.It contains data from nearly 1300 healthcare facilities,based on which portraits of nursing service qualities can be drawn.The patient experience big data platform has shown potentials for healthcare facilities to improve patient care quality.More efforts are needed to achieve the goal of enhancing people’s sense of health gain.

Characterizing the patient experience during neoadjuvant therapy for pancreatic ductal adenocarcinoma:A qualitative study

BACKGROUND Neoadjuvant therapy(NT)has increasingly been utilized for patients with localized pancreatic ductal adenocarcinoma(PDAC).It is the recommended approach for borderline resectable(BR)and locally advanced(LA)cancers and an increasingly utilized option for potentially resectable(PR)disease.Despite its increased use,little research has focused on patient-centered metrics among patients undergoing NT,including patient experiences,preferences,and recommendations.A better understanding of all aspects of the patient experience during NT may identify opportunities to design interventions aimed at improving quality of life;it may also facilitate the completion of NT and receipt of surgery,ultimately optimizing long-term outcomes.AIM To understand the experience of patients initiating and receiving NT to identify opportunities to improve neoadjuvant cancer care delivery.METHODS Semi-structured interviews of patients with localized PDAC during NT were conducted to explore their experience initiating and receiving NT.Interviews took place between August 2020 and October 2021.Due to the descriptive nature of the research,questions were open ended.Interviews were conducted over the phone,audio recorded and then transcribed.All interviews were coded by two independent researchers using NVivo 12,iteratively identifying themes until thematic saturation was achieved.An integrative approach to qualitative analysis was used,utilizing both inductive and deductive methods.RESULTS A total of 12 patients with localized PDAC were interviewed.Patients with BR(n=7),PR(n=2),and LA(n=3)cancers participated in the study.All patients indicated that choosing NT was the doctor’s recommendation,while most reported not being familiar with the concept of NT(n=11)and that NT was presented as the only option(n=8).Five themes describing the patient experience emerged:physical symptoms,emotional symptoms,coping mechanisms,access to care,and life factors.The most commonly cited recommendation for improving the experience of NT was improved education before and during NT(n=7).Patients highlighted the need for more information on the rationale behind choosing NT prior to surgery,the anticipated surgery and its likelihood of surgery occurring after NT,as well as general information prior to starting NT treatment.The need for seeing different members of the healthcare team,including ancillary services was also frequently cited as a recommendation for improving the experience of NT(n=5).CONCLUSION This study provides a framework to allow for a better understanding of the PDAC patient experience during NT and highlights opportunities to improve quality and quantity of life outcomes.

Progress in applying patient experience in nursing quality improvement

Background: Improving and sustaining the quality of nursing care is an intractable and persistent challenge. The patient experience of nursing care can give a different perspective on nursing quality and help clinical nursing staff to direct quality improvement. Attempts to identify what is patient experience,the relationship with nursing care, and the application of patient experience in nursing quality improvement practice, in order to provide advices for constructing the quality standards and quality improvement strategies of nursing care.Methods: We conducted a literature review of original research publications. The database platforms Pubmed, Web of Science, China National Knowledge Infrastructure(CNKI) and Wanfang were searched from inception until end of August 2015. After screening retrieved articles, 40 sources(articles and organizational websites) were selected for analysis for the connotation, development and application of patient experience in nursing quality researches.Results: Our study identified several concepts about patient experience, roughly sorted out the development path of patient experience in worldwide and the application of patient experience in nursing quality improvement. It points out four precautions when applying patient experience in nursing quality improvement, which are differentiating patient satisfaction and patient experience, choosing appropriate data collection method and appropriate feedback time, and the last but the most important, applying theories to actual clinical practice.Conclusions: Professional indexes are important to maintain the care quality, but it cannot fully reflect quality of nursing care, which needs patient experience as the supplement. Nursing staffs need to make more efforts to enhance patient's nursing care experience, and apply the research results to clinical practice, and finally make patient-centered care come true. For future study, the evaluation system and management strategies about patient experience need to be developed to guide nursing quality improvement.

