Jan Hb Geertzen

Discomfort and factual recollection in intensive care unit patients

IntroductionA stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU stay. This study addresses the following questions. What is the incidence of discomfort reported by patients recently discharged from an ICU? What were the sources of discomfort reported? What was the degree of factual recollection during patients stay in the ICU? Finally, was discomfort reported more often in patients with good factual recollection?MethodsAll ICU patients older than 18 years who had needed prolonged (>24 hour) admission with tracheal intubation and mechanical ventilation were consecutively included. Within three days after discharge from the ICU, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete a questionnaire consisting of 14 questions specifically concerning the environment of the ICU they had stayed in. Furthermore, they were asked whether they remembered any discomfort during their stay; if they did then they were asked to specify which sources of discomfort they could recall. A reference group of surgical ward patients, matched by sex and age to the ICU group, was studied to validate the questionnaire.ResultsA total of 125 patients discharged from the ICU were included in this study. Data for 123 ICU patients and 48 surgical ward patients were analyzed. The prevalence of recollection of any type of discomfort in the ICU patients was 54% (n = 66). These 66 patients were asked to identify the sources of discomfort, and presence of an endotracheal tube, hallucinations and medical activities were identified as such sources. The median (min–max) score for factual recollection in the ICU patients was 15 (0–28). The median (min–max) score for factual recollection in the reference group was 25 (19–28). Analysis revealed that discomfort was positively related to factual recollection (odds ratio 1.1; P < 0.001), especially discomfort caused by the presence of an endotracheal tube, medical activities and noise. Hallucinations were reported more often with increasing age. Pain as a source of discomfort was predominantly reported by younger patients.ConclusionAmong postdischarge ICU patients, 54% recalled discomfort. However, memory was often impaired: the median factual recollection score of ICU patients was significantly lower than that of matched control patients. The presence of an endotracheal tube, hallucinations and medical activities were most frequently reported as sources of discomfort. Patients with a higher factual recollection score were at greater risk for remembering the stressful presence of an endotracheal tube, medical activities and noise. Younger patients were more likely to report pain as a source of discomfort.

Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study

Objective: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. Design: A long-term follow-up study of upper extremity RSD patients. Setting: A university hospital. Subjects: Sixty-five patients, 3–9 years (mean interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). Main outcome measures: Impairments: range of motion, moving two point discrimination, muscle strength of the hand and pain were measured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social functioning, role limitations due to physical problems and role limitations due to emotional problems) of the RAND-36. Results: After RSD of the upper extremity, 62% of the patients are limited in activities of daily living (ADL) and/or instrumental ADL (IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strength are the most important impairments limiting ADL and IADL. Patients with limitations in ADL and IADL are significantly more handicapped than patients without limitations. Pain is the most important factor contributing to handicap. Conclusion: The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disability and handicap.

Skin problems in lower limb amputees: an overview by case reports

The stump in lower limb amputees is prone to skin problems because it is exposed to several unnatural conditions (shear and stress forces and increased humidity) when a prosthesis is used. This study reviews the literature on case reports of lower limb amputees with skin problems on the stump. In total, 56 reports comprising 76 cases were identified in the literature. The main disorders are acroangiodermatitis, allergic contact dermatitis, bullous diseases, epidermal hyperplasia, hyperhidrosis, infections, malignancies and ulcerations.

Neck Pain and Disability Scale and Neck Disability Index: validity of Dutch language versions

