Objective Assessment of Postoperative Morbidity After Breast Cancer Treatments with Wearable Activity Monitors: The "BRACELET" Study.

BACKGROUND: Current validated tools to measure upper limb dysfunction after breast cancer treatment, such as questionnaires, are prone to recall bias and do not enable comparisons between patients. This study aimed to test the feasibility of wearable activity monitors (WAMs) for achieving a continuous, objective assessment of functional recovery by measuring peri-operative physical activity (PA). METHODS: A prospective, single-center, non-randomized, observational study was conducted. Patients undergoing breast and axillary surgery were invited to wear WAMs on both wrists in the peri-operative period and then complete upper limb function (DASH) and quality-of-life (EQ-5D-5L) questionnaires. Statistical analyses were performed to determine the construct validity and concurrent validity of WAMs. RESULTS: The analysis included 39 patients with a mean age of 55 ± 13.2 years. Regain of function on the surgically treated side was observed to be an increase of arm activity as a percentage of preoperative levels, with the greatest increase observed between the postoperative days 1 and 2. The PA was significantly greater on the side not treated by surgery than on the surgically treated side after week 1 (mean PA, 75.8% vs. 62.3%; p < 0.0005) and week 2 (mean PA, 91.6% vs. 77.4%; p < 0.005). Subgroup analyses showed differences in recovery trends between different surgical procedures. Concurrent validity was demonstrated by a significant negative moderate correlation between the PA and DASH questionnaires (R = -0.506; p < 0.05). CONCLUSION: This study demonstrated the feasibility and validity of WAMs to objectively measure postoperative recovery of upper limb function after breast surgery, providing a starting point for personalized rehabilitation through early detection of upper limb physical morbidity.

General patient satisfaction after elective and acute thoracic surgery is associated with postoperative complications.

BACKGROUND: Patient's satisfaction has been regarded as a subjective reflection of the quality of care received by patients during their hospital stay. However, which factors may influence patient satisfaction in different healthcare settings needs to be determined. METHODS: Cross-sectional investigation of satisfaction at the time of discharge in 52 consecutive patients admitted in a UK Referral Centre for Thoracic Surgery for either elective (41 patients) or acute (11 patients) procedures. We evaluated patients' satisfaction with the inpatient service through the European Organisation for the Research and Treatment of Cancer IN-PATSAT32 standardised questionnaire. Major cardiopulmonary complications were defined according to the definition of the European Society of Thoracic Surgeons database. We focused on the General Patient Satisfaction Scale of the questionnaire to explore its relationship with several demographic and clinical factors. Relationships were tested using univariate regression analyses. RESULTS: General inpatient satisfaction was lower in patients with complications rather than those without (P=0.006) and in males rather than females (P=0.04). Living area, sex, and complications explained 22% of the variation in general inpatient satisfaction (P=0.006). CONCLUSIONS: Regardless of the diagnosis, post-operative complications were associated with a lower patient satisfaction following thoracic surgery in our group of patients. This was particularly so for males and patients from rural areas. Research should focus on different clinical groups in our speciality to determine the specific strategies warranted to improve their quality of care and hence increase their satisfaction with inpatient services.

The impact of an acute chest pain pathway on the investigation and management of cardiac chest pain.

Emergency department (ED) presentation with chest pain accounts for approximately 20% of acute hospital admissions, and delays in the investigation and management of these patients increase the pressure on emergency and medical departments. We implemented a pathway within our trust to improve the efficiency of acute chest pain management. This included the development of a chest pain management algorithm, a short-stay heart assessment centre and a policy to immediately transfer acute coronary syndrome patients to cardiology. The introduction of the chest pain pathway resulted in fewer admissions from the ED with chest pain (34.2% vs 19.0%; p<0.0001), a reduction in time from ED attendance to cardiology transfer (9.3 hours vs 5.7 hours; p<0.0001) and a reduction in time to angiography (62.5 hours vs 26.6 hours; p<0.0001). Length of stay was reduced for cardiology patients (4.7 days vs 2.4 days, p<0.001) and mean length of stay for all patients attending ED with chest pain was reduced by 8.3 hours (27.5 hours vs 19.1 hours; p<0.0001). The changes have significantly improved the management of acute chest pain within our trust and we would suggest that adoption of these changes in other trusts could significantly improve the quality of the care for these patients throughout the NHS.