Understanding Factors Impacting Coronavirus Disease 2019 Vaccine Hesitancy in a Rural Surgical Clinic.

Objective: Evaluate patient hesitancy about the coronavirus disease 2019 (COVID-19) vaccine. Patients and Methods: English and Spanish pre-and post-video surveys were completed by patients at rural surgery clinics. The surveys consisted of 25 or 21 five-point Likert statements, respectively. Paired difference t-tests and independent sample t-tests were performed. Results: Ninety-four patients completed the surveys: 137 females (73%) and 51 (27%) males; 113 patients were Hispanic (64%); 63 patients were white (36%). The pre-video survey showed that the top two factors influencing patients were: preference for wearing masks over vaccination (n = 185; x¯ = 3.55) and not trusting the effectiveness of the vaccine (n = 186; x¯ = 3.01). Patients agreed that the video made them want to talk to their family about getting vaccinated (n = 176; x¯ = 3.14) and made them appreciate that they can get really sick from COVID-19 (n = 177; x¯ = 3.14). After watching the video, women of childbearing age (WCBA; n = 65; x¯ = 3.20) agreed more that the video made them want to get the COVID-19 vaccine than non-WCBA (n = 59; x¯ = 2.37; p = 0.0123). Women of childbearing age (n = 66; x¯ = 3.32) also agreed more that the video made them appreciate that they can get really sick from the COVID virus than non-WCBA (n = 60; x¯ = 2.58; p = 0.0254). Post-video statements showed that patients agreed that the video was easy to understand, they liked the video, and the video was helpful. Conclusions: There is room to better inform patients in a rural setting, especially WCBA, about COVID-19 illness and vaccination through video testimonies. Surgeons are uniquely positioned to offer effective recommendations, to increase vaccination rates, and address vaccine hesitancy.

Patient-satisfaction in an outpatient vein surgery office: A comparison of English- and Spanish-speaking patients.

BACKGROUND: In spite of an increasing Latino population and accompanying rise in demand for health care, not much is known about patient-satisfaction in Spanish-speaking patients and how to improve patient-satisfaction when using interpreters. We sought to compare patient-satisfaction with vein surgery office visits between English-speaking and Spanish-speaking patients. METHODS: Directly before and after the office visit, 126 patients completed a socio-demographic survey, a five-point ordinal rating survey of physician and interpreter satisfaction with the encounter. Measures were satisfaction with the provider's friendliness, respectfulness, concern, ability to make the patient comfortable, and time spent for the exam. RESULTS: When the provider was fluent in the language that the patient spoke, patients ( M = 4.954, SD = 0.21) were significantly more satisfied with their visit at VVHC than patients who required an interpreter ( M = 4.762, SD = 0.71), z = 2.230, p = 0.012. Spanish speaking patients were more likely to be satisfied with the visit when they felt their interpreter was friendly ( n = 58, p = 0.049). There was no difference found with regard to the provider being thoughtful and comforting. CONCLUSION: Spanish-speaking patients are less satisfied with the care provided in a vein surgery office. Patients who communicated through an interpreter were less satisfied with the patient-provider relationship. In light of the growing diversity of the US population and the fact that patient-satisfaction is increasingly tied to reimbursement, additional research might identify potential areas of improvement for the surgeon, interpreter, and patient perspectives.

Radiofrequency ablation as first-line treatment of varicose veins.

Endovascular radiofrequency ablation is a minimally invasive method to safely treat symptomatic refluxing varicose veins. A retrospective chart review was used to determine patient demographics, disease severity, treatment algorithm, and outcome in patients who underwent radiofrequency ablation of symptomatic refluxing veins that had failed conservative management. Statistical analysis was done using GraphPad Demo Version (San Diego, CA). Two hundred forty-one limbs in 179 patients (average age, 53 years; 73% females, 27% males) were treated. Preprocedure Clinical Etiological Anatomic and Pathologic (CEAP) scores were C2s: 236, C3s: 4, and C5s:1. Procedures were performed in the office using tumescent anesthetic; all patients could ambulate immediately after the procedure. Postprocedure total occlusion (TO) rate was seen in 93 per cent of limbs (223 limbs) at 3 months and 91 per cent of limbs (220 limbs) at 12 months posttreatment. No relationship was found between patients who did not have total occlusion and age, sex, diameter of veins, CEAP scores, preoperative reflux time, and volume of tumescent anesthetic (P > 0.05). The VNUS procedure is an in-office, minimally invasive procedure with a low complication rate and quick recovery. Total occlusion rates are high and there is improvement in disease severity after treatment.

Management of ovarian cysts in women undergoing restorative proctocolectomy for ulcerative colitis.

