1
|
Hadler RA, Weeks S, He Y, Fraer M, Dexter F. Dignity-related distress and recall among alert, non-delirious critically ill patients. Palliat Support Care 2024:1-5. [PMID: 38736418 DOI: 10.1017/s1478951524000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Critical illness is associated with multiple undesired impacts, including residual psychological distress, frequently associated with recollections of critical illness. Dignity-related distress is highly prevalent among the one-fifth of critically ill patients who are alert. The distress may be associated with unpleasant recollections of care. We examined whether patients at risk for dignity-related distress had recall of their reported distress approximately 1 week after assessment and whether this recall differed from another high-risk group, specifically patients undergoing dialysis for end-stage renal disease. METHODS The prospective cohort study included patients with critical illness and patients with end-stage renal disease enrolled from intensive care units (ICUs) and dialysis units at 1 academic center. Distress was assessed using the Patient Dignity Inventory (PDI). Participants received in-patient or telephonic follow-up 7-10 days after the initial interaction. Follow-up encounters focused on recollection of key aspects of the interpersonal interaction as well as the content of the PDI. RESULTS A total of 32 critically ill patients participated in initial assessment and follow-up. In total, 26 dialysis patients participated in both phases. The groups' demographics differed. Fifty percent (n = 16) of critically ill patients and 58% (n = 15) of dialysis patients reported a mean score per item of >1.6, corresponding with severe distress on the PDI. Among the ICU patients, the 95% upper 2-sided confidence interval for the median level of recall was commensurate with the participant having had no recall of the initial interview beyond remembering that there was an interview. The end-stage renal disease group did not demonstrate significantly better recall. SIGNIFICANCE OF RESULTS Dignity-related distress is high in both critically ill patients and those with end-stage renal disease; however, recollection of assessment is poor in both groups. Any intervention designed to mitigate dignity-related distress will need either to be immediately deployable or not to be reliant upon recollection for impact.
Collapse
Affiliation(s)
- Rachel A Hadler
- Department of Anesthesiology, Emory University, Atlanta, GA, USA
- Emory Critical Care Center, Emory University, Atlanta, GA, USA
- Department of Geriatrics and Extended Care, Division of Palliative Medicine, Atlanta VA Medical Center, Decatur, GA, USA
| | - Seth Weeks
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Yifan He
- Department of Anesthesiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mony Fraer
- Division of Nephrology, Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Franklin Dexter
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
2
|
Moritz NMP, Moritz JE, Parma GOC, Dexter F, Traebert J. Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744471. [PMID: 37952775 PMCID: PMC11148495 DOI: 10.1016/j.bjane.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The Iowa Satisfaction with Anesthesia Scale (ISAS) was developed to assess the satisfaction of patients undergoing sedation with monitored anesthesia care. This study aimed to cross-culturally adapt the ISAS instrument and evaluate the acceptability, validity, and reliability of the proposed Brazilian version (ISAS-Br). METHODS The cross-cultural adaptation process involved translation, synthesis, back-translation, expert committee review, pre-testing, and final review of the ISAS-Br. A cross-sectional study was conducted, involving 127 adult individuals undergoing ambulatory surgeries with moderate/deep sedation. The acceptability, reliability, and construct validity of the scale were assessed. RESULTS The cross-cultural adaptation process did not require significant changes to the final version of the scale. The ISAS-Br demonstrated excellent acceptability, with a completion rate of 99% and an average completion time of 4.6 minutes. Exploratory factor analysis revealed three factors: emotional well-being, physical comfort, and anxiety relief, with respective composite reliability coefficient values of 0.874, 0.580, and 0.428. The test-retest reliability of the ISAS-Br, measured by the intraclass correlation coefficient, was 0.67 (95% confidence interval [95% CI] 0.42 to 0.83), and the Bland-Altman plot showed satisfactory agreement between the measurements. CONCLUSION The proposed Brazilian version of the ISAS underwent successful cross-cultural adaptation according to international standards. It demonstrated good acceptability and reliability, regarding the assessment of temporal stability. However, the ISAS-Br exhibited low internal consistency for some factors, indicating that this instrument lacks sensitivity to assess the satisfaction of deeply sedated patients. Further studies are necessary to explore the hypotheses raised based on the knowledge of its psychometric properties.
