How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale

Postoperative satisfaction following lumbar spinal fusion surgery: patient expectation versus actuality

OBJECTIVE

Due to the reported benefits associated with minimally invasive spine surgery (MIS), patients seeking out minimally invasive surgery may have higher expectations regarding their outcomes. In this study the authors aimed to assess the effects of preoperative expectations and postoperative outcome actuality, and the difference between the two, on postoperative satisfaction following MIS for lumbar fusion procedures.

METHODS

Patients scheduled for either a 1- or 2-level lumbar fusion MIS were administered confidential surveys preoperatively and at 6 months postoperatively. The surveys administered preoperatively consisted of 2 parts: preoperative patient-reported outcomes (PROs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) back pain, and VAS leg pain, and expected postoperative PROs. The surveys administered 6 months postoperatively consisted of 2 parts: postoperative PROs and satisfaction. Preoperative symptoms, expected postoperative symptoms, and actual postoperative symptoms were compared using paired t-tests. Pearson correlation was used to compare the association between 1) postoperative change in PROs and satisfaction, 2) expectation and satisfaction, 3) expectation-actuality discrepancy and satisfaction, and 4) actuality and satisfaction.

RESULTS

In total, 101 patients completed all surveys. Patients expected to improve in all PROs from baseline, except for ODI personal care, in which they expected to get worse after surgery. In actuality, patients improved in all PROs from baseline, except for ODI personal care, in which they did not demonstrate improvement or worsening. Patients did not surpass any expectations regarding PRO improvement. The association between patient satisfaction and postoperative change was strong for the VAS back pain score, while ODI and VAS leg pain scores showed moderate correlations. Preoperative expectation and postoperative satisfaction demonstrated weak to moderate correlations for all outcome measures. All 3 PROs demonstrated moderate correlation between patient satisfaction and the expectation-actuality discrepancy. All 3 PROs demonstrated strong correlations between satisfaction and actual postoperative outcomes, with ODI having the strongest correlation.

CONCLUSIONS

In this observational study, the authors determined that the actual postoperative results following surgery were strongly correlated with patient satisfaction, while the patients' expectation, the expectation-actuality discrepancy, and the postoperative improvement did not demonstrate strong correlations for all patient-reported outcome measures utilized in this study. The investigation results suggest that the most important indicator of how satisfied patients feel following surgery may be the actual outcome itself, rather than the preoperative expectation or the degree to which the expected result was met.

Konrad A, Hoyer J. Die Cambridge Depersonalisation Scale-Situational (CDS-S) zur Erfassung von situationsabhängigem Depersonalisationserleben

Zusammenfassung. Depersonalisations- / Derealisationssymptome sind während der Konfrontation mit angstbesetzten Reizen oder Situationen häufig. Zur Erfassung dieses situationsbezogenen Depersonalisationserlebens wurde die Cambridge Depersonalisation Scale adaptiert. Die psychometrischen Gütekriterien der CDS-Situational (CDS-S) wurden in 2 Studien untersucht. 53 Patientinnen und Patienten mit Sozialer Angststörung und 32 gesunde Kontrollprobandinnen und Kontrollprobanden führten zweimal im Abstand von 4 Monaten den Trier Social Stress Test durch und schätzten anschließend die Schwere der Depersonalisation / Derealisation (CDS-S) und der Angst während des Tests ein. Ferner bearbeiteten 26 Studierende mit Prüfungsangst und 43 Studierende ohne Prüfungsangst die CDS-S direkt nach einer mündlichen Prüfung sowie 7 Tage später. Je nach Studie waren Cronbachs α (α ≥ .88), Item-Trennschärfen, Split-Half-Reliabilität ( rtt ≥ .74) und Retest-Reliabilität ( rtt = .40 – .88) zufriedenstellend bis sehr gut. Die Überprüfung der Veränderungssensitivität, Konstruktvalidität und faktoriellen Validität ergab zufriedenstellende Ergebnisse. Die CDS-S erfasste in 2 Studien situationsbezogenes Depersonalisations- / Derealisationserleben hinreichend reliabel und valide und ist zur Messung von Depersonalisations- / Derealisationssymptomen im sozialen und Leistungskontext zu empfehlen.

Clinician Perceptions of the Importance of Hospital Discharge Components for Children

BACKGROUND

Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians.

METHODS

March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states. The DCE consisted of 14 discharge care components randomly presented two at a time for a total of 28 choice tasks. Best-worst scaling of participants' choices generated mean relative importance (RI) scores for each component, which allowed for ranking from least to most important.

RESULTS

Participants, regardless of field or practice setting, perceived "Discharge Education/Teach-Back" (RI 11.1 [95% confidence interval, CI: 11.0-11.3]) and "Involve the Child's Care Team" (RI 10.6 [95% CI: 10.4-10.8]) as the most important discharge components, and "Information Reconciliation" (RI 4.1 [95% CI: 3.9-4.4]) and "Assigning Roles/Responsibilities of Discharge Care" (RI 2.8 [95% CI: 2.6-3.0]) as least important.

CONCLUSIONS

A diverse group of pediatric clinicians value certain components of the pediatric discharge care process much more than others. Efforts to optimize the quality of hospital discharge for children should consider these findings.

Pharmacologic and Nonpharmacologic Interventions for Perioperative Anxiety in Patients Undergoing Mohs Micrographic Surgery: A Systematic Review

BACKGROUND

Perioperative anxiety is associated with negative patient outcomes in Mohs micrographic surgery (MMS). Both pharmacologic and nonpharmacologic therapies have been used to alleviate perioperative anxiety in MMS.