Patient Experience during Hospital Stay: A Pilot Survey

Introduction: Hospital inpatient care is provided to individuals who have a condition that requires them to stay in hospital. Patient experience is an important aspect of high-quality patient-centered care. Aim: With this pilot survey we aimed to obtain patient feedback on their experiences during their hospital stay, highlight areas of best practice and areas for improvement and provide a basis for a hospital-wide inpatient experience survey. Patients and Methods: Anonymous patient experience questionnaires were given to patients who were discharged from hospital during the month of May 2016. Patients were asked to answer 45 questions concerning their experience during hospital stay using the five-point Likert scale, and hand back the questionnaire before leaving the hospital. A suggestion box was provided for comments and suggestions for improvement. Results: Fifty-six questionnaires were handed out and 50 (from 27 males, 17 females and 6 patients who did not specify their gender) questionnaires were returned (89% response rate). Most of the responses fell within the “agree” to “strongly agree” range indicating a positive patient experience for most of the items addressed. Patients also provided useful comments and suggestions. Conclusion: Results of this survey indicate that patients generally had a positive experience during their hospital stay. This survey has revealed areas for improvement, and highlights the importance of patient experience when assessing a patient-centered service.

Twitter Sentiment at the Hospital and Patient Level as a Measure of Pediatric Patient Experience

Although pediatric cancer survival rates have improved, cancer is still the leading cause of death by disease among children in the United States. With nearly 16,000 new diagnoses each year of children having an average age of six years old, there is still much to be done to improve survival rates among children diagnosed with cancer. Additionally, clinical outcomes can be greatly improved by first understanding the patient perspective and, consequently, there is a need to understand the pediatric cancer patient experience. Interest in the analysis of patient-reported outcome (PRO) measures, including those specific to patient experience, has grown in recent years as attempts are made to understand and assess latent (i.e., unobserved) traits such as quality of life. While most traditional PRO measures involve lengthy and costly surveys that are limited in scope, posts on social media platforms are frequently lauded as more authentic, unbiased measures of patient experience. While many previous studies have utilized Twitter as a source for patient experience data that is not easily captured by traditional PROs, very few studies have examined the use of Twitter data to explore and better understand the experience of pediatric cancer patients specifically. Lexicon-based sentiment analysis of Twitter data was used both to examine the pediatric cancer patient experience as well as to compare the attitudes, perceptions, and overall impressions of individuals with St. Jude experiences to those with more general experiences. Results indicated that patients reflected on their care with more relative negativity when speaking of experiences other than St. Jude. While there were some notable differences between the two comparison groups, the sentiment of both was still mostly positive. Pediatric oncology differs greatly from adult oncological care and, thus, the proposed use of sentiment analysis with patient social media posts serving as authentic PRO data likely differentiates more between medical providers and clinical care settings when assessing adult patient experience. Despite limitations, this exploratory study suggests that Twitter can be utilized as a source for authentic, real-time patient experience data that will improve overall care and better clinical outcomes, even among the pediatric cancer patient population.

What factors influence patient experience in orthopedic oncology office visits?

BACKGROUND Patient satisfaction and reported outcomes are becoming increasingly important in determining the efficacy of clinical care.To date no study has evaluated the patient experience in the orthopedic oncology outpatient setting to determine which factors of the encounter are priorities to the patient.AIM To evaluate what factors impact patient experience and report satisfaction in an outpatient orthopedic oncology clinic.METHODS Press Ganey®patient surveys from a single outpatient orthopedic oncology clinic at a tertiary care setting were prospectively collected per routine medical care.All orthopedic oncology patients who were seen in clinic and received electronic survey were included.All survey responses were submitted within one month of clinic appointment.IRB approval was obtained to retrospectively collect survey responses from 2015 to 2016.Basic demographic data along with survey category responses were collected and statistically analyzed.RESULTS One hundred sixty-two patient surveys were collected.Average patient age was 54.4 years(SD=16.2 years)and were comprised of 51.2% female and 48.4%male.64.2%of patients were from in-state.Out of state residents were more likely to recommend both the practice and attending physician.The likelihood to recommend attending physician was positively associated with MD friendliness/courtesy(OR=14.4,95%CI:2.5-84.3),MD confidence(OR=48.2,95%CI:6.2-376.5),MD instructions follow-up care(OR=2.5,95%CI:0.4-17.4),and sensitivity to needs(OR=16.1,95%CI:1-262.5).Clinic operations performed well in the categories of courtesy of staff(76%)and cleanliness(75%)and less well in ease of getting on the phone(49%),information about delays(36%),and wait time(37%).CONCLUSION Orthopedic specialties can utilize information from this study to improve care from the patient perspective.Future studies may be directed at how to improve these areas of care which are most valued by the patient.

