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A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan.

ABSTRACT: To compare the societal preferences for finger replantation between the United States (US) and Japan and to investigate factors influencing the preferences.A sample of the general population without current hand disease or condition was recruited via flyers posted in public areas of 2 major academic centers in the US and Japan. The recruited subjects completed a survey presenting finger amputation scenarios and various factors that may affect treatment decisions. We performed univariate analysis using treatment preference as the outcome and all other factors as possible predictors using the chi-square test.Most respondents in both countries preferred replantation and there was no significant difference between the US and Japan. Treatment preference was significantly associated with the importance of appearance, recovery time, and the chance of survival of the replanted digit. There was no association between treatment preference and attitudes regarding body integrity or estimate of stigma toward finger amputees. Japanese participants agreed more with statements of body integrity, and Japanese respondents rated appearance, sensation, and chance of survival of the replant as more important than did American participants.Patient preference is not driving the decrease in finger replantations in the US. The general public in both countries prefer replantation over wound closure for digit amputations.Economic and decision analysis III.

SUBMITTER: Nishizuka T

PROVIDER: S-EPMC4800816 | biostudies-other | 2015 Aug

REPOSITORIES: biostudies-other

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A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan.

Nishizuka Takanobu T Shauver Melissa J MJ Zhong Lin L Chung Kevin C KC Hirata Hitoshi H

The Journal of hand surgery 20150801 8

<h4>Purpose</h4>To compare the societal preferences for finger replantation between the United States (US) and Japan and to investigate factors influencing the preferences.<h4>Methods</h4>A sample of the general population without current hand disease or condition was recruited via flyers posted in public areas of 2 major academic centers in the US and Japan. The recruited subjects completed a survey presenting finger amputation scenarios and various factors that may affect treatment decisions. ...[more]

PMID: 26213200

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Project description:ImportanceRisk-adjusted variation in surgeon outcomes has been traditionally explained by surgeon volume and hospital infrastructure, yet it is unclear how a surgeon's operative proficiency directly contributes to their patients' outcomes.ObjectiveTo assess the variation of surgeons' operative proficiency and investigate its association with surgical outcomes.Design, setting, and participantsThis case series was a retrospective analysis of all digit replantations and revascularizations at a single US university medical center between January 2000 and August 2020. Surgeons were assigned a proficiency score based on the expected procedure difficulty and outcomes from a sample of their cases. Surgeon proficiency scores were then used to determine associations with outcomes from subsequent cases. The expected difficulty of each case was calculated using a novel scoring system that applied pooled relative risks from a meta-analysis of risk factors for replantation and revascularization failure.ExposuresDigit replantation and revascularization.Main outcomes and measuresDigit survival at 1-month follow up (case success) and number of complications.ResultsA total of 145 patients and 226 digits were treated by 11 surgeons with training in hand or microsurgery (mean [SD] age, 41.9 [15.2] years; 204 [90%] men); there were 116 replantations and 110 revascularizations. Surgeon proficiency scores ranged from 1.3 to 5.7, with a mean (SD) of 3.4 (1.4). Case success rates among surgeons varied from 20.0% to 90.5%, with a mean (SD) of 64.9%. Higher proficiency scores were associated with fewer case failures: each point increase was associated with 40% decreased odds of failure (odds ratio, 0.60; 95% CI, 0.38-0.94). Every 3-point increase in proficiency score was associated with 1 less complication (effect estimate, -0.29; 95% CI, -0.56 to 0.02). Surgeon proficiency score had a greater association with case failure than surgeon volume (16.7% vs 12.0%). The final model's association with case failure had an area under the receiver operating characteristics curve of 0.93.Conclusions and relevanceOperative proficiency varied widely among practicing surgeons and accounted for 17% of estimative ability for success of digit replantation and revascularization. Greater surgeon proficiency was associated with better outcomes, indicating that the value of surgical care may be optimized by improving surgeon proficiency.

Project description:IntroductionNurses encounter children who report of pain of diverse and unknown causes in their professional work. The current study therefore assessed and compared nursing students and nurses' knowledge and attitudes pertaining to children's pain in the Ghanaian context. The goal of this was to have a baseline information to guide the development and implementation of the content for a sustainable educational programme (short-course) for nursing students and nurses in Ghana.MethodsBetween October and December 2018, a cross-sectional study was carried out among 554 final year nursing students and 65 nurses in Ghana. The Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain (PNKAS) was used to collect data from participants who were affiliated to four educational institutions and eight hospitals. Data were descriptively and inferentially analyzed using chi-square test of independence, independent samples t-test and one-way analysis of variance (ANOVA).ResultsOur findings revealed that nursing students and nurses generally had unsatisfactory knowledge and attitudes towards pain management in children. Nursing students however, had significantly higher scores than nurses in the total PNKAS score and in 10 out of the 13 identified item-areas. Greater scores were obtained by nursing students in areas which were related to pain physiology, pharmacokinetics, pharmacology of analgesics and pain perceptions (p < .05). All the participating nurses could not accurately determine: the onset of action of orally administered analgesics, equianalgesia of orally administered morphine, and the right dosage of prescribed morphine for a child who consistently reported of moderate to severe pain.ConclusionFinal year nursing students and nurses have unsatisfactory knowledge and attitudes regarding children's pain; which reiterates the need for urgent and effective educational efforts in this area. Regular in-service training should be offered to post-registration nurses to enhance their pediatric pain knowledge and attitudes for improved pain care in children.

Dataset Information

A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan.

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A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan.

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