OBJECTIVE

To systematically evaluate the efficacy of therapies aimed at reducing perioperative anxiety in MMS.

METHODS AND MATERIALS

Eligible articles were identified using PubMed MEDLINE, Cochrane Central Register of Controlled Trials, metaRegister of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. All available studies investigating interventions to reduce perioperative anxiety during MMS were considered.

RESULTS

Of the 183 abstracts identified and screened, 5 studies met inclusion criteria. Three studies reported a postintervention reduction in patient anxiety (midazolam, educational video, and personalized music). Two studies reporting on similar interventions did not find an effect.

CONCLUSION

There is currently limited evidence to support either pharmacologic or nonpharmacologic therapy for alleviation of perioperative patient anxiety in MMS. Midazolam may provide patients a short-term benefit, though any estimate of the effect is very uncertain. Personalized music may be a promising nonpharmacologic intervention for future research.

A Measurement Scale to Assess Children's Satisfaction with Hospitalization in the Andalusian Population

Background: Patient satisfaction is a principal indicator in the evaluation of the stay of pediatric patients in hospitals, since its consequences can emotionally interfere with health treatment. The aim of this study was to obtain a valid scale to assess children’s satisfaction with their time spent as a patient in an Andalusian hospital. Method: The Children’s Satisfaction with Hospitalization Questionnaire (CSHQ) was applied to 623 pediatric patients hospitalized in Andalusia. An exploratory factor analysis (EFA) showed one dimension underlying the children’s satisfaction with their hospitalization. After that, we developed a depuration analysis process to achieve a valid and unidimensional scale to assess children’s satisfaction. Results: The eleven-item one-dimension solution showed suitable consistency and goodness-of-fit indices. The final scale addresses hosting aspects as the main dimension of a minor’s satisfaction in Andalusian hospitals. Conclusion: A unidimensional scale has been determined for the assessment of children’s satisfaction with their stay in Andalusian hospitals based on hosting aspects. Nonetheless, other dimensions underlying the satisfaction of patients should also be considered.

The Effects of Mental Stress on Non-insulin-dependent Diabetes: Determining the Relationship Between Catecholamine and Adrenergic Signals from Stress, Anxiety, and Depression on the Physiological Changes in the Pancreatic Hormone Secretion

Non-insulin-dependent diabetes or type II diabetes is prevalent around the world. A high-fat diet and chronic inactivity are often responsible for this chronic ailment. However, it is suspected that a high level of stress can also exacerbate diabetes. High anxiety can result in the release of sympathetic hormones that can elevate both cortisol and glucose levels, decrease insulin release, or affect the sensitivity and resistant of the insulin hormone. We have analyzed three research articles to see how stress and anxiety can affect non-insulin-dependent diabetes. In the first article, we selected participants with type II diabetes and injected them with saline or norepinephrine. The results indicated that participants with norepinephrine had experienced a decrease in glucose disposal and reduction in insulin secretion rate. Our second article utilizes African-American adults with type II diabetes. We provide them with a survey to determine how stress, anxiety, and depression can affect adherence to lifestyle modifications such as exercise and eating a proper diet. We find that subjects with higher stress levels tend to have lower compliance with their lifestyle regimes. Our third article focuses on female participants and divides them into two categories which are high chronic stress (HCS) and low chronic stress (LCS). We use an MRI to observe their brain activity while they stare at a picture of high-caloric type food. Our results indicate that there are different responses in various brain structure activities between subjects with HCS and LCS group. With these analyses, it can improve on the way healthcare providers can consult with their patients who have exacerbated type II diabetes despite proper medication and lifestyle modification.

Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study

OBJECTIVES

To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations.

DESIGN

Multi-method study using observational and self-reported measures of SDM and qualitative analysis.

SETTING

Breast care and predialysis teams who had already implemented SDM.

PARTICIPANTS

Breast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions.

METHODS

Consultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure.

RESULTS

Twenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were 'incorporating patient preferences into decisions' for the breast team (mean 18.5, range 12.5-20, SD 2.39) and 'eliciting patient preferences to options' for the renal team (mean 16.15, range 10-20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions.

CONCLUSIONS

Self-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice.

Caring for the carer of someone who has had a stroke: findings from an innovative project

Background/Aims

Going into and coming out of hospital can be an uncertain and sometimes emotional experience for carers as well as patients. Many carers feel insufficiently involved and unsupported in the discharge process. However, we know that if hospital discharge is well-planned and the right services put in place then there is a much greater likelihood of the cared for person remaining at home with carer support and the carer feeling able to continue in their caring role. The aim of this article is to analyse an intervention that provided unpaid stroke carers with tailored support to meet their needs and prepare them for the discharge of their stroke survivor.

Methods

A carer support worker focused on the needs of carers of inpatients in an integrated stroke unit. The impact of the service was measured using the Caregiver Strain Index and the Preparedness for Caregiving Scale, together with carer self-ratings as to whether and/or how their needs were met.

Results

The most common outcomes, in order of reported importance were: confidence in accessing services, confidence in caring, requiring specific information, and the ability to improve or maintain their own wellbeing. Bed days saved and reductions in post-discharge packages of care were estimated. The median reduction in length of stay was 9 days, and potential savings were calculated at £35 367 during the 19-month study period.