More than half of all patients undergoing restorative proctocolectomy (RP) for ulcerative colitis (UC) are women, yet there is a paucity of information regarding the frequency, management, and outcome of ovarian cysts. A single surgeon's (E.W.F.) experience with female patients (N = 165) who underwent RP for UC at an academic medical center was retrospectively evaluated for postoperative complications and overall outcome. Patients with large ovarian cysts (LOCs), defined as being greater than 5 cm in diameter, were further segregated for subanalysis. All results were analyzed using the Student's t test and Fisher's exact test. Patients were 29.3 +/- 13 years (mean) at the time of RP; 34 patients were less than 16 years old (21%), 113 patients (68%) were between the ages of 17 and 46 years, and 18 patients were over 46 years old (11%). All patients underwent total colectomy, mucosal proctectomy ileal pouch-anal anastomosis, and temporary end ileostomy. The ileostomy was closed 3 months later. Fifty-five of the 165 patients had ovarian cysts (33%) identified at operation, 46 had unilateral cysts, and nine had bilateral cysts. Mean ovarian cyst size was 4.6 +/- 2.7 cm (range <1-13 cm); 14 were LOCs. Patients with cysts <3 cm in diameter at operation were treated by observation with hormonal manipulation. Seventeen patients with cysts 3 to 5 cm in diameter required partial resection of one or both ovaries. Six of 14 patients with LOC underwent unilateral oophorectomy (cyst size range 10-13 cm). Twelve patients presented within 3 years after RP with malfunction of the pouch because of adhesions or minimal and uncontrolled passage of fecal material (soiling), partial obstruction due to LOC compression of the ileoanal pouch (n = 6), or adhesions. When evaluated on the basis of ovarian cyst size those without cysts and those with small cysts were significantly more likely to have children than those with LOC: 54 of 110 patients without cysts (49%), 18 of the 41 with cysts less than 5 cm in diameter (44%), and two of the 14 patients with LOC (14%) have had children (P = 0.047). Ovarian cysts are common in women undergoing RP for UC. Ovarian cysts often complicate postoperative intestinal function and are best treated by cyst resection or oophorectomy at the time of RP or ileostomy closure. Cysts under 3 cm in diameter may often be managed conservatively with few complications. Women with LOC after RP for UC have decreased fertility compared with those without cysts.

Morbidity and mortality of short-bowel syndrome in infants with abdominal wall defects.

Total parenteral nutrition (TPN) has made survival beyond infancy possible for many infants who have sustained small intestinal loss as a result of gastroschisis or omphalocele. The length and quality of life in these patients have often been limited by the development of late sequelae secondary both to the protracted use of TPN and the long-term complications of a shortened gut. This study was undertaken to determine what factors influence the morbidity and mortality of short-bowel syndrome (SBS) due to gastroschisis or omphalocele. A retrospective chart review of 850 infants who received TPN from January 1977 through December 1999 was carried out. All infants were treated at one academic medical center; those who had received > or =3 months of TPN were further segregated and their diagnosis, surgical procedures, length of bowel, ability to wean from TPN, follow-up weight and height, and developmental progress were recorded. Seventeen children were identified with SBS and either gastroschisis or omphalocele. Tight primary or secondary closure of the abdominal wall was believed to be a major cause of bowel necrosis and SBS in at least ten of the 17 patients. Overall survival was 76 per cent (13/17); survival was correlated with length of remaining bowel and was 86 per cent in patients having more than 15 cm of small bowel remaining but only 33 per cent in patients with less than 15 cm of small bowel remaining (P = 0.05). A longer length of residual small bowel resulted in a significantly shorter duration of TPN with a mean duration of 1.0 year for survivors having >38 cm and 10.0 years for survivors with <38 cm of bowel remaining (P = 0.03). Hepatic dysfunction with progressive failure resulting from TPN was related to death in three of the four nonsurvivors. The presence or absence of an ileocecal valve appeared unrelated both to the success of TPN weaning and to the length of time on TPN (P > 0.2). Eight of the 13 survivors have no ileocecal valve; five have undergone >50 per cent colonic resection. Nine of the survivors have adapted to enteral feedings (mean 36 +/- 60 months) during which time weaning from TPN occurred. The mean age of survivors is 7.9 +/- 5.1 years. Near-normal weights (defined as exceeding the fifth percentile for weight) were achieved for 92 per cent of the patients (12/13) with 46 per cent of the patients (6/13) exceeding the 50th percentile. Near-normal heights (exceeding the fifth percentile) were achieved for 77 per cent of the patients (10/13) with 15 per cent of the patients (2/13) exceeding the 50th percentile. Quality of life was measured on the basis of return to public school: nine of ten school-age survivors attend school and eight are normal without signs of developmental delay. Tight abdominal closure of gastroschisis or omphalocele may cause bowel necrosis and SBS. TPN has improved the long-term survival and quality of life in infants with SBS.

Increasing social capital via local networks: analysis in the context of a surgical practice.

The relationship between social capital (support, trust, patient awareness, and increased practice revenue) and local networks (university hospital) in communities has received little attention. The development of computer-based communication networks (social networks) has added a new dimension to the argument, posing the question of whether local networks can (re-)create social capital in local communities. This relationship is examined through a review of the literature on local networks and social capital and a surgeon's practice management from 1990 to 2001 with respect to repair of pectus chest deformities. With respect to pectus repair there was a consistent but small number of new referrals (15-20 new patients/year), lack of patient awareness (eight to 12 self-referred patients/year), and modest practice revenue. Since the inception of an Internet website (social network) dedicated to pectus repair in 1996 there has been increased social participation (n = 630 hits/year to the website); facilitation of spread of information through E-mail messages (n = 430 messages/year); and a greater participation of groups such as women, minorities, adults, and those with disability (n = 120 patients/year). The dissemination of information via the local network has also allowed an "outward movement" with increased participation by interconnecting communities (n = 698,300 global Internet participants based on statistical ratios). We conclude that local networks have enhanced social networks providing new grounds for the development of relationships based on choice and shared interest.