Una investigación etnográfica sobre la violencia médica en los centros de salud de Nepal / Ethnographic Investigation into Medical Violence in Nepali Healthcare Facilities / Uma investigação etnográfica da violência médica em centros de saúde no Nepal

Introducción: la violencia no es un subproducto inherente de las relaciones humanas, pero los con-flictos sí lo son. En este artículo se examinan los factores y circunstancias que conducen a la tensión y los conflictos entre las personas que buscan atención médica y los establecimientos médicos nepalíes y los miembros del personal que trabajan allí. Desarrollo: embebido con una revisión de la literatura relevante, a través del análisis de datos etnográficos generada a partir de la investigación de campo y el análisis de contenido de la representación de noticias seleccionada, el artículo se desarrolla en cuatro secciones diferentes. La primera parte trata sobre el contexto de las consultas médicas que resultan en el desarrollo de una relación problemática. A esto le sigue el examen de los diferentes tipos de violencia, enfrentamientos y protestas que surgen a través de tales relaciones. En la tercera parte se analizan las implicaciones de las crecientes promesas médicas y el consiguiente aumento de las expectativas, mien-tras que la última parte destaca cómo las prácticas médicas típicas que existen en los propios hospitales nepaleses aumentan la posibilidad de enfrentamientos y violencia. Conclusión: la frecuente ocurrencia de peleas y violencia médica tanto en hospitales públicos como privados en Nepal sugiere que hay una bre-cha de comunicación entre los proveedores de servicios y el paciente debido a la naturaleza esotérica de la medicina. El conflicto y la violencia hacia los proveedores de servicios también pueden prosperar en el contexto de un modelo explicativo diferencial de las dos partes. La creciente animosidad también indica una disminución de la confianza entre los proveedores de atención médica y los solicitantes en Nepal

Introduction: Violence is not an inherent by-product of human relationships, but conflicts are. This arti-cle examines the factors and circumstances that lead to tension and conflicts between health seekers, and their counterpart Nepali medical establishments, and their staff members. Development: The article is divided into four sections by embedding a relevant literature review, analyzing ethnographic data generated from field research, and analyzing the content analysis of selected news portrayals. The first section discusses the context of the medical consultations that lead to the development of a problematic relationship. This is followed by examining the various types of violence, confrontations, and protests that arise from such relationships. The implications of rising medical promises and resulting height-ened expectations are discussed in the third section. The last section focuses on how common medical practices in Nepali hospitals increase the possibility of confrontations and violence. Conclusions: The prevalence of tussles and medical violence in Nepal's public and private hospitals suggests that they can occur in any hospital, regardless of ownership. Because of the esoteric nature of medicine, there is always a communication gap between service providers and patients. Conflict and violence against service providers can thrive in the context of a two-sided differential explanatory model. The growing hostility also indicates a decline in trust between healthcare providers and patients in Nepal

Introdução: a violência não é um subproduto inerente às relações humanas, mas o conflito é. Este artigo examina os fatores e circunstâncias que levam à tensão e ao conflito entre as pessoas que pro-curam cuidados médicos e os estabelecimentos médicos nepaleses e os funcionários que aí trabalham. Desenvolvimento: incorporada a uma revisão da literatura relevante, através da análise de dados etno-gráficos gerados a partir da pesquisa de campo e da análise de conteúdo da representação noticiosa selecionada, o artigo desenvolve-se em quatro seções distintas. A primeira parte trata do contexto das consultas médicas que resultam no desenvolvimento de uma relação problemática. Em seguida, exa-minamos os diferentes tipos de violência, confrontos e protestos que surgem através de tais relações. A parte três discute as implicações das crescentes promessas médicas e o consequente aumento das expectativas, enquanto a última parte destaca como as práticas médicas típicas que existem nos próprios hospitais nepaleses aumentam o potencial de confrontos e violência. Conclusão: a frequente ocorrência de brigas e violência médica em hospitais públicos e privados no Nepal sugere-nos que podem ocorrer em qualquer hospital, independentemente do proprietário. Sempre existe uma lacuna de comunicação entre os prestadores de serviços e o paciente devido à natureza esotérica da medicina. O conflito e a vio-lência contra os prestadores de serviços também podem florescer no contexto de um modelo explicativo diferencial das duas partes. A crescente animosidade também indica um declínio na confiança entre os prestadores de cuidados de saúde e os requerentes no Nepal

Patient Perceptions Regarding Ciltacabtagene Autoleucel Treatment: Qualitative Evidence From Interviews With Patients With Relapsed/Refractory Multiple Myeloma in the CARTITUDE-1 Study.