Conclusions

A dedicated support service for unpaid stroke carers was effective in addressing carers' unmet needs and delivered health care cost savings.

One-bloc percutaneous large biopsy of soft-tissue tumours: feasibility study and possible indications

AIM

To report the early results of the Intact lesion excision system (LES) regarding feasibility, tolerance and efficiency in obtaining soft-tissue tumour samples under ultrasound guidance.

MATERIALS AND METHODS

The feasibility and tolerance of Intact LES procedures under ultrasound guidance were studied prospectively in 15 patients. The procedure was performed on an outpatient basis under local anaesthesia by a single interventional radiologist with 6 years of experience and lasted around 30 min.

RESULTS

The feasibility of the Intact LES for soft-tissue masses was good except when lesions were hard and calcified. Tolerance was good, with median pain experienced during the procedure evaluated at 4.5/10 (SD 2.2) and median post-procedural pain at day 1 evaluated at 1.8/10 (SD 2.5). No major complications were observed; however, for vascularised lesions, one case of acute wound bleeding and two post-procedural haematomas led to delayed pain.

CONCLUSION

Percutaneous biopsy of suspected soft-tissue sarcoma using the LES device under ultrasound guidance is well tolerated and feasible. After a first non-contributing core biopsy, and especially, in the case of lipomatous lesions, it is a valuable option to consider, as is surgical incision biopsy.

Cross-Cultural Adaptation of the Work Rehabilitation Questionnaire (WORQ) to French: A Valid and Reliable Instrument to Assess Work Functioning

Purpose The Work Rehabilitation Questionnaire (WORQ) is a patient-reported instrument to assess work related functioning in vocational rehabilitation (VR) and work, based on the International Classification of Functioning, Disability and Health (ICF) core set for VR. The objective of this study was to cross-culturally adapt WORQ to French and to evaluate its psychometric properties. Methods The cross-cultural adaptation followed a dual-panel approach. Psychometrics was examined in one VR-centre in the French speaking part of Switzerland. Test-retest reliability was analyzed with intraclass correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha. Construct validity was determined by convergence to the self-reported general functioning scale and the Hospital Anxiety and Depression Scales (HADS). The association of patient's return-to-work expectation within 6-months and having a case manager was examined. The usability of WORQ-French was tested in 10 VR patients. Results Eighty-nine patients with musculoskeletal injuries were included. WORQ-French showed excellent internal consistency (0.968) and a high test-retest reliability (0.935). WORQ-French was positively associated with self-reported general functioning (r = 0.662) and both HADS scales (r = 0.56-0.57). Neither the patient's return-to-work expectation nor having a case manager were significantly correlated with WORQ-French. Usability in terms of understandability of questions and response options was found to be good. Seven patients rated the length of WORQ-French as good, while two found the instrument a little too long and one found it too long. Conclusions WORQ French is a valid, reliable, and easy to administer instrument to assess self-reported work functioning given our study setting and sample characteristics.

Clients' experiences utilizing a safer conception service for HIV affected individuals: implications for differentiated care service delivery models

Background

Safer conception services promote the reproductive health and rights of families, while minimizing HIV transmission risks between partners trying to conceive, as well vertical transmission risks. Implementation data, including clients’ experiences utilizing safer conception services in sub-Saharan Africa are limited.

Methods

Hillbrow Community Health Centre began offering safer conception services for individuals and couples affected by HIV in Johannesburg, South Africa in June 2015. A stratified sub-sample of safer conception clients were consecutively recruited from April 2016–August 2017 for a cross-sectional interview assessing clients’ perceptions of service acceptability and value, as well as perceived safer conception knowledge and self-efficacy. Visual analog scales from 0 to 100 were used to measure clients’ experiences; scores were classified as low, moderate and high acceptance/value/knowledge/self-efficacy if they were < 50, 50–79 and ≥ 80 respectively. Comparisons of scores were made across safer conception visits attended.

Results

Among 692 clients utilizing safer conception services, 120 (17%) were sampled for the process evaluation; sub-sample participant characteristics were similar to the overall cohort. Clients gave a mean score of ≥90-points for each question assessing service acceptability and 96% (114/119) indicated a high perceived value (scores ≥80) for regular safer conception attendance until conception. Fifty-eight percent (n = 70) of clients reported learning something new during the visit completed the day of the survey, though acquisition of new information tended to decrease as visits increased (p = 0.09). In terms of safer conception strategies, 80% of clients reported high levels of knowledge on the impact of antiretroviral treatment (ART) and viral suppression on HIV transmission, 67% reported high levels of knowledge of the importance of STI screening and 56% regarding limiting condomless sex to days of peak fertility; 34% in sero-different relationships reported high pre-exposure prophylaxis (PrEP) knowledge. Self-efficacy varied by safer conception methods and was similar across study visits.

Conclusions

Clients perceived high value from their safer conception visits and preferred regular attendance until conception, however we observed a plateau in knowledge and self-efficacy across subsequent visits after initially attending safer conception care. More intensive services may be appropriate for certain clients based on clinical circumstances, but many couples may potentially receive a ‘lighter touch’ approach while still minimizing HIV transmission risks.

Electronic supplementary material

The online version of this article (10.1186/s12978-019-0718-5) contains supplementary material, which is available to authorized users.