Collapse
Affiliation(s)
- Nicole Morem Pilau Moritz
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Palhoça, SC, Brazil; Hospital Universitário da Universidade Federal de Santa Catarina, Departamento de Anestesia, Florianópolis, SC, Brazil.
| | | | | | - Franklin Dexter
- University of Iowa, Department of Anesthesia, Iowa City, United States of America
| | - Jefferson Traebert
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Palhoça, SC, Brazil
| |
Collapse
|
3
|
Amato CA, White NW, Tio JD, Rodriguez W, Matullo KS. Postoperative Instruction Retention, Written Versus Audiovisual Adjuncts: A Prospective Randomized Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:146-150. [PMID: 38903830 PMCID: PMC11185882 DOI: 10.1016/j.jhsg.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/19/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose Adherence to postoperative protocols is an integral perioperative intervention that impacts surgical outcomes. The focus of this study was to identify the baseline postoperative instruction retention of our traditional written format and compare that with the retention when using an audiovisual adjunct. We hypothesize that the addition of audiovisual adjuncts would result in greater patient retention of their postoperative instructions. Methods Sixty consecutive adult patients undergoing soft tissue procedures of the hand and wrist were enrolled prospectively at a single institution. Patients were randomized to receive postoperative instructions with either a written or an audiovisual adjunct format. Two days after surgery, a blinded investigator contacted the participants to administer a standardized phone questionnaire. Responses were recorded, and the data were analyzed by another blinded team member. Analysis was performed using χ 2 and Student t tests as appropriate. Results Fifty patients were included in the final analysis. The written group scored an average retention of 80%, whereas the audiovisual group showed a retention score of 85%. Demographic analysis of men versus women, and patients <60 versus >60 years of age did not demonstrate significant score differences. The subgroup analysis of patients receiving local anesthesia alone demonstrated significantly higher rates of percent correct and perfect recall in the audiovisual compared with the written-only group (87.5 vs 80.5 and 44% vs 7%, respectively). Conclusions For patients undergoing common soft tissue procedures of the hand, the addition of audiovisual supplementation to written instructions, especially in those undergoing wide awake, local anesthesia, no tourniquet procedures, is associated with higher rates of retention of a patient's postoperative instructions. The specific improvement in the local anesthesia cohort is especially relevant today due to an increased prevalence of wide awake, local anesthesia, no tourniquet style procedures, and the increasing reliance on patient engagement in postoperative care. Type of study/level of evidence Randomized control trial; Diagnostic Level 2b.
Collapse
Affiliation(s)
- Chad A. Amato
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - Nathan W. White
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - Juan D. Tio
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - William Rodriguez
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - Kristofer S. Matullo
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| |
Collapse
|
4
|
Eom Y, Koh E, Lee DH, Lee SJ, Nam DH. Comparison of patient experiences and clinical outcomes between an illuminated chopper and a conventional chopper under a surgical microscope. J Cataract Refract Surg 2023; 49:1036-1042. [PMID: 37440456 DOI: 10.1097/j.jcrs.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To compare patient experiences and cooperation and the clinical outcomes illuminated chopper vs conventional chopper during cataract surgery. SETTING 4 tertiary institutions in Korea. DESIGN Prospective, randomized, paired-eye, controlled pilot study. METHODS 152 eyes of 76 patients who underwent bilateral cataract surgeries were enrolled in this study. The surgical method was randomly assigned to each patient's eye (1 eye using the illuminated chopper with a light source and the other using the conventional chopper under the microscope light). Patient suffering scores (the degree of strong light perception, glare, inability to fixate, anxiety, discomfort, and fear) from 0 to 10 (10 being the most severe level); cooperation score from 0 to 3 (3 being the best cooperation); operating time; and corneal endothelial cell density (ECD) preoperatively and postoperatively were compared between the 2 groups. RESULTS The mean patient suffering score of all 6 parameters in the iChopper group was significantly smaller than those in the control group (all P < .05). The mean patient cooperation score of the iChopper group (2.3 ± 0.8) was significantly greater than that of the control (1.6 ± 0.9; P < .001). There was no significant difference in the mean operating time and corneal ECD at each visit between the groups, albeit the mean corneal ECD was significantly decreased from baseline to 1 month after cataract surgery in both groups. CONCLUSIONS Phacoemulsification using the illuminated chopper provides less glare and anxiety and better cooperation during cataract surgery without increasing the operating time and damaging corneal endothelium compared with the conventional chopper.
