RESUMO
Background: Plastic surgeons treat a large volume of patients with upper limb morbidity resulting from intravenous drug use. The use of motivational interviewing by health care providers has demonstrated effectiveness in eliciting behavioral change, leading to improved health outcomes. This paper aims to explore the concept and process of motivational interviewing and its role in facilitating behavior change in the plastic surgery setting. Methods: The authors reviewed the literature on motivational interviewing in various health care settings. Results: Motivational interviewing, first developed in the field of psychology, has demonstrated effectiveness in facilitating behavior change in various clinical contexts, including brief clinical encounters. Using motivational interviewing guides the patient as they move through the stages of readiness for change in dealing with unhealthy behaviors. The authors demonstrate these techniques in a supplemental instructional video. Conclusions: Motivational interviewing is an evidence-based method for facilitating behavior change. All plastic surgeons should be prepared to use this person-centred counselling method in clinical practice.
Contexte: Les chirurgiens plastiques traitent un grand nombre de patients présentant une morbidité des membres supérieurs liée à l'utilisation de drogues intraveineuses. Le recours à un entretien motivationnel par des prestataires de soins de santé a montré son efficacité pour induire un changement de comportement aboutissant à un meilleur état de santé. Cet article vise à étudier le concept et le processus de l'entretien de motivation, ainsi que son rôle dans la facilitation du changement de comportement dans le cadre de la chirurgie plastique. Méthodes: Les auteurs ont analysé les publications sur les entretiens motivationnels dans différents contextes de soins de santé. Résultats: L'entretien de motivation, tout d'abord développé dans le domaine de la psychologie, a fait la démonstration de son efficacité pour faciliter les changements de comportement dans des contextes cliniques variés, y compris de courtes rencontres cliniques. L'utilisation de l'entretien de motivation guide le patient dans son parcours à travers les stades de préparation pou un changement envers des comportements malsains. Les auteurs démontrent ces techniques dans une vidéo de formation supplémentaire. Conclusions: La technique d'entrevue motivationnelle est une méthode basée sur des faits probants pour faciliter le changement de comportement. Tous les chirurgiens plastiques devraient être préparés à utiliser cette méthode de conseils centrée sur la personne du patient en pratique clinique.
RESUMO
BACKGROUND: Open carpal tunnel release is commonly performed with the use of a tourniquet. The combination of local anesthetic and epinephrine with a pneumatic tourniquet helps provide clear visualization during decompression of the median nerve. There has been a rapid expansion of literature challenging the use of tourniquets in open carpal tunnel release. Consequently, the local anesthesia/no tourniquet approach has become increasingly popular. The authors evaluated the outcomes of awake open carpal tunnel release with and without a tourniquet. METHODS: The authors attempted to identify all relevant studies, regardless of language or publication status. A systematic database search for relevant studies was conducted in MEDLINE, EMBASE, EBSCO, and CENTRAL. Included studies compared patients undergoing awake open carpal tunnel release with and without an arm or forearm tourniquet. RESULTS: Eight studies evaluating 765 patients and 866 hands were included. Open carpal tunnel release with the wide awake, local anesthesia, no tourniquet approach resulted in a 2.14 point reduction on the visual analog scale (95% CI, 1.30 to 2.98; p < 0.001). The procedure was 1.82 minutes faster with the use of a tourniquet (95% CI, -3.26 to -0.39; p = 0.01). There were no significant differences between groups in intraoperative blood loss, surgeon perceived difficulty, and complications. CONCLUSION: This systematic review found that tourniquet use causes significantly more pain with no significant clinical benefit as compared with using a wide awake, no tourniquet approach in carpal tunnel decompression.