Reducing ceiling effects in the Working Alliance Inventory-Rehabilitation Dutch Version

Purpose: To reduce ceiling effects on domain scores (Task, Goal, and Bond) of the Working Alliance Inventory (WAI)-Rehabilitation Dutch Version by changing response scales and using Visual Analogue Scales (VASs).Methods: Clients, who had at least three treatment sessions prior, randomly received one of the three versions of the WAI-Rehabilitation Dutch Version, using items with a balanced Likert scale, Positive-Packed Likert scale or VAS. Primary outcome was percentage of ceiling effects in total- and domain scores, secondary outcomes were construct validity and internal consistency of the three versions.Results: One hundred and seventy-six clients randomly received a set of questionnaires (one of the three versions of the WAI-Rehabilitation Dutch Version, Session Rating Scale (SRS) and Helping Alliance Questionnaire (HAQ)-II); 152 participants (mean age 51.5 ± 16.3, 106 women) returned the questionnaires. No ceiling effects were present in the total scores of all versions. Significantly fewer ceiling effects were found in the VAS-Version (Goal: 8.0%, Bond: 7.7%) compared to the original (Goal: 18.0%, Bond: 29.8%) and Positive-Packed Version (Goal: 27.1%, Bond: 29.8%). Spearman's correlations between VAS-Version, SRS and HAQ-II ranged 0.747-0.845.Conclusions: Visual Analogue Scales effectively reduced ceiling effects on domain scores of the WAI-Rehabilitation Dutch Version, while maintaining validity.Implications for RehabilitationVisual Analogue Scales effectively reduced ceiling effects on domain scores of the Working Alliance Inventory-Rehabilitation Dutch Version, while maintaining construct validity.The Working Alliance Inventory version with Visual Analogue Scales can be used in rehabilitation.

The Language of First-Trimester Nonviable Pregnancy: Patient-Reported Preferences and Clarity

OBJECTIVE

To document the terminology patients hear during the treatment course for a nonviable pregnancy and to ask patients their perceived clarity and preference of terminology to identify a patient-centered lexicon.

METHODS

We performed a preplanned substudy survey of English-speaking participants in New York, Pennsylvania, and California at the time of enrollment in a randomized multisite trial of medical management of first-trimester early pregnancy loss. The six-item survey, administered on paper or an electronic tablet, was developed and piloted for internal and external validity. We used a visual analog scale and quantified tests of associations between participant characteristics and survey responses using risk ratios.

RESULTS

We approached 155 English-speaking participants in the parent study, of whom 145 (93.5%) participated. In the process of receiving their diagnosis from a clinician, participants reported hearing the terms "miscarriage" (n=109 [75.2%]) and "early pregnancy loss" (n=73 [50.3%]) more than "early pregnancy failure" (n=31 [21.3%]) and "spontaneous abortion" (n=21 [14.4%]). The majority selected "miscarriage" (n=79 [54.5%]) followed by "early pregnancy loss" (n=49 [33.8%]) as their preferred term. In multivariable models controlling for study site, ethnicity, race, history of induced abortion, and whether the current pregnancy was planned, women indicated that "spontaneous abortion" and "early pregnancy failure" were significantly less clear than "early pregnancy loss" (53/145, adjusted risk ratio 0.12, 95% CI 0.07-0.19 and 92/145, adjusted risk ratio 0.38, 95% CI 0.24-0.61, respectively, as compared with 118/145 for "early pregnancy loss"). "Miscarriage" scored similarly to "early pregnancy loss" in clarity (119/145, adjusted risk ratio 1.05, 95% CI 0.62-1.77).

CONCLUSION

The terminology used to communicate "nonviable pregnancy in the first trimester" is highly variable. In this cohort of women, most preferred the term "miscarriage" and classified both "miscarriage" and "early pregnancy loss" as clear labels for a nonviable pregnancy. Health care providers can use these terms to enhance patient-clinician communication.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT02012491.

Effectiveness and safety of gastrointestinal endoscopy during a specific sedation training program for non-anesthesiologists

INTRODUCTION

sedation is a key component for the improvement of sedation quality. A correct administration requires appropriate training. We performed a study to compare sedation effectiveness, safety and patient satisfaction when administered by gastroenterologists, with and without specific training.

METHODS

a training program enrolled a group of gastroenterologists (trained group, n = 4) and their results were compared to those from a non-trained group (n = 3). ASA 1-3 patients who had undergone sedation by a gastroenterologist using midazolam and fentanyl were included over a period of 30 months. Safety was assessed in terms of the complication rate, effectiveness was assessed via the rate of completed endoscopic procedures and patient satisfaction was evaluated via a phone interview the day after the procedure.

RESULTS

a total of 3,475 patients were sedated by gastroenterologists during the study period. Significant differences were found that favored the trained group for completed procedures (5.6% vs 8.9%). A lower rate of excessive sedation (1.3% vs 8.61%), hypoxemia (0.72% vs 2.49%) and post-procedural pain (1.8% vs 4.3%) were also achieved. Patient satisfaction surpassed 99.5% and there were no significant differences between groups.

CONCLUSIONS

our sedation training program improved the effectiveness and safety outcomes when compared to sedation administered by gastroenterologists without this specific training.

Long-term follow-up after anterior cruciate ligament reconstruction using a press-fit quadriceps tendon-patellar bone autograft

Background

The use of a quadriceps tendon-patellar bone (QTPB) autograft provides an alternative procedure in primary reconstruction of the anterior cruciate ligament (ACL). Using the press-fit technique for femoral fixation and knotting over a bone bridge as well as additional spongiosa filling for tibial fixation can completely eliminate the need for fixation implants. The objective of this study was to evaluate the long-term clinical, functional and radiological results of this operating method.