INTRODUCTION: Ciltacabtagene autoleucel (cilta-cel), a novel chimeric antigen receptor T (CAR-T) cell therapy, has demonstrated early, deep, and durable clinical responses in heavily pretreated patients with relapsed/refractory multiple myeloma (RRMM), and improvements in health-related quality of life (HRQoL) in CARTITUDE-1 (NCT03548207). Patient perspectives on treatment provide context to efficacy outcomes and are an important aspect of therapeutic evaluation. METHODS: Qualitative interviews were conducted in a subset of CARTITUDE-1 patients (n = 36) at screening, Day 100, and Day 184 post cilta-cel on living with MM, therapy expectations, and treatment experiences during the study. RESULTS: Patients most wanted to see change in symptoms with the greatest impact on HRQoL: pain (85.2%) and fatigue (74.1%). The primary treatment expectation was achieving remission (40.7%), followed by extended life expectancy (14.8%). Patients most often defined meaningful change as improvement in symptoms (70.4%) and return to normalcy (40.7%). The percentage of patients reporting symptoms (pain, fatigue, bone fracture, gastrointestinal, neuropathy, and weakness) decreased from 85.2% to 22.2% across symptom types at baseline to 29.2% to 0% on Day 184 after cilta-cel. Improved symptoms and positive sentiments corresponded with improved perception of overall health status and reduced pain level, respectively. Most patients reported that their expectations of cilta-cel treatment had been met (70.8%) or exceeded (20.8%) at Day 184, and 70.8% of patients considered cilta-cel therapy better than their previous treatments. CONCLUSION: Overall HRQoL improvements and qualitative interviews showed cilta-cel met patient expectations of treatment and suggest the long treatment-free period also contributed to positive sentiments.

Patients' Evaluations of Complete Denture Therapy and Their Association with Related Variables: A Pilot Study.

PURPOSE: Patient satisfaction is an important goal in complete denture therapy, and many factors influence this parameter. This study aimed to evaluate expectations before and satisfaction after therapy with complete dentures. As a secondary objective, other variables that may interfere with patient satisfaction were also evaluated. MATERIAL AND METHODS: A representative sample of 99 patients assigned visual analog scale (VAS) scores to their expectations before and satisfaction after therapy regarding chewing, esthetics, comfort, and phonetics. Demographic data and answers to a questionnaire concerning the dentists' conduct were recorded. Multiple linear regression was used to evaluate the association among studied variables and patients' expectation and satisfaction with their dentures. RESULTS: The average VAS scores were high for both expectations and satisfaction, and satisfaction exceeded expectations. Patients' expectations about esthetics and comfort were associated with age and self-reported time of using complete dentures. Patient satisfaction regarding chewing was associated with the number of postdelivery adjustments. Also, patient satisfaction regarding esthetics was associated with gender and esthetic expectations. In regard to phonetic satisfaction, associations were verified among self-reported time of using complete dentures, comfort and phonetics expectations, and dentists' explanations. Comfort satisfaction was associated only with educational level. CONCLUSIONS: Patient satisfaction regarding complete dentures exceeded expectations and an expressive majority of positive evaluations of the dentists was noticed. Many patient-related variables seemed to influence their evaluations of their dentures.

Patients' Expectation Before and Satisfaction After Full-Arch Fixed Implant-Prosthesis Rehabilitation.

This study evaluated patients' expectation before and satisfaction after full-arch fixed implant-prosthesis rehabilitation. Other variables that could influence patient satisfaction with this therapy were also evaluated. Using a visual analog scale (VAS), a sample of 28 patients assigned scores for their expectation before and satisfaction after therapy regarding chewing, esthetics, comfort, and phonetics. They also completed a questionnaire concerning their evaluation of the dentists' conduct. The average VAS scores were high for both expectation prior to treatment and satisfaction after treatment, and there was no statistical difference between them. Women presented higher expectations than men regarding esthetics (P = 0.040), phonetics (P = 0.043) and comfort (P = 0.013). Significant differences were not found between VAS scores with clinical variables (arch, radiographic bone quality, surgical bone quality, and implant inclination), educational level, and patients' evaluation of the dentists' conduct. Considering the results obtained in this study, expectation before implant-supported, full-arch fixed prosthesis therapy were met following treatment, with women having higher expectations than men.

Patients' perceptions of benefits and risks of complete denture therapy.

PURPOSE: The aim of this study was to assess patients' perceptions of benefits and risks concerning complete denture therapy. A secondary objective was to assess the influence of clinical and sociodemographic variables on patients' perceptions. MATERIALS AND METHODS: The sample was composed of 104 volunteers who presented themselves for complete denture treatment at a dental school. The average age of the volunteers was 69.2 years (±) 9.3. Patient opinions concerning the benefits of complete denture therapy were recorded using a previously reported questionnaire. The answers were evaluated in three domains: (1) benefits (positive perceptions); (2) risks (negative perceptions); and (3) consequences of no treatment. RESULTS: The average time of use of the previous dentures was 20 years (SD ±12.9). Risk factors (negative perceptions) received lower scores by the patients, while the consequences of no treatment received higher scores. No association was found among evaluations of the previous dentures and educational level, marital status, and gender; however, patients' evaluation about their previous dentures was significantly different depending on age (p = 0.001) and previous dentures' time of use (p = 0.038). CONCLUSIONS: Patients presented a positive perception of complete denture therapy, and the risk factors (negative perceptions) received the lowest scores. Patient perception regarding complete denture therapy was not influenced by educational level, evaluation of the previous dentures, or marital status.