Patients’ Experiences of Trust in the Patient-Nurse Relationship——A Systematic Review of Qualitative Studies

Aims and Objectives: To report a synthesis of the literature on the meaning of trust in the context of patients’ experiences of nursing. The review question was “How do patients describe the meaning of trust in the nursing relationship?” Background: Trust is essential in nursing as it has the potential to create opportunities for the human being to gain faith, hope and meaning in life as well as open up for new experiences. Trust is an interpersonal and essential element of all patient-nurse relationships and requires nurses to create a trusting relationship with the patients. Design: Systematic qualitative literature review. Methods: Systematic searches were conducted for the period January 2002 to December 2012, updated in January 2014. 20 papers were included. Results: Four categories emerged: Attitudes related to trust, indicating that trust is fundamental and existential;Experiences of trust, concerning how trust can be sensed;The patient-nurse relationship, revealing the qualities of the person who creates trust;and Where trust occurs, illuminating the contextual relevancies of trust. Conclusions: Patients’ experiences of trust in nursing are dependent on the nurses’ knowledge, level of commitment in the dialogue to creating and developing the relationship and contextual issues. Implications for nursing practice: Reflection on a trusting relationship with the patient is necessary for a deeper conceptual understanding of trust in nursing. Clinical nurse researchers nurse supervisors, managers and nurse educatorsshould discuss different areas of trust during nursing supervision and focus-group meetings as well as with nursing graduates to ensure that nurses develop knowledge of how to create a trusting patient-nurse relationship.

Symptom experience in patients with cancer-related fatigue:A systematic review and meta-synthesis

To understand the real experiences of patients with cancer-related fatigue and to promote quality of life,the researchers used computer searches of PubMed,EMbase,CINAHL,PsycINFO,Web of Science,and China National Knowledge Infrastructure,China Biology Medicine disc,Wanfang Data,China Science and Technology Journal Database for relevant qualitative studies from the inception to November 1,2021.The results showed that a total of 16 papers were included,and 57 outcomes were distilled into 9 categories,which were pooled into four integrated outcomes,such as somatic,psychological and social support and so on.It is concluded that patients with cancer-related fatigue are not only in the midst of multidimensional,unspeakable somatic experiences,and complex psychological experiences,they are also hindered in coping with fatigue symptom and social life.Therefore,healthcare professionals should provide health interventions and psychological support to those patients whenever possible.

Exploring the Experiences of Chinese Patients Waiting for Heart Transplantation

Background: Patients waiting for heart transplantation (HT) have complex physiological and psychosocial problems. Factors such as psychological state, behavior, social relationships, and cultural background of patients influence the HT process, such as causing psychotic disorder, difficult decision and close dependence. Care during the waiting period needs to be aimed at not only treating the symptoms but also the specific status. Purpose: To describe the physical and psychosocial experiences of the patients waiting for HT in one general hospital in the northern part of China. Methods: A qualitative approach was used in this study. Fifteen patients waiting for HT were selected based on purposive sampling, and semi-structured interviews were carried out. Results: In the analysis process, reported experiences of the participants were categorized into five main themes as follows: 1) feeling the impact;2) uncertainty about the future;3) difficult to make decisions;4) negative emotions and 5) request support. Conclusion: This study provides an in-depth description of patients waiting for HT who haveexperienced many physical, psychosocial, and familial problems due to disease and their cultural background. It found that Chinese patients have some special experiences due to their psychosocial background. This study suggests that nurses should focus on not only physical but also psychosocial problems of these patients, and provide understandings to develop more effective strategies to solve their problems. Relevance to Clinical Practice: This study focused on the special patients who are waiting for heart transplantation, and got the special results about the feelings and experiences. The results can help the doctors and nurses to help the patients pass the special period smoothly.