Methods

Sixty-nine patients (27 female-42 male) were included in this study. Fifty-seven patients (83%) received a comprehensive follow-up review after an average period of 7.5 years (range: 7–8.7). All other patients were surveyed by telephone. Six patients (9%) suffered a re-rupture of the ACL graft caused by a new related trauma and were therefore excluded from the statistical analysis.

Results

Of all patients, 98% were satisfied with the operation. Normal or almost normal results were recorded in the subjective IKDC scores form by 88% of the patients. The Lysholm score demonstrated very good and good results in 83% of the patients. Only 1 patient reported minor complaints in the donor area. Seven (12%) patients developed Cyclops syndrome with limited knee extension. This complication was treated arthroscopically within the first year postoperatively. Their results on follow-up were not worse than the results of the patients without Cyclops syndrome.

Regarding the 57 patients who received a comprehensive evaluation, the stability test with the KT-1000 Arthrometer yielded a difference of less than 3 mm in the contralateral comparison for 89% of the operated knees. The pivot-shift test was normal in 79% and almost normal in 21%. In the Single-leg Triple Hop Test, patients achieved an average of 98% of the hopping distance attained with the contralateral leg. The radiological examination revealed a slight deterioration in the Kellgren-Lawrence Score in 2 patients.

Conclusion

The ACL reconstruction using the QTPB autograft performed with the press-fit technique leads to good results in comparison with published results of established procedures for primary ACL surgery using other autografts. Further investigations should involve comparative studies with the objective of providing evidence-based, individually adapted therapy for ACL rupture.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2271-8) contains supplementary material, which is available to authorized users.

Le syndrome postgarde de nuit chez les médecins urgentistes : caractéristiques et facteurs influençants

Introduction : Les urgentistes connaissent une privation de sommeil en lendemain de garde. Beaucoup ont des perceptions ou des comportements inhabituels que nous appelons syndrome post-garde de nuit (PGN). L’objectif principal était de caractériser le syndrome PGN des urgentistes. Les objectifs secondaires étaient d’établir une note évaluant le syndrome PGN et de déterminer les facteurs influençant ce syndrome PGN.

Méthode : Étude prospective de cohorte, observationnelle, multicentrique, auprès des urgentistes du Gard et de l’Hérault entre janvier et juin 2017. Deux questionnaires informatiques anonymes étaient diffusés aux structures d’urgences du Gard et de l’Hérault. En journée normale, hors sortie de garde, un questionnaire colligeait les symptômes ressentis habituellement en lendemain de garde, à coter entre 0 et 10. En sortie de garde, un autre questionnaire s’intéressait au ressenti de la garde réalisée et aux caractéristiques de cette garde. Les médecins étaient encouragés à répondre aux deux questionnaires.

Résultats : Cent treize médecins (45 %) ont répondu, 67 (59 %) à distance d’une garde et 46 (41 %) en post-garde immédiat. Le syndrome PGN comprend des symptômes somatiques (échelle visuelle analogique (EVA) = 5 [2–8]), comportementaux (EVA = 7 [3–8]), liés à l’humeur (EVA = 7[5–8]) et psychiques (EVA = 6 [4–8]). Ces symptômes en post-garde immédiat étaient ressentis de manière moins importante que lorsque décrit à distance (respectivement p = 0,001, p <0,001, p < 0,001, p = 0,002). Les gardes de SMUR (service mobile d’urgence et de réanimation) et de traumatologie étaient associées à un syndrome PGN moins marqué (respectivement p =0,035 et p = 0,02) que les gardes des filières médico-chirurgicales.

Conclusion : Il s’agit de la première évaluation du syndrome PGN chez les urgentistes français. Les symptômes en sont moins importants en post-garde immédiat. Les gardes de traumatologie et de SMUR semblent mieux tolérées.

Self-confidence for the initial management of health issues in schools: construction and validation of a visual analogue scale

Abstract Objective: To describe the construction and validation of a visual analogue scale of teachers' self-confidence with regard to the initial management of health issues in schools. Method: A methodological study was developed based on theoretical (items' construction and content validation), empirical (semantic analysis and pilot test), and analytical procedures (internal consistency analysis). The project was approved by a research ethics committee. Results: The scale consisted of 12 items regarding the main health issues in schools, presented content validity index of 100% in the second round, was understood by the target audience, and presented high internal consistency among items (Cronbach's alpha of 0.89). Conclusion and implications for practice: An easy-to-use tool that proved to be relevant to meet the dimension of teachers' self-confidence in the initial management of health issues in schools. The scale may contribute to the planning of systematized and effective educational strategies among teachers.

The efficacy and safety of other cryotherapy compounds for the treatment of genital warts: a randomized controlled trial

BACKGROUND

Cryotherapy using Wartner compound that contains a mixture of dimethyl ether (75%) and propane (25%) has been recently reported as an effective treatment for warts. The present study aimed to evaluate the safety and efficacy of Wartner in male patients with genital warts.

METHODS

A Phase II parallel-randomized clinical trial was performed on 16 Iranian men affected by genital warts who were referred to a dermatology clinic at Tehran University of Medical Sciences. Two genital warts of each patient were selected and randomly assigned to receive either Wartner (intervention) or liquid nitrogen (control).