Factors influencing patients’ satisfaction with complete dentures: a qualitative study / Fatores que influenciam a satisfação dos pacientes com prótese totais: estudo qualitativo

Objective: The treatment most used worldwide for edentulism is conventional complete dentures, and the most important factor for the success of denture treatment seems to be patient satisfaction. The present study aims to use a qualitative approach to investigate factors that were previously associated with patient satisfaction with dentures by quantitative techniques (correlational studies). Material & Methods: twenty patients (12 women and 8 men, age 59-87) participated in open and semi-structured interviews, both pre- and post-treatment. All the interviews were recorded, listened to, and transcribed verbatim, after which the content was analyzed thematically. Results: for most respondents, tooth loss represented, first of all, difficulty chewing and eating. Some patients have not accepted the loss of their teeth and felt sadness and shame. Other patients have adapted to their dentures, through acceptance. Regarding expectations, patients expressed very high expectations, especially for the stability and adjustment of dentures, and also for a better appearance. The majority of respondents showed great satisfaction with treatment outcomes; their expectations were met, and the dentures did provide functional benefits. Patients also believed that a trusting relationship between the dentist and the patient plays a fundamental role in treatment outcomes, and they reported that currently dentists are more open to dialogue with their patients. Conclusion: confidence between the dentist and the patient plays a fundamental role in their evaluation of the treatment outcomes.

Objetivo: O tratamento mais utilizado em todo o mundo para o edentulismo são as próteses totais convencionais, e o fator mais imporatante para o sucesso desta terapia parece ser a satisfação do paciente. Este estudo tem como objetivo utilizar uma abordagem qualitativa para investigar os fatores que foram previamente associados (em estudo quantitativos) com a satisfação dos pacientes com as próteses totais. Material e Métodos: vinte pacientes (12 mulheres e 8 homens, entre 59 e 87 anos de idade) participaram em entrevistas abertas e semiestruturadas, tanto antes quanto após o tratamento. Todas as entrevistas foram gravadas, ouvidas e transcritas, e o conteúdo foi analisado tematicamente. Resultados: para a maioria dos indivíduos, a perda dos dentes representa, antes de tudo, dificuldade em mastigar e comer. Alguns pacientes não aceitaram a perda do dentes, e sentiam-se tristes e envergonhados. Outros pacientes adaptaram-se às próteses, por meio da aceitação. Os pacientes expressaram expectativas bastante altas, especialmente quanto à estabilidade e adaptação das próteses e também quanto à aparência. A maioria dos pacientes demonstrou grande satisfação com os resultados do tratamento, suas expectativas foram atendidas e as próteses ofereceram benefícios funcionais. Os pacientes também acreditam que uma relação de confiança com o dentista é de fundamental importância para o resultado do tratamento. Os pacientes reportaram ainda que atualmente os dentistas são mais abertos ao dialógo com os pacientes. Conclusão: a confiança entre o dentista e o paciente tem papel fundamental na avaliação dos pacientes quanto ao resultado da terapia.

Correlation of previous experience, patient expectation and the number of post-delivery adjustments of complete dentures with patient satisfaction in a Brazilian population.

A number of variables may influence the outcome of complete denture therapy. The objective of this study was to verify possible correlations between previous experience with dentures, patient expectation and the number of post-delivery adjustments with patient satisfaction after treatment. One hundred patients (mean age 61·9 ± 10·3) rated their previous experiences with complete dentures and their expectations before and satisfaction after treatment on a visual analogue scale (VAS) using scores from 0 (worst results) to 10 (best results). The number of post-delivery adjustments and other patient-related clinical variables was also noted. Patient expectation scores were higher than previous experience scores and satisfaction after treatment scores. Positive and weak correlations were found between previous chewing experiences with complete dentures, with regard to chewing expectations and comfort of use. Phonetics and comfort of use in previous experiences presented a positive correlation with expectations for chewing, aesthetics, phonetics and comfort of use. Groups of patients with different levels of education presented significant differences in expectation scores regarding comfort of use as well. A negative and weak correlation was found between phonetics satisfaction and the number of post-delivery adjustments. Patients' expectations for the therapy were higher than their satisfaction after treatment. Previous experiences with complete dentures could slightly influence patients' expectations and satisfaction, whereas lower scores for previous experience with complete dentures caused lower scores for both expectation and satisfaction. Patients' educational levels and the number of post-delivery adjustments influenced negatively the expectations about comfort of use and patient satisfaction, respectively.