Patient Life Experience and Activity of Daily Living before and after Total Knee Arthroplasty

Background: As the population ageing, more patients suffer from joint disease. Joint replacement surgery performed in Taiwan is about 10,000 to 20,000 cases yearly. Aims: The purpose of this study is to realize Total Knee Arthroplasty (TKA) patients’ views about life experiences and difficulty in daily life before and after the surgery. Methods: In this study, in-depth interview with interview guideline was used to analyze patients’ experience by using a qualitative research method, and questionnaires were used to collect quantity data. Results: 1) A total of 20 participants were recruited. Average age was 75.15 (SD = 6.468). Eighteen of the participants were female and the other two were male. The majority of participants indicated that their home facilities were convenient or very convenient. 2) Motivations of the participants to undergo TKA were joint pain, limited joint range of motion, and weakness in legs. Participants’ expectations after surgery were no more pain and ease in walking, and able to manage daily life. 3) Depending on the time after surgery, joint pain and walking ability had improved to some extent. The joint range of motion increased, but kneeling remained difficult, and the participants’ mood and exercise capacity were improved. Conclusions: The finding can be as a reference for clinical practitioner to provide preoperative education for total knee arthroplasty patients.

Construction of a New Model of Contactless Medical Services for Outpatients Based on the Project-Achieving Quality Control Circle

Objective: To carry out empirical research on the role of project-achieving quality control circle (QCC) in constructing a new model of contactless medical service for outpatients. Methods: A QCC, consisting of information office members from a grade A tertiary hospital in Wenzhou, was established to conduct a research project with the theme “Constructing a new model of contactless medical service based on outpatients’ experience.” According to the ten steps and PDCA cycle, an analysis was carried out before and after the QCC activities, focusing on improving pre-consultation services, providing steward-like services, and facilitating post-consultation management. Results: After the QCC activities, the mobile appointment rate, missed appointment rate, the proportion of smart check-ins, and the average check-in time were 55.68%, 4.02%, 39.75%, and 8.24 ± 3.66 min, respectively;in contrast, before the activities, they were 32.00%, 7.88%, 0.00%, and 14.96 ± 4.98 min, respectively;the difference between the two groups was statistically significant (χ2 = 3480.112, 4994.496;Fisher’s exact probability = 963788.570;t = 5.323, P < 0.001). Many experts have also visited the hospital to learn about this system, thus rendering social and economic benefits. Conclusion: Project-achieving QCC activities are suitable for complex situations, such as constructing a new model of contactless medical service, and can significantly improve outpatient service quality, enhance patients’ experience, and improve the abilities of circle members.

Evaluation of Patients’ Experience Following Dental Implant Surgical Procedure

Background: Patient’s acceptability of dental implant prostheses may be influenced the fact that a surgical procedure is involved. Adequate relevant information by the dental professionals pre-surgery, is therefore, paramount to alleviating the fear of surgery and contribute positively to patient’s ability to cope with post-surgical experience. This study, therefore, aimed at evaluating the postsurgical experience of the dental implant patients. As against what was expected, and relate this with the information given pre surgery. Methodology: Post treatment self-completed questionnaires were administered to consented patients that had dental implants placed between July 2017 and December 2019. The surgical procedure followed the standard protocol and data related to post-surgical experience were collected one week after the surgery to obtain information on the level of pain/discomfort and amount of swelling experienced following surgery. The effect of the information on coping ability following surgery was also assessed. Data were analyzed using descriptive statistics (p value ≤ 0.05). Results: Twenty-seven patients received 44 implants to replace 48 teeth. The mean age of the patients was 45 ± 16.3 (SD) years. Teeth mostly replaced were the maxillary central incisors (39.6%). The majority of the patients 77.7% reported to experience less pain/discomfort than expected and 66.6% had less swelling than expected. While 29.6% felt they had excellent explanation of what to expect, 51.9% said they had good explanation. The post-surgical experience between males and females was not statistically significant (pain: p = 0.08, swelling: p = 0.64). However, the majority (8/12) that had good to excellent information preoperatively, had significantly less discomfort than expected. Conclusion: Positive, encouraging and satisfactory experience of patients following implant surgical procedure is related to adequate and correct information pre-surgery.

Experience of the patient's success in facing post-stroke urinary incontinence: the patient's perspective