Collapse
Affiliation(s)
- Youngsub Eom
- From the Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, South Korea (Eom); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Eom); Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia (Eom); Medical College of Georgia, Augusta University, Augusta, Georgia (Koh); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea (S.J. Lee); Department of Ophthalmology, Gachon University Gil Hospital, Gachon University College of Medicine, Incheon, South Korea (Nam)
| | | | | | | | | |
Collapse
|
5
|
David AC, Pereira K, Hartman E, Dear G, Thompson J, Funk E. Improving Nursing Knowledge and Patient Education about Aprepitant's Effects on Hormonal Contraception: A Performance Improvement Project. J Perianesth Nurs 2023:S1089-9472(22)00515-9. [PMID: 36599790 DOI: 10.1016/j.jopan.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this project was to improve the consistency of verbal and written discharge instructions for women of childbearing age (13-55 years) taking hormonal contraceptives who receive aprepitant perioperatively, to address the need to use a secondary form of birth control for 28 days, as well as to increase the knowledge and confidence of Registered Nurses when providing discharge instructions. DESIGN This quality improvement project used a pre/post design to evaluate two separate groups of patients and registered nurses. METHODS The patient sample consisted of 30 total women of childbearing age who received aprepitant during the perioperative period (15 pre and 15 post). The PACU nurse sample included 15 ambulatory surgery center nurses and 58 main hospital nurses for a combined sample of 73 PACU nurses. The PACU nurses were provided with educational in-service regarding information about aprepitant and its drug interactions. PACU nurses were additionally instructed to provide patient discharge instructions using both a written and verbal format. Patients were called postoperatively before and after both the written after visit summary (AVS) changes and the PACU nurse in-services, PACU nurses were evaluated on their knowledge, confidence, and frequency of discharge teaching before and after their educational in-service. The PACU nurses were surveyed 90 days after the intervention to assess their long-term knowledge retention. FINDINGS There was a significant increase in nurse knowledge about aprepitant from preimplementation to postimplementation (61.39% vs 81.95%, P < .001). Nursing knowledge showed a non-significant decline at 90-days postimplementation (81.95% vs 73.68%, P = .096) although remained significantly higher than preimplementation scores (73.68% vs 61.39%, P = .003). There was an overall 33.3% increase in the percentage of patients who were able to recall receiving aprepitant and the need to use a secondary form of birth control when comparing the preintervention group to the postintervention group (26.7% vs 60%, P = .123). CONCLUSIONS The findings suggest that providing a standardized presentation about aprepitant may improve the PACU nurses' ability to verbalize key information about aprepitant, including the need for patients to use a secondary form of birth control. This increase in nursing knowledge and confidence, along with improved written discharge instructions, may have led to improved patient comprehension of aprepitant discharge education. Additionally, there was an increase in the percentage of patients who were able to recall the need to use a secondary form birth control for 28 days, to reduce the likelihood of an unintentional pregnancy.
Collapse
Affiliation(s)
| | | | | | - Guy Dear
- Duke University Medical Center, Durham, NC
| | | | - Emily Funk
- Duke University School of Nursing, Durham, NC; Duke University Medical Center, Durham, NC.
| |
Collapse
|
6
|
Kwak SK, Kim J. Transparency considerations for describing statistical analyses in research. Korean J Anesthesiol 2021; 74:488-495. [PMID: 34784456 PMCID: PMC8648514 DOI: 10.4097/kja.21203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022] Open
Abstract
Researchers who use the results of statistical analyses to draw conclusions about collected data must write a statistical analysis section in their manuscript. Describing statistical analyses in precise detail is as important as presenting the dosages of drugs and methodology of interventions. It is also essential for scientific accuracy and transparency in scientific research. We evaluated the quality of the statistical analysis sections of clinical research articles published in the Korean Journal of Anesthesiology between February 2020 and February 2021. Using a Likert scale where 1, 2, and 3 represented “not described at all,” “partially described,” and “fully described,” respectively, the following 6 items were assessed: 1) stating of the statistical analysis methods used, 2) rationale for and detailed description of the statistical analysis methods used, 3) parameters derived from the statistical analyses, 4) type and version of the statistical software package used, 5) significance level, and 6) sidedness of the test (one-sided vs. two-sided). The first 3 items evaluate issues directly related to the statistical analysis methods used and last 3 are indirectly related items. In all the included articles, the statistical analysis methods used were stated (score of 3). However, only 4 articles (12.9%) fully described the sidedness of the test (score of 3). Authors tend not to describe the sidedness of statistical analysis tests in the methodology section of clinical research articles. It is essential that the sidedness be described in research studies.
