Background: Physician review websites have influence on a patient’s selection of a provider. Written reviews are subjective and difficult to quantitatively analyze. Sentiment analysis of writing can quantitatively assess surgeon reviews to provide actionable feedback for surgeons to improve practice. The objective of this study is to quantitatively analyze large subset of written reviews of hand surgeons using sentiment analysis and report unbiased trends in words used to describe the reviewed surgeons and biases associated with surgeon demographic factors. Methods: Online written and star-rating reviews of hand surgeons were obtained from healthgrades.com and webmd.com . A sentiment analysis package was used to calculate compound scores of all reviews. Mann-Whitney U tests were performed to determine the relationship between demographic variables and average sentiment score of written reviews. Positive and negative word and word-pair frequency analysis was also performed. Results: A total of 786 hand surgeons’ reviews were analyzed. Analysis showed a significant relationship between the sentiment scores and overall average star-rated reviews ( r2 = 0.604, P ≤ .01). There was no significant difference in review sentiment by provider sex; however, surgeons aged 50 years and younger had more positive reviews than older ( P < .01). The most frequently used bigrams used to describe top-rated surgeons were associated with good bedside manner and efficient pain management, whereas those with the worst reviews are often characterized as rude and unable to relieve pain. Conclusions: This study provides insight into both demographic and behavioral factors contributing to positive reviews and reinforces the importance of pain expectation management.

Background Targeted muscle reinnervation (TMR) is growing in popularity; however, literature evaluating patient characteristics and outcomes is limited. Methods The EMBASE database was queried with the search terms “targeted muscle reinnervation” OR “TMR” AND “outcomes” OR “patient outcomes.” Clinical human studies in English were eligible for inclusion, yielding 89 articles. After rigorous exclusion criteria, a total of 13 articles were included in this review. Study data including geographic location, patient demographics, TMR indication, amputation level, number of nerve transfers performed, length of follow-up, and reported outcomes were extracted and analyzed. Results The included articles represent 338 patients (341 limbs). Average patient age was 47.4 years. Indication for amputation included trauma (n = 125), infection (n = 76) cancer/tumor resection (n = 71), ischemia (n = 18), failed Charcot reconstruction (n = 15), failed hardware (n = 9), burn (n = 4), and CRPS (n = 4). Five studies included upper extremity TMR only, two included lower extremity TMR only, and six included both upper and lower extremity TMR. TMR was performed in an immediate or delayed fashion, with an average of 2.2 nerve transfers performed per limb overall. Average length of follow-up was 22.3 months. In three studies, patients with phantom limb pain undergoing delayed TMR were found to have significant or trending toward significant reduction in pain after TMR using numeric rating scale and patient-reported outcomes measurement information system scales. One article reported 9/10 patients with improved or complete resolution of phantom limb pain after delayed TMR. Three studies found that patients undergoing immediate TMR had lower pain scores compared with non-TMR controls. Conclusion While there is evidence that TMR reduces neuroma-related pain and improves the quality of life for amputees, further outcomes studies are needed to study the patient experience with TMR on a larger scale. Establishing standardized, validated patient-reported outcomes assessment tools is critical to future investigation in this field.

Oncology nurses care for persons with cancer and thus play an important role in providing palliative care to this population. However, a valid instrument to measure United States oncology nurses’ confidence in providing palliative care service to persons with cancer is not available. This study examined the psychometric properties of the Palliative Care Nursing Self-Competence (PCNSC) scale in measuring oncology nurses’ confidence in providing all aspects of palliative care to persons with cancer. An online survey with demographic questions and the PCNSC scale was sent to registered nurse (RN) members of the Oncology Nursing Society (ONS). The PCNSC scale consists of 50 items and 10 domains. A confirmatory factor analysis (CFA) was conducted to test the psychometric properties of the PCNSC scale in examining oncology nurses’ confidence in providing palliative care. The CFA showed that the model fit reached adequate levels with the 10-factor structure of the PCNSC scale (χ2 = 2104.1, df = 1130, CFI = 0.88, RMSEA = 0.06) thus validating the scale in measuring oncology nurses’ confidence in providing palliative care to persons with cancer in the United States. PCNSC retained the same 10-factor structure with 5 items in each factor, thus validating the scale. This scale can be used to assess oncology nurses’ overall confidence and confidence in each domain of palliative care provision. These results can inform the development of targeted educational programs geared to enhancing oncology nurses’ confidence in the United States.

Objectives: To examine health outcomes in community-dwelling older adults with: dementia only, cancer only, and comorbid cancer and dementia. Methods: Longitudinal analysis was conducted using data from 2010 to 2016 waves of the Health and Retirement Study. Health outcomes included mortality, limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), nursing home utilization, hospital stay, homecare use, self-rated health, and out-of-pocket medical expenditure. Panel regression was used for statistical analysis. Results:The prevalence of comorbid cancer and dementia ranged from 2.56% to 2.97%. Individuals with comorbid cancer and dementia demonstrated a higher likelihood of nursing home utilization and poorer self-rated health but a lower likelihood of hospital stay, homecare use, and out-of-pocket expenditures, compared to the cancer only or dementia only groups. The differences in mortality and ADL and IADL limitations were not statistically significant. Conclusion: Comorbid cancer and dementia predicted longer nursing home utilization and poorer self-rated health. The results help guide care planning for individuals with comorbid cancer and dementia.