Objective:Post-stroke urinary incontinence(UI)is one of the sequelae of stroke.This situation affects all aspects of the patient’s life–physically,psychologically,socially,and spiritually.This study aimed to investigate the experience of patients’success in facing a post-stroke UI.Methods:A qualitative study using the Rapid Assessment Procedure(RAP)approach was used in this study.Informants were selected using purposive sampling.In-depth interviews with as many as 8 patients who had recovered from post-stroke UI and living in the greater area of Southeast Sulawesi(Indonesia)were conducted.In-depth interviews were also conducted with 8 caregivers and 2 nurses.Data were analyzed using a thematic analysis approach and interpretation of data was based on Humanbecoming theory and Self-care deficit theory of nursing.Results:Five successful things the patients experienced during post-stroke UI were identified.The five successes were as follows:they provided information to get to know and understand post-stroke UI,followed the procedures to overcome post-stroke UI,conducted self-control exercises and stayed motivated,performed daily activities independently according to ability,and made use of family suppor t and peers’attention.Conclusions:These findings indicated that persistence,belief,independence,and social support(family and peer)made patients to successfully face their post-stroke UI and improved their quality of life.These findings also became the basis for developing a poststroke UI management model based on Humanbecoming theory and Self-care deficit theory of nursing.

Experiences of Psychiatric Day-Care Patients during the Introductory Period in Japan

Psychiatric day care plays an important role as transitional support after discharge in Japan. However, interruption rate of the day care treatment is high during the introductory period. The purpose of this study was to clarify the experiences of psychiatric day-care patients during the introductory period and find an approach to care. A qualitative study with thirteen patients at the introductory period was designed to explore participant’s experiences through semi-structured interviews. At first, patients were confused about their attitude because they paid attention to themselves, and consequently closed their involvement with others. However, through therapeutic day care activities, they attempted to adapt themselves and gradually turned their attention toward others and accumulated interpersonal experiences. As interactions with others became more frequent, they became conscious of themselves and others. Finally, while having worries about the future, they looked toward recovery and became aware that they were changing. Experiences of patients during the introductory period were essential to their recovery and gave meaning to their day care usage. Nurses should collaborate with patients to determine whether day care would serve to open a patient’s life to new possibilities.

Innovative Applications of Patient Experienee Big Data in Modern Hospital Management Improve Healthcare Quality

It is important for modern hospital management to strengthen medical humanistic care and build a harmonious doctor-patient relationship.Innovative applications of the big data resources of patient experience in modern hospital management facilitate hospital management to realize real-time supervision,dynamic management and s&entitle decision-making based on patients experiences.It is helping the transformation of hospital management from an administrator^perspective to a patients perspective,and from experience-driven to data-driven.The technological innovations in hospital management based on patient experience data can assist the optimization and continuous improvement of healthcare quality,therefore help to increase patient satisfaction to the medical services.

Medical consultation in ulcerative colitis:Key elements for improvement

Ulcerative colitis(UC)is a chronic inflammatory disease with a high impact.In order to improve patient outcomes,the clinician-patient relationship in daily practice is critical.Clinical guidelines provide a framework for UC diagnosis and treatment.However,standard procedures and the medical content focused upon medical consultations in UC patients has not yet been defined.Moreover,UC is a complex disease,given that patient characteristics and patient needs have been proven to vary during clinical consultation since establishing the diagnosis and upon the course of the disease.In this article,we have discussed the key elements and specific objectives to consider in medical consultation,such as diagnosis,first visits,follow-up visits,active disease patients,patients on topical therapies,new treatment initiation,refractory patients,extra-intestinal manifestations,as well as challenging situations.The key elements have been mentioned to comprise effective communication techniques,motivational interviewing(MI),as well as information and educational aspects,or organizational issues.The key elements to be implemented in daily practice were reported to comprise several general principles like duly prepared consultations,in addition to honesty and empathy with patients,as well as effective communication techniques,MI,information and educational points,or organizational issues.The role of other healthcare professionals such as specialized nurses,psychologists,or the use of checklists was also discussed and commented on.

基于患者视角的公立医院互联网医院发展路径

目的从患者视角出发,以上海市儿童医院互联网医院为例,通过调查患者对互联网医院的知晓、使用和满意情况,了解公立医院互联网医院的运行现状和存在的问题,有针对性地提出优化方案和发展路径,从而推动公立医院互联网医院持续健康发展。方法在文献研究和专家访谈的基础上,设计调查问卷并对上海市儿童医院线下门诊患儿家长进行调查。调查内容包括个人基本信息,对互联网医院的知晓度、利用度和满意度等情况,共有560人参与并完成了调查。应用SPSS 26.0软件对数据进行统计分析。结果53.21%的受调查者知晓上海市儿童医院开通了互联网医院;知晓并已使用该院互联网医院的受调查者对预约挂号(96.64%)、在线缴费(56.04%)和报告查询(44.97%)等服务功能的利用度较高,而对在线咨询、在线复诊、配药到家等医患互动服务的利用率较低。98.21%的患者对互联网医院总体表示满意,并希望增加高级专家问诊、诊前导诊、商业保险在线理赔等线上服务。结论目前公立医院互联网医院在运行过程中主要存在着宣传力度不足、高级专家少、问诊响应时间长等问题,患者的线上就医过程仍不便利,需要通过加强宣传推广、优化服务方式、丰富服务功能、打通线上线下医疗服务流程等举措,推动公立医院互联网医院高质量发展,不断提升患者就医体验。

