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      A telehealth intervention to increase patient preparedness for surgery: a randomized trial

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          Abstract

          Introduction and hypothesis

          Methods to increase surgical preparedness in urogynecology are lacking. Our objective was to evaluate the impact of a preoperative provider-initiated telehealth call on surgical preparedness.

          Methods

          This was a multicenter randomized controlled trial. Women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence were randomized to either a telehealth call 3 (± 2) days before surgery plus usual preoperative counseling versus usual preoperative counseling alone. Our primary outcome was surgical preparedness, as measured by the Preoperative Prepardeness Questionnaire. The Modified Surgical Pain Scale, Pelvic Floor Distress Inventory-20, Patient Global Impressions of Improvement, Patient Global Impressions of Severity, Satisfaction with Decision Scale, Decision Regret Scale, and Clavien–Dindo scores were obtained at 4–8 weeks postoperatively and comparisons were made between groups.

          Results

          Mean telehealth call time was 11.1 ± 4.11 min. Women who received a preoperative telehealth call ( n = 63) were significantly more prepared for surgery than those who received usual preoperative counseling alone ( n = 69); 82.5 vs 59.4%, p < 0.01). A preoperative telehealth call was associated with greater understanding of surgical alternatives (77.8 vs 59.4%, p = 0.03), complications (69.8 vs 47.8%, p = 0.01), hospital-based catheter care (54 vs 34.8%, p = 0.04) and patient perception that nurses and doctors had spent enough time preparing them for their upcoming surgery (84.1 vs 60.9%, p < 0.01). At 4–8 weeks, no differences in postoperative and patient reported outcomes were observed between groups (all p > 0.05).

          Conclusions

          A short preoperative telehealth call improves patient preparedness for urogynecological surgery.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00192-021-04831-w

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          Most cited references19

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          Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery.

          To estimate the lifetime risk of stress urinary incontinence (SUI) surgery, pelvic organ prolapse (POP) surgery, or both using current, population-based surgical rates from 2007 to 2011.
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            Validation of two global impression questionnaires for incontinence.

            The purpose of this study was to assess the construct validity of two global assessment questions, the Patient Global Impression of Severity and of Improvement, in female patients with stress urinary incontinence. This was a secondary analysis of data from two double-blind, placebo-controlled studies that evaluated duloxetine for the treatment of predominant stress urinary incontinence in the United States (n = 1133 patients). Assessment variables included incontinence episode frequency, the Incontinence Quality of Life Questionnaire results, fixed volume (400 mL) stress pad test results, and the Patient Global Impression of Improvement and of Severity question results. Spearman correlation coefficients were 0.36, 0.20, and -0.50 among the Patient Global Impression of Severity question and incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire results, respectively (all P <.0001). Mean incontinence episode frequency and median stress pad test results increased and mean Incontinence Quality of Life Questionnaire results decreased with increasing Patient Global Impression of Severity question severity levels. Similarly, significant (P <.0001) correlations were observed between the Patient Global Impression of Improvement question response categories and the three independent measures of improvement in stress urinary incontinence (0.49, 0.33, and -0.43 with incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire results, respectively). As with the Patient Global Impression of Severity question, differences in mean changes for Incontinence Quality of Life Questionnaire and median percent changes for incontinence episode frequency and stress pad test among the Patient Global Impression of Improvement question response categories were highly significant (P <.0001). These relationships indicate appropriate and significant associations between the Patient Global Impression of Severity and of Improvement questions and the three independent measures of stress urinary incontinence severity and improvement, respectively. The Patient Global Impression of Severity and of Improvement question responses were correlated significantly with incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire measures, which established the construct validity of these two global assessment questions for baseline severity and treatment response, respectively.
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              Prevalence and trends of symptomatic pelvic floor disorders in U.S. women.

              To estimate the prevalence and trends of these pelvic floor disorders in U.S. women from 2005 to 2010. We used the National Health and Nutritional Examination Survey from 2005-2006, 2007-2008, and 2009-2010. A total of 7,924 nonpregnant women (aged 20 years or older) were categorized as having: urinary incontinence (UI)-moderate to severe (3 or higher on a validated UI severity index, range 0-12); fecal incontinence-at least monthly (solid, liquid, or mucus stool); and pelvic organ prolapse-seeing or feeling a bulge. Potential risk factors included age, race and ethnicity, parity, education, poverty income ratio, body mass index ([BMI] less than 25, 25-29, 30 or greater), comorbidity count, and reproductive factors. Using appropriate sampling weights, weighted χ analysis and multivariable logistic regression models with odds ratios and 95% confidence intervals (95% CIs) were reported. The weighted prevalence rate of one or more pelvic floor disorders was 25.0% (95% CI 23.6-26.3), including 17.1% (95% CI 15.8-18.4) of women with moderate-to-severe UI, 9.4% (95% CI 8.6-10.2) with fecal incontinence, and 2.9% (95% CI 2.5-3.4) with prolapse. From 2005 to 2010, no significant differences were found in the prevalence rates of any individual disorder or for all disorders combined (P>.05). After adjusting for potential confounders, higher BMI, greater parity, and hysterectomy were associated with higher odds of one or more pelvic floor disorders. Although rates of pelvic floor disorders did not change from 2005 to 2010, these conditions remain common, with one fourth of adult U.S. women reporting at least one disorder. III.
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                Author and article information

                Contributors
                gabrielahalder@gmail.com
                Journal
                Int Urogynecol J
                Int Urogynecol J
                International Urogynecology Journal
                Springer International Publishing (Cham )
                0937-3462
                1433-3023
                24 May 2021
                : 1-9
                Affiliations
                [1 ]GRID grid.89336.37, ISNI 0000 0004 1936 9924, Department of Women’s Health, , University of Texas Austin Dell Medical School, ; Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX 78705 USA
                [2 ]Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin-Maddison, Maddison, WI USA
                [3 ]GRID grid.413558.e, ISNI 0000 0001 0427 8745, Department of Obstetrics and Gynecology, , Albany Medical Center, ; Albany, NY USA
                Author information
                http://orcid.org/0000-0002-5505-9638
                Article
                4831
                10.1007/s00192-021-04831-w
                8142611
                34028575
                51b9b81e-fe2c-4e8d-a572-fa1ea4aa7359
                © The International Urogynecological Association 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 5 March 2021
                : 26 April 2021
                Categories
                Original Article

                Obstetrics & Gynecology
                telemedicine,surgery,counseling,preoperative care
                Obstetrics & Gynecology
                telemedicine, surgery, counseling, preoperative care

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