RESULTS

Two weeks after the treatment, the sizes of the lesions in control and intervention groups decreased by 17.87 ± 2.14 mm² and 15.81 ± 1.80 mm², respectively (p = .299). Fourteen days after a single session of treatment, 81% of lesions in the control group and 50% in the Wartner group were completely eradicated, however, the difference was not statistically significant (p = .063).

CONCLUSIONS

The Wartner compound is as effective as the conventional cryotherapy method for treating genital warts. It is particularly valuable when there are contraindications or no access to common treatment options.

The Likert scale is a powerful tool for quality of life assessment among patients after minimally invasive coronary surgery

Introduction

Health-related quality of life (QoL) is an acknowledged index of treatment effectiveness. There are several methods of its evaluation which are predisposed to different risk of bias.

Aim

To investigate the agreement between objective and subjective tools of QoL assessment in patients who underwent endoscopic atraumatic coronary artery bypass (EACAB) grafting.

Material and methods

This prospective observational study covered 705 consecutive patients who underwent EACAB between April 1998 and December 2010. Quality of life was assessed in a follow-up of 2132 ±1313 days among 482 subjects using the WHOQoL-BREF questionnaire as an objective tool and the Likert scale as a more subjective method.

Results

There was good agreement between a 5-step Likert scale and a 5-step BREF Q1 (‘overall quality of life’) and Q2 (‘general health’) with a concordance correlation coefficient of CCC = 0.64 (95% CI: 0.58–0.69) and CCC = 0.49 (95% CI: 0.43–0.55), respectively. There was also a statistically significant correlation between answers reported using the Likert scale and all domains of BREF: physical health (R = 0.54, p < 0.001), psychological health (R = 0.56, p < 0.001), social relationships (R = 0.45, p < 0.001) and environment (R = 0.56, p < 0.001).

Conclusions

The Likert scale is useful in QoL assessment in patients after minimally invasive coronary surgery. This simple and easy-to-use screening method may be used interchangeably with a more reliable but also more complex questionnaire tool.

Development and validation of the Working Alliance Inventory Dutch version for use in rehabilitation setting

Background: In rehabilitation, therapeutic alliance is associated with improvements in clinical outcomes. The Working Alliance Inventory (WAI) measures therapeutic alliance and is frequently used in rehabilitation research; however, it has not been validated for rehabilitation. Objectives: To determine content validity, internal consistency and construct validity of the Working Alliance Inventory Rehabilitation Dutch Version (WAI-ReD). Methods: In phase 1, content and face validity of the WAI-ReD was judged by professionals (n = 15) and in phase 2 by patients (n = 22). In phase 3, 14 hypotheses were tested in patients (n = 138) regarding: content validity (i.e., missing items, floor, and ceiling effects); internal consistency; and construct validity (i.e., factor structural testing correlations of WAI-ReD scores with Session Rating Scale (SRS), the Helping Alliance Questionnaire II (HAQ-II), and Visual Analog Scale of Pain (VAS_pain)). Results: After phase 1 and phase 2, the WAI-ReD was formulated and tested. Content validity; missing items were negligible. Ceiling effects were present in all domains. Internal consistency; Cronbach's α ranged between 0.804 and 0.927. Construct validity; correlations between WAI-ReD, SRS, HAQ-II, and VAS_pain fell within the hypothesized ranges. Conclusion: Eleven of the 14 hypotheses were not rejected confirming good clinimetric properties of the WAI-ReD. The WAI-ReD can be used in rehabilitation to measure therapeutic alliance.

Bias in patient satisfaction surveys: a threat to measuring healthcare quality

Patient satisfaction surveys are an increasingly common element of efforts to evaluate the quality of healthcare. Many patient satisfaction surveys in low/middle-income countries frame statements positively and invite patients to agree or disagree, so that positive responses may reflect either true satisfaction or bias induced by the positive framing. In an experiment with more than 2200 patients in Nigeria, we distinguish between actual satisfaction and survey biases. Patients randomly assigned to receive negatively framed statements expressed significantly lower levels of satisfaction (87%) than patients receiving the standard positively framed statements (95%-p<0.001). Depending on the question, the effect is as high as a 19 percentage point drop (p<0.001). Thus, high reported patient satisfaction likely overstates the quality of health services. Providers and policymakers wishing to gauge the quality of care will need to avoid framing that induces bias and to complement patient satisfaction measures with more objective measures of quality.

Prevalence and correlates of non-adherence to immunosuppressants and to health behaviours in patients after kidney transplantation in Brazil - the ADHERE BRAZIL multicentre study: a cross-sectional study protocol

BACKGROUND

Non-adherence to immunosuppressive therapy is a prevalent risk factor for poor clinical and after kidney transplantation (KT), and has contributed to the lack of improvement in long-term graft survival over the past decade. Understanding the multilevel correlates and risk factors of non-adherence is crucial to determine the optimal level for planning interventions, namely at the patient, health care provider, KT centre, and health care system level. Brazil, having the largest public transplantation program in the world and with regional differences regarding access to health services and service implementation, is in a unique position to study this multilevel approach. Therefore, the Adhere Brazil Study (ADHERE BRAZIL) was designed to assess the prevalence and variability of non-adherence to immunosuppressants and to health behaviours among adult KT recipients in Brazil, and to assess the multilevel correlates of non-adherence to immunosuppressive medication. We describe the rationale, design, and methodology of the ADHERE BRAZIL study.