Can bedside needle arthroscopy of the ankle be an accurate option for intra-articular delivery of injectable agents?

BACKGROUND Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents.Accuracy and tolerability of this approach in the clinical setting–including patients with end-stage ankle pathology and/or a history of prior surgery–is not known.AIM To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint.METHODS This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint.In our center,these injections are used as a last resort prior to extensive surgery.The primary outcome was injection accuracy,which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint space.Secondary outcome measures included a patientreported numeric rating scale(NRS,0-10)of pain during the procedure and willingness of patients to return for the same procedure.NRS of ankle pain at rest and during walking was collected at baseline and at 2-wk follow-up.Complications were monitored from inclusion up to a 2-wk control visit.RESULTS We performed 24 inspection-injections.Eleven(46%)participants were male,and mean age was 46.8±14.5 years.Osteoarthritis was the indication for injection in 20(83%)cases,of which 8(33%)patients suffered from osteoarthritis Kellgren-Lawrence grade IV,and 10(42%)patients from Kellgren-Lawrence grade III.An osteochondral defect was the indication for injection in 4(17%)cases.A history of ankle surgery was present in 14(58%)participants and a history of multiple ankle surgeries in 11(46%)participants.It was possible to confirm accuracy in 21(88%)procedures.The 3(12%)participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV osteoarthritis.Pain during the procedure was reported with a median of 1[interquartile ranges(IQR):0–2].Willingness to return was 100%.Pain in rest decreased from a median NRS of 4(IQR:2–7)at baseline to a median of 3(IQR:1–5)at follow-up(P<0.01).Pain during walking decreased from a median NRS of 8(IQR:6–9)to a median of 7(IQR:4–8)(P<0.01).Infections or other complications were not encountered.CONCLUSION Clinical accuracy and tolerability of bedside needle arthroscopy of the ankle as a delivery system for injectable agents are excellent.Accuracy was 100%in patients without total ventral joint obliteration.

Barriers and facilitators to participating in cardiac rehabilitation and physical activity:A cross-sectional survey

BACKGROUND Cardiovascular diseases(CVD)have been shown to be the greatest cause of death worldwide and rates continue to increase.It is recommended that CVD patients attend cardiac rehabilitation(CR)following a cardiac event to reduce mortality,improve recovery and positively influence behaviour around CVD risk factors.Despite the recognised benefits and international recommendations for exercisebased CR,uptake and attendance remain suboptimal.A greater understanding of CR barriers and facilitators is required,not least to inform service development.Through understanding current cardiac patients’attitudes and opinions around CR and physical activity(PA)could inform patient-led improvements.Moreover,through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the future.AIM To investigate participants’attitudes and opinions around CR and PA.METHODS This study employed a cross-sectional survey design on 567 cardiac patients.Cardiac patients who were referred for standard CR classes at a hospital in the Scottish Highlands,from May 2016 to May 2017 were sampled.As part of a larger survey,the current study analysed the free-text responses to 5 open-ended questions included within the wider survey.Questions were related to the participants’experience of CR,reasons for non-attendance,ideas to increase attendance and their opinions on PA.Qualitative data were analysed using a 6-step,reflexive thematic analysis.RESULTS Two main topic areas were explored:“Cardiac rehabilitation experience”and“physical activity”.Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment offered.Barriers ranged from age and health to distance and starting times of the classes which increased travel time and costs.Moreover,responses demonstrated a lack of information and communication around the classes.Respondents highlighted that the provision of more classes and classes being held out with working hours,in addition to a greater variety would increase attendance.In terms of PA,respondents viewed this as different to the CR experience.Responses demonstrated increased freedom when conducting PA with regards to the location,time and type of exercise conducted.CONCLUSION Changes to the structure of CR may prove important in creating long term behaviour change after completing the rehabilitation programme.