Objective Preoperative counseling can affect postoperative outcomes and satisfaction. We hypothesized that patient preparedness would be equivalent after preoperative counseling phone calls versus preoperative counseling office visits before prolapse surgery. Methods This was an equivalence randomized controlled trial of women undergoing pelvic organ prolapse surgery. Participants were randomized to receive standardized counseling via a preoperative phone call or office visit. The primary outcome was patient preparedness measured on a 5-point Likert scale by the Patient Preparedness Questionnaire at the postoperative visit. A predetermined equivalence margin of 20% was used. Two 1-sided tests for equivalence were used for the primary outcome. Results We randomized 120 women. The study was concluded early because of COVID-19 and subsequent surgery cancellations. There were 85 participants with primary outcome data (43 offices, 42 phones). Mean age was 62.0 years (±1.0) and 64 (75.3%) had stage III or stage IV prolapse. The primary outcome, patient preparedness measured at the postoperative visit, was equivalent between groups (office, n = 43 [97.7%]; phone, n = 42 [97.6%], P < 0.001). Most women reported they would have preferred a phone call (n = 66, 65.5%) with more women in the phone group expressing this preference than the office group (office 40.5% vs phone 90.5%, P < 0.001). Ultimately, nearly all women (96.5%) were satisfied with their method of counseling. Conclusions Preoperative counseling phone calls were equivalent to office visits for patient preparedness for pelvic organ prolapse surgery. This study demonstrates patient acceptance of phone calls for preoperative counseling. Telehealth modalities should be considered as an option for preoperative patient counseling.
Metopic craniosynostosis (MCS) refers to the premature fusion of the metopic cranial suture resulting in trigonocephaly, characterized by a keel-shaped forehead, suture ridging, orbital hypotelorism, retrusion and upsloping of the lateral supraorbital rim, and bitemporal narrowing. 1 Although severe trigonocephaly is pathognomonic for MCS, mild to moderate phenotypes are more difficult to diagnose and classify by severity. There is currently no standard for classification of severity, and variability in management protocols exists. Surgical intervention for mild to moderate phenotypes remains controversial as objective methods to delineate which patients require surgery are lacking. 1 Although operative intervention effectively preserves normal neurocognition, studies have demonstrated a worsening aesthetic result with Background: Quantifying the severity of head shape deformity and establishing a threshold for operative intervention remains challenging in patients with metopic craniosynostosis (MCS). This study combines three-dimensional skull shape analysis with an unsupervised machine-learning algorithm to generate a quantitative shape severity score (cranial morphology deviation) and provide an operative threshold score. Methods: Head computed tomography scans from subjects with MCS and normal controls (5 to 15 months of age) were used for objective three-dimensional shape analysis using ShapeWorks software and in a survey for craniofacial surgeons to rate head-shape deformity and report whether they would offer surgical correction based on head shape alone. An unsupervised machine-learning algorithm was developed to quantify the degree of shape abnormality of MCS skulls compared to controls. Results: One hundred twenty-four computed tomography scans were used to develop the model; 50 (24% MCS, 76% controls) were rated by 36 craniofacial surgeons, with an average of 20.8 ratings per skull. The interrater reliability was high (intraclass correlation coefficient, 0.988). The algorithm performed accurately and correlates closely with the surgeons assigned severity ratings (Spearman correlation coefficient, r = 0.817). The median cranial morphology deviation for affected skulls was 155.0 (interquartile range, 136.4 to 194.6; maximum, 231.3). Skulls with ratings of 150.2 or higher were very likely to be offered surgery by the experts in this study. Conclusions: This study describes a novel metric to quantify the head shape deformity associated with MCS and contextualizes the results using clinical assessments of head shapes by craniofacial experts. This metric may be useful in supporting clinical decision making around operative intervention and in describing outcomes and comparing patient population across centers. (Plast.
Patient preparedness before surgery-a patient's readiness to undergo surgery, their related perioperative expectations, and postoperative satisfaction-has been shown to positively affect postoperative satisfaction and surgical outcomes. In a urogynecologic population, increased patient preparedness has been associated with improved symptoms and quality of life.Conversely, women who felt unprepared for pelvic organ prolapse (POP) surgery were more likely to report postoperative dissatisfaction and perceived complications. Health care providers and patients differ in their perception of complications and their severity.Several approaches to preoperative counseling have been used; recently, there has been increase in utilization of telehealth platforms. Telehealth counseling is convenient for both patient and health care provider and is efficient. In addition, the limited travel and decreased resource consumption lower costs. A previous study showed that telehealth services, specifically phone calls, were noninferior to office visits for postoperative care among a urogynecologic population and have the ability to make preoperative patient counseling more accessible.The aim of this randomized controlled trial was to determine if a preoperative counseling phone call is equivalent to a preoperative counseling office visit among women undergoing POP surgery. A second aim was to compare postoperative patient satisfaction with the decision to have surgery in women who received a preoperative counseling phone call and those with a preoperative counseling office visit. Participants were randomized 1:1 to receive either a preoperative counseling phone call or office visit. The primary outcome, patient preparedness, was measured at the postoperative visit on a 5-point Likert scale using the Patient Preparedness Questionnaire. A predetermined equivalence margin of 20% was chosen based on clinical judgment. Two 1-sided tests for equivalence were used for the primary and secondary outcomes.A total of 120 women were randomized. The study was ended early because of COVID-19 and subsequent cancellations of surgery. Of the randomized patients, 85 had primary outcome data (43 offices, 42 phones). Mean age of patients was 62.0 (SD, 1.0) years; 64 (75.3%) had stage III or IV prolapse. The primary outcome, patient preparedness at the postoperative visit, was equivalent in the 2 groups (office, n = 42 [97.7%]; phone, n = 42 [97.6%]; P < 0.001; 95% confidence interval, −0.10 to 0.10). Most women expressed preference for a phone call (n = 66 [65.5%]). More women in the phone group preferred a phone call (phone: 90.5% vs office: 40.5%; P < 0.001). Overall, nearly all women (96.5%) were satisfied with their choice of counseling method.This study demonstrates that a phone call is equivalent to an office visit for patient preparedness before POP surgery, suggesting that telehealth modalities should be considered an option for preoperative patient counseling. The results are consistent with the growing body of literature in support of telehealt...
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