METHODS/DESIGN

This is an observational, cross-sectional, multicentre study that includes 20 Brazilian KT centres. A stratified sampling approach is used, based on strata, with the following characteristics considered: geographical region and transplant activity (number of KTs per year). A random sample of patients (proportional to the size of the centre within each stratum) is selected from each centre. The prevalence of different health behaviours is assessed through self-report. The assessment of multilevel correlates of non-adherence is guided by the ecological model that considers factors at the level of the patient, health-care professional, and transplant centre, using established instruments or instruments developed for this study. Data will be collected over an 18-month period, with information obtained during the regular follow-up visits to the transplant outpatient clinic and directly entered into the Research Electronic Data Capture (RedCap) system. Data entry is performed by a trained professional who is part of the transplant team. The data collection began in December 2015.

DISCUSSION

This multicentre study is the first to evaluate multilevel correlates of non-adherence in KT patients and will provide a reliable estimate of non-adherence in Brazilian KT patients.

TRIAL REGISTRATION

ClinicalTrials.gov on 10/10/2013, NCT02066935 .

Construct validation and correlates of preoperative expectations of postsurgical recovery in persons undergoing knee replacement: baseline findings from a randomized clinical trial

Background

A patient’s recovery expectations prior to knee arthroplasty influence postsurgical outcome and satisfaction but a unidimensional measure of expectation has not been reported in the literature. Our primary purpose was to determine the extent to which a patient expectations scale reflects a unidimensional construct. Our second purpose was to identify pre-operative variables associated with patients’ expectations. We hypothesized that previously identified predictors of the latent expectation scale score would be associated with expectations and that previously unexplored variables of pain catastrophizing, depressive and anxiety symptoms, self-efficacy and number of painful body regions would also associate with pre-operative expectations.

Methods

Our randomized clinical trial had 384 patients assessed prior to knee replacement surgery. The expectations scale along with several predictor variables including WOMAC, psychological distress, and sociodemographic variables were obtained. Confirmatory factor analysis tested the unidimensionality of the measure and structural equation modeling identified predictors of the latent expectations measure.

Results

The expectations scale was found to be unidimensional with superior model fit (χ2 = 1.481; df = 2; p = 0.224; RMSEA = 0.035; 90% CI = [0–0.146]; CFI = 0.999; TLI = 0.993). The only variable significantly associated with expectations in the multivariate model was self-efficacy.

Conclusions

The expectations scale used in our study demonstrated unidimensionality and has strong potential for clinical application. Poor self-efficacy is a potential target for intervention given its independent association with expectation. Addressing expectations directly and indirectly through self-efficacy assessment may assist in better aligning patient’s expectations with likely outcome.

Trial registration

ClinicalTrials.gov NCT01620983.

Esthetic Evaluation of Implant-Supported Single Crowns: The Implant Restoration Esthetic Index and Patient Perception

PURPOSE

To test the validity and reliability of a newly developed Implant Restoration Esthetic Index (IREI) and to compare esthetic outcomes reported by patients and professionals.

MATERIALS AND METHODS

Ten graduate students and 10 prosthodontists assessed esthetic outcomes of 27 single-tooth implants with the IREI. Six peri-implant soft tissue parameters were measured using visual analog scales: mesial papilla presence, distal papilla presence, gingival trigone, soft tissue curvature, alveolar process deficiency, and soft tissue color and texture, as well as the six crown parameters: crown contour, crown position, crown labial convexity, crown characterization, crown color and translucency, and abutment visibility. The validity was tested based on Pearson's correlation. The internal consistency reliability was analyzed by Cronbach's alpha. Interclass correlation coefficients (ICC) were calculated to express the test-retest reliability and the inter-rater reliability. The correlations between patient and professional evaluations were analyzed by Pearson's correlation.

RESULTS

The IREI demonstrated significant correlation (p < 0.05) to the pink esthetic score and white esthetic score (PES/WES). The internal consistency reliability showed a Cronbach's Alpha of 0.830. The test-retest reliability was excellent in both the graduate student group and the prosthodontist group, with ICCs of 0.961 and 0.952, respectively (p < 0.05). The inter-rater reliability was acceptable, with ICCs of 0.649 and 0.667, respectively (p < 0.05). Low correlation coefficients were found between patient and professional evaluations.

CONCLUSIONS

The results of this study indicated that the IREI was considered a valid and reliable index involving sufficient parameters for professional esthetic evaluation of single-tooth implant restorations. The patient-reported esthetic outcomes had poor or no significant correlation to professional-reported outcomes.

Nursing Staff's Perceptions of Quality of Care for Children in Emergency Departments-High Respect, Low Resources

PURPOSE

To describe the quality of care for children in emergency departments (ED) as perceived by the nursing staff, and to compare the quality of care for children in a pediatric ED and in a general ED and to identify care quality factors that predict nursing staff's satisfaction with pediatric care in an ED.

DESIGN AND METHODS

A cross-sectional survey study was performed using the 41-item Children Revised Humane Caring Scale (CRHCS) to collect data (n=147) from acute hospitals' pediatric EDs and general EDs in November 2015. The data were analyzed using descriptive statistics and multiple linear regression.