Collapse
Affiliation(s)
- Sang Kyu Kwak
- Department of Medical Statistics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jonghae Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| |
Collapse
|
7
|
Chua GCC, Cyna AM. Satisfaction measures in pediatric anesthesia and perioperative care. Paediatr Anaesth 2021; 31:746-754. [PMID: 33899988 DOI: 10.1111/pan.14197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/21/2021] [Accepted: 04/15/2021] [Indexed: 12/20/2022]
Abstract
Patient satisfaction is routinely used to assess the quality of care in medicine. In the field of anesthesia, research has been primarily directed toward developing satisfaction measures in adults with little attention paid to the pediatric population. Satisfaction in pediatric anesthesia and perioperative care is poorly understood. We have identified existing satisfaction measures in pediatric perioperative care and examined their similarities and differences. A search of relevant published trials up to January 2021 identified 17 studies using 14 unique satisfaction measures of perioperative care in children. Eleven of these assessed satisfaction multidimensionally while three assessed overall satisfaction of parents with their child's anesthesia. Of the six dimensions of satisfaction identified, all were duplicated to some degree across studies. The dimensions were: "staff rapport and communication" and "anesthetic and nursing quality of care" in eight satisfaction measures; "information giving" in seven measures; "postoperative symptom control" in six; "hospital experience" in five; and "involvement in decision-making" in three. The most important items from the parents' perspective were: "staff rapport and communication;" "information giving;" and "decision-making". No study examined all dimensions of satisfaction. Although all studies questioned parents, only three asked satisfaction questions of the child. No study was analyzed the child's direct responses. In three studies, parental involvement in decision-making was reported to be important as a satisfaction measure of their child's perioperative care. Of the few existing satisfaction measures evaluated, there is no accepted standard in current practice. Future studies identifying the important determinants of satisfaction in pediatric perioperative care, perhaps also using a Delphi approach with parents, might allow for the development of a patient-focused standardized measure in this setting.
Collapse
Affiliation(s)
- Graham C C Chua
- The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Allan M Cyna
- Department of Children's Anaesthesia, Women's and Children's Hospital, North Adelaide, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide Health Sciences, Adelaide, SA, Australia
| |
Collapse
|
8
|
Falempin AS, Pereira B, Gonnu-Levallois S, de Chazeron I, Dexter F, Bazin JÉ, Dualé C. Transcultural validation of a French version of the Iowa Satisfaction with Anesthesia Scale (ISAS-F). Can J Anaesth 2020; 67:541-549. [PMID: 31898775 DOI: 10.1007/s12630-019-01563-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE We sought to validate a French translation of the Iowa Satisfaction with Anesthesia Scale (ISAS), a tool to assess the patient's satisfaction with monitored anesthesia care for surgery. The ISAS tool is particularly pertinent as surgery with monitored anesthesia care is increasingly used in ambulatory surgery settings. METHODS We studied content validity, internal consistency, convergent validity (vs physician-estimated satisfaction), and test-retest reliability of the French version of the ISAS (ISAS-F) in 122 adult patients undergoing a brief outpatient invasive procedure under conscious sedation. The ISAS-F was answered twice by the patient, once in the postanesthesia care unit and once before discharge from the ambulatory care unit. RESULTS The median [interquartile range (IQR)] time of completion at the first assessment was 2 [2-4] min. The total median [IQR] ISAS-F score was 2.3 [1.8-2.7]. Internal consistency of the ISAS-F was found to be good (Cronbach's α = 0.68). Test-retest reliability was significant, with an intra-class correlation coefficient at 0.74 (95% confidence interval [CI], 0.63 to 0.85). The ISAS-F score correlated with the physician-estimated satisfaction score, with an intra-class correlation coefficient of 0.28 (95% CI, 0.12 to 0.44; P = 0.01). DISCUSSION This validated version of the ISAS can now be used by French-speaking researchers and physicians to assess patient satisfaction with the anesthesia technique.
Collapse
Affiliation(s)
| | - Bruno Pereira
- Direction de la Recherche Clinique et des Innovations, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Franklin Dexter
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - Jean-Étienne Bazin
- Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Christian Dualé
- Centre de Pharmacologie Clinique (INSERM CIC1405), CHU de Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex 1, France.
| |
Collapse
|