Browsing by Person "Gaston, P."

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A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components
(British Editorial Society of Bone and Joint Surgery, 2008-01) Nutton, R. W.; van der Linden, Marietta; Rowe, P. J.; Gaston, P.; Wade, F. A.
Modifications in the design of knee replacements have been proposed in order to maximise flexion. We performed a prospective double-blind randomised controlled trial to compare the functional outcome, including maximum knee flexion, in patients receiving either a standard or a high flexion version of the NexGen legacy posterior stabilised total knee replacement. A total of 56 patients, half of whom received each design, were assessed pre-operatively and at one year after operation using knee scores and analysis of range of movement using electrogoniometry. For both implant designs there was a significant improvement in the function component of the knee scores (p < 0.001) and the maximum range of flexion when walking on the level, ascending and descending a slope or stairs (all p < 0.001), squatting (p = 0.020) and stepping into a bath (p = 0.024). There was no significant difference in outcome, including the maximum knee flexion, between patients receiving the standard and high flexion designs of this implant.
Assessing treatment outcomes using a single question: the Net Promoter Score
(British Editorial Society of Bone & Joint Surgery, 2014-05) Hamilton, D. F.; Lane, Judith; Gaston, P.; Patton, J. T.; MacDonald, Deborah; Simpson, Hamish; Howie, Colin
Satisfaction with care is important to both patients and to those who pay for it. The Net Promoter Score (NPS), widely used in the service industries, has been introduced into the NHS as the 'friends and family test'; an overarching measure of patient satisfaction. It assesses the likelihood of the patient recommending the healthcare received to another, and is seen as a discriminator of healthcare performance. We prospectively assessed 6186 individuals undergoing primary lower limb joint replacement at a single university hospital to determine the Net Promoter Score for joint replacements and to evaluate which factors contributed to the response. Achieving pain relief (odds ratio (OR) 2.13, confidence interval (CI) 1.83 to 2.49), the meeting of pre-operative expectation (OR 2.57, CI 2.24 to 2.97), and the hospital experience (OR 2.33, CI 2.03 to 2.68) are the domains that explain whether a patient would recommend joint replacement services. These three factors, combined with the type of surgery undertaken (OR 2.31, CI 1.68 to 3.17), drove a predictive model that was able to explain 95% of the variation in the patient's recommendation response. Though intuitively similar, this 'recommendation' metric was found to be materially different to satisfaction responses. The difference between THR (NPS 71) and TKR (NPS 49) suggests that no overarching score for a department should be used without an adjustment for case mix. However, the Net Promoter Score does measure a further important dimension to our existing metrics: the patient experience of healthcare delivery.
Post-operative pain management through audio-analgesia: Investigating musical constructs
(SAGE, 2015-04-01) Finlay, K. A.; Wilson, J. A.; Gaston, P.; Al-Dujaili, Emad A. S.; Power, I.
Distraction and attention-diversion approaches are widely integrated into pain management. Music-induced analgesia, the ability of music to reduce pain perception, is a clinically-relevant approach for managing pain, anxiety and psychological well-being. Research categorizes audio-analgesic interventions as homogenous, however enquiry is required to identify which musical constructs may be therapeutically effective. This study investigated the impact of harmony and rhythm on acute, post-operative pain in a sample of 98 patients scheduled for knee surgery. Four music-listening groups were compared against controls using silent relaxation. After surgery using standardized anaesthesia, participants undertook a 15-minute intervention per day of in-patient stay. Measures of pain intensity, pain interference, salivary cortisol concentration and mood were obtained. All participants showed reductions in pain from pre- to post-test, indicating silent relaxation was as effective as music-listening. Salivary cortisol concentrations showed that music with high harmonicity/rhythmicity reduced cortisol concentration to a greater extent on Day 1 than music with low harmonicity/rhythmicity. These findings validate the homogenous use of auditory distraction for audio-analgesia, and importantly emphasize the core role of compositional musical constructs in maximizing early postoperative recovery. Results support the need for additional psychobiological research examining the efficacy of audio-analgesic attention-diversion interventions used in pain management. The Author(s) 2015.
What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement
(2013-04) Hamilton, D. F.; Lane, Judith; Gaston, P.; Patton, J. T.; MacDonald, D.; Simpson, AHRW; Howie, C. R.
Objectives To investigate the factors which influence patient satisfaction with surgical services and to explore the relationship between overall satisfaction, satisfaction with specific facets of outcome and measured clinical outcomes (patient reported outcome measures (PROMs)). Design Prospective cohort study. Setting Single National Health Service (NHS) teaching hospital. Participants 4709 individuals undergoing primary lower limb joint replacement over a 4-year period (January 2006-December 2010). Main outcome measures Overall patient satisfaction, clinical outcomes as measured by PROMs (Oxford Hip or Knee Score, SF-12), satisfaction with five specific aspects of surgical outcome, attitudes towards further surgery, length of hospital stay. Results Overall patient satisfaction was predicted by: (1) meeting preoperative expectations (OR 2.62 (95% CI 2.24 to 3.07)), (2) satisfaction with pain relief (2.40 (2.00 to 2.87)), (3) satisfaction with the hospital experience (1.7 (1.45 to 1.91)), (4) 12-months (1.08 (1.05 to 1.10)) and (5) preoperative (0.95 (0.93 to 0.97)) Oxford scores. These five factors contributed to a model able to correctly predict 97% of the variation in overall patient satisfaction response. The factors having greatest effect were the degree to which patient expectations were met and satisfaction with pain relief; the Oxford scores carried little weight in the algorithm. Various factors previously reported to influence clinical outcomes such as age, gender, comorbidities and length of postoperative hospital stay did not help explain variation in overall patient satisfaction. Conclusions Three factors broadly determine the patient's overall satisfaction following lower limb joint arthroplasty; meeting preoperative expectations, achieving satisfactory pain relief, and a satisfactory hospital experience. Pain relief and expectations are managed by clinical teams; however, a fractured access to surgical services impacts on the patient's hospital experience which may reduce overall satisfaction. In the absence of complications, how we deliver healthcare may be of key importance along with the specifics of what we deliver, which has clear implications for units providing surgical services.