RESULTS

Nurses evaluated the quality of professional practice to be high. Children were treated in a respectful and friendly fashion, and received help when needed. The nurses perceived a lack of human resources in the studied EDs. Nurses in pediatric EDs gave more positive evaluations of the quality of care for children than nurses in general EDs. Positive assessments of professional practice, interdisciplinary collaboration and human resources by nursing staff predicted higher satisfaction with the quality of ED care for children.

CONCLUSIONS

The quality of children's care seemed to be higher in the pediatric ED than in the general ED. Key predictors of quality in children's care are professional practices of nursing staff, interdisciplinary collaboration and adequate human resources.

PRACTICE IMPLICATIONS

In EDs, children should be treated by nursing staff and facilities designated for them. Pediatric nursing and teamwork skills should be maintained in the training of nurses.

Longevity of fiber-reinforced composite fixed partial dentures (FRC FPD)-Systematic review

OBJECTIVES

to assess FRC FPDs longevity through systematically reviewing contemporary clinical evidence. Population investigated comprised patients requiring replacement of a single missing anterior/posterior tooth. Intervention was FRC FPDs. No control/comparison selected. Outcome was longevity of FRC FPDs. The focus question was: 'What is the longevity of FRC FPDs used to replace one anterior or posterior tooth in patients?'

DATA

Randomised, non-randomised, controlled, prospective and retrospective clinical studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were applied. The Overall Strength of Clinical Recommendation (OSCR) was assessed using the Strength of Recommendation Taxonomy system. Survival of FPDs was assessed using the Kaplan-Meier method. Analysis of FPD-survival according to location and occurrence of different failures was performed using Logrank and Chi-square testing.

SOURCES

PubMed, MEDLINE, and Web of Science databases were searched between January 2007 and December 2015.

STUDY SELECTION

Nine studies were included, involving placement of 592 FRC FPDs in 463 patients. Follow-up periods ranged between 2 months and 8 years. Kaplan-Meier overall survival probability was 94.5% (95%C.I: 92.5%-96.5%) at 4.8 years. There was no significant difference in survival probability of anterior versus posterior FRC FPDs (P=0.278). Veneering material fracture/delamination occurred significantly more than other types of failures (Ps<0.05). A meta-analysis could not be performed. OSCR was moderate.

CONCLUSIONS

FRC FPDs demonstrated high overall survival with predictable performance outcomes. However, long-term performance remains unclear.

CLINICAL SIGNIFICANCE

FRC FPDs are viable medium-term management alternatives for replacing single anterior or posterior teeth in patients.

Meta-analysis: complex relationships between patient satisfaction, age and item-level response rate

Causality of the relationship between the objective quality outcomes of care and patient satisfaction has been questioned in many studies. Consequently, it is highly important to study potential confounders in order to improve reliability and validity of patient satisfaction surveys and enable comparisons between objective and subjective outcomes. This study aimed to test the effect of item-level response rate on the results of patient satisfaction surveys and its interaction with another potential confounding factor, patient age. The data included 39 surveys with balanced Likert-scale items. The surveys were systematically gathered from PubMed and had been published 2005–2014. The relationship between the item-level patient satisfaction and item-level response rate was almost without exception positive when the overall patient satisfaction was >4.2 on a traditional 1–5 scale and patients were middle-aged or older. The meta-analysis demonstrated that the relationship between item-level patient satisfaction and item-level response rate is situational, and generalisations regarding the size of the correlation should be made with caution. Controlling for item-level response rate and patient age, simultaneously, is necessary to improve validity of patient satisfaction surveys. The present study calls for novel age-specific approaches to deal with missing data.

The Universal Patient Centeredness Questionnaire: scaling approaches to reduce positive skew

PURPOSE

Surveys of patients' experiences typically show results that are indicative of positive experiences. Unbalanced response scales have reduced positive skew for responses to items within the Universal Patient Centeredness Questionnaire (UPC-Q). The objective of this study was to compare the unbalanced response scale with another unbalanced approach to scaling to assess whether the positive skew might be further reduced.

PATIENTS AND METHODS

The UPC-Q was included in a patient experience survey conducted at the ward level at six hospitals in Norway in 2015. The postal survey included two reminders to nonrespondents. For patients in the first month of inclusion, UPC-Q items had standard scaling: poor, fairly good, good, very good, and excellent. For patients in the second month, the scaling was more positive: poor, good, very good, exceptionally good, and excellent. The effect of scaling on UPC-Q scores was tested with independent samples t-tests and multilevel linear regression analysis, the latter controlling for the hierarchical structure of data and known predictors of patient-reported experiences.

RESULTS

The response rate was 54.6% (n=4,970). Significantly lower scores were found for all items of the more positively worded scale: UPC-Q total score difference was 7.9 (P<0.001), on a scale from 0 to 100 where 100 is the best possible score. Differences between the four items of the UPC-Q ranged from 7.1 (P<0.001) to 10.4 (P<0.001). Multivariate multilevel regression analysis confirmed the difference between the response groups, after controlling for other background variables; UPC-Q total score difference estimate was 8.3 (P<0.001).

CONCLUSION

The more positively worded scaling significantly lowered the mean scores, potentially increasing the sensitivity of the UPC-Q to identify differences over time and between providers. However, none of the groups exhibited large positive skew and ceiling effects, implying that such effects might not be a big measurement problem for either scaling format. We recommend using the standard scaling in surveys producing external indicators for inter-provider comparisons. The more positively worded scaling has greater relevance for local measurement work where the results of patient experience surveys have shown large positive skew, and intra-provider comparison is the primary goal.