Assessment of patients' tendency to give a positive or negative rating to healthcare.

BACKGROUND: Adjustment of patient satisfaction scores for case-mix variables such as age and sex may lead to overadjustment. The patient's tendency to rate healthcare positively or negatively may be the only variable that should be adjusted to improve the comparability of satisfaction scores between healthcare providers. OBJECTIVE: To develop a measure of "rating tendency", assess its stability over time, explore its distribution across subgroups of patients and its association with patient opinion scores. DESIGN AND SUBJECTS: A scale based on 10 hypothetical scenarios describing hospital care episodes was developed. It was administered both before and after hospitalisation to 203 patients programmed for elective orthopaedic surgery in a Swiss teaching hospital. A problem score regarding the actual hospitalisation was obtained at follow-up. RESULTS: The rating tendency scale had good internal consistency (Cronbach alpha 0.85), and factor analysis confirmed that it measured a single underlying concept. However, the correlation between prehospitalisation and posthospitalisation measures was moderate (intraclass correlation coefficient 0.55, p<0.001), as was the correlation with the hospitalisation problem score (Spearman r = -0.22, p = 0.002). The pattern of rating tendency across subgroups of respondents mirrored the pattern of problem scores. Adjusting for the rating tendency had little effect on comparisons of problem scores between subgroups of patients, all of whom were treated at the same hospital. CONCLUSIONS: A patient's "rating tendency" can be measured using a reliable 10-item scale. The utility of adjusting satisfaction scores for rating tendency when comparing hospitals remains to be tested.

[Lengthening of the Achilles tendon by the Baker method in cerebral palsy]. / L'allungamento del tendine achilleo secondo Baker nelle paralisi cerebrali infantili.

Authors describes the Baker's surgical gastrocnemius lengthening of equinus deformity in cerebral palsy. Results and surgical Technics related to clinical situation of patients are presented.

[Congenital pseudoarthrosis of the femur neck (description of a clinical case)]. / La pseudoartrosi congenita del collo del femore (descrizione di un caso clinico)

Authors report a case of so called Proximal Femoral Focal Deficiency. After remembered different classifications, histological, clinic and radiological findings of this anomaly and analyzed some aspect of the treatment.

[Clinico-radiographic aspects of the post-traumatic instability of the radio-carpal joint]. / Aspetti clinico-radiografici della instabilità post-traumatica della radio-carpica.

Authors describes biomechanics, etiopatogenetics and clinical aspects of carpal injury, which given at an radio-carpic instability.

[Osteoid osteoma of the femur neck (report of a case)]. / Osteoma osteoide del collo del femore (segnalazione di un caso)

After presentation of statistical data on the incidence of osteoid osteoma, a case of femoral neck localization is presented with details of medical history, clinical data, and X-Ray aspects. The operation itself is also described with anatomo-pathological and histological results. These data and the problems of differential diagnosis from other bone tumours is discussed.

[Homologous and heterologous grafts in experimental animals (considerations and preliminary results)]. / Innesti omologhi ed eterologhi negli animali da esperimento (considerazioni e risultati preliminari)

Authors report a preliminary results of omo and ethero-neuro grafts in rats and rabbit.

[Osteopecilia (presentation of a clinical case)]. / L'osteopecilia (presentazione di un caso clinico)

Authors describe after a review of literature a case of Osteopoecilia, a rare localized Osteosclerosis Syndrome.

[Fractures of the astragalus. The results of surgical treatment]. / Fratture dell'astragalo. Risultati del trattamento chirurgico.

After some short anatomo-physiologic notes, the Authors study the methods of treatment of talus fractures, and determine the different indications thereof. The Authors conclude both the conservative and surgical treatment supply concrete chances of recovery, provided, depending on type and place of fracture, they ensure the articular firmness and vascularization of bone.

[Importance of additional radiological studies in posterior fractures of the cotyloid cavity]. / Importanza delle indagini supplementari radiologiche nelle fratture posteriori del cotile.

The Authors describe the usefulness of the additional radiologic investigations (stratigraphy and computed tomography) in the study of the back acetabular fractures. The larger information supplied by such investigation about the anatomopathological picture of said fractures allows surgeon to plot the intervention in all details, exactly controlling the remote results.

[Nail synthesis in fractures of the distal phalanx]. / La sintesi ungueale nella frattura della telefalange.

Authors describes a new simplified approach of dorsal sectioning of the distal phalanx, with the suture of the nail. That is a simple method of treatment and its give a good results.

[Bi-bone fractures of the leg. Indications and treatment]. / Fratture biossee di gamba. Indicazioni e trattamento.

After recalling some anatomical aspects (with particular reference to the diaphysary vascularization), the authors determine the limits of the conservative treatment of leg fractures, and then describe the surgical techniques they used in the different types of leg fracture. The authors point out the treatment of such fractures does not follow rigid patterns, but it should be chosen case by case after a careful evaluation of general and local factors.

[Posttraumatic ischemic syndrome of the anterior compartment of the leg]. / Sindrome ischemica postraumatica della loggia anteriore della gamba.

The authors report three cases of post-traumatic ischemia of leg forward loggia. After some notes of normal anatomy and hemodynamics of microcirculation, they emphasize the importance of an immediate surgical intervention of fasciotomy, in order to prevent a necrosis of the muscular and nervous structures.

[Short-term prophylaxis in orthopedic and traumatologic surgery]. / La short term prophylaxis in chirurgia ortopedico traumatologica.

The rational and selective use of the perioperative antibiotic prophylaxis plays a decisive role in prevention of post-operative infections in orthopedic surgery and traumatology. The conceptual bases for the application of the Short-Term chemioprophylaxis are presented in accord to the most recent data reported in the literature.

[Different methods of osteosynthesis in the treatment of pseudoarthrosis of the carpal scaphoid]. / Differenti metodiche di osteosintesi nel trattamento della pseudoartrosi dello scafoide carpale.

The authors after remembered shortly, mechanical and biological factors which can determine beginning of carpus scaphoid pseudoarthrosis, described the surgical techniques more frequently used confirmed the important idea of the stable osteosynthesis for a recovery fast and completely.