PurposeTo investigate the validity of the Neck Pain and Disability Scale Dutch Language Version (NPAD-DLV) and the Neck Disability Index (NDI)-DLV.MethodsNPAD–DLV, NDI–DLV, Short-Form-36 Health Survey (SF-36)-DLV, visual analog scale (VAS)pain and VASdisability were administered to 112 patients with non-specific chronic neck pain in an outpatient tertiary rehabilitation setting. Twenty seven hypotheses were formulated regarding validity. NPAD–DLV and NDI–DLV were evaluated for content validity (normal distribution total scores, missing items, floor and ceiling effects), internal consistency (Cronbach’s alpha and Spearman Item–total correlations), construct validity (Pearson correlations with SF-36 domains, VASpain and VASdisability and Pearson correlation between total scores of NPAD–DLV and NDI–DLV).ResultsNPAD–DLV and NDI–DLV scores were distributed normally. Missing items were negligible. Floor and ceiling effects were absent in NPAD–DLV and in NDI–DLV two items had floor effects and one item had a ceiling effect. Cronbach’s alpha of NPAD–DLV was 0.93 and of NDI–DLV 0.83. Item–total correlations ranged for NPAD–DLV from 0.45 to 0.73 and for NDI–DLV from 0.40 to 0.64. The correlation between, respectively, NPAD–DLV and NDI–DLV and: SF-36 domains ranged from −0.36 to −0.70 and from −0.34 to −0.63; VASpain was 0.54 and 0.43; VASdisability was 0.57 and 0.52. The correlation between the total scores of NPAD–DLV and NDI–DLV was 0.77. Twenty six hypotheses were not rejected and one hypothesis was rejected.ConclusionThe NPAD–DLV and NDI–DLV are valid measures of self-reported neck-pain related disability.

Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands

Objective: To describe characteristics of hip disarticulation and hemipelvectomy amputees, to assess their level of activities, participation and experienced limitations in mobility and to describe the amputation-related problems. Design: A cross-sectional study. Setting: Patients were mainly recruited via orthopaedic workshops in the Netherlands. Subjects: Forty-six patients with an acquired unilateral hip disarticulation or hemipelvectomy at least one year post amputation. Main outcome measures: Sickness Impact Profile 68 (SIP 68) to assess the level of activity and participation and the questionnaire Rising and Sitting Down, Walking and Climbing Stairs to assess perceived limitations in mobility. Results: The 46 patients (31 with hip disarticulation and 15 with hemipelvectomy) had a mean age of 55.8 years (SD 12.1). In 78% of cases the reason for amputation was a tumour. Mean SIP 68 was low, 10.5 (SD 6.9). Hip disarticulation amputees had significantly poorer emotional stability than the hemipelvectomy amputees (P = 0.04). All amputees experienced considerable limitations in their mobility according to the Rising and Sitting Down, Walking and Climbing Stairs scores. Conclusions: Hip disarticulation and hemipelvectomy amputees have a relatively high level of activity and participation (SIP scores) but at the same time experience limitations in walking, rising and sitting down and climbing stairs.

Construct validity of functional capacity tests in healthy workers

BackgroundFunctional Capacity (FC) is a multidimensional construct within the activity domain of the International Classification of Functioning, Disability and Health framework (ICF). Functional capacity evaluations (FCEs) are assessments of work-related FC. The extent to which these work-related FC tests are associated to bio-, psycho-, or social factors is unknown. The aims of this study were to test relationships between FC tests and other ICF factors in a sample of healthy workers, and to determine the amount of statistical variance in FC tests that can be explained by these factors.MethodsA cross sectional study. The sample was comprised of 403 healthy workers who completed material handling FC tests (lifting low, overhead lifting, and carrying) and static work FC tests (overhead working and standing forward bend). The explainable variables were; six muscle strength tests; aerobic capacity test; and questionnaires regarding personal factors (age, gender, body height, body weight, and education), psychological factors (mental health, vitality, and general health perceptions), and social factors (perception of work, physical workloads, sport-, leisure time-, and work-index). A priori construct validity hypotheses were formulated and analyzed by means of correlation coefficients and regression analyses.ResultsModerate correlations were detected between material handling FC tests and muscle strength, gender, body weight, and body height. As for static work FC tests; overhead working correlated fair with aerobic capacity and handgrip strength, and low with the sport-index and perception of work. For standing forward bend FC test, all hypotheses were rejected. The regression model revealed that 61% to 62% of material handling FC tests were explained by physical factors. Five to 15% of static work FC tests were explained by physical and social factors.ConclusionsThe current study revealed that, in a sample of healthy workers, material handling FC tests were related to physical factors but not to the psychosocial factors measured in this study. The construct of static work FC tests remained largely unexplained.

Hoofdstuk 10 Amputatie en prothesiologie van de onderste extremiteit

Het amputeren van een voet, onderbeen of bovenbeen is voor veel chirurgen een teleurstellende ingreep, omdat de amputatie gezien wordt als het resultaat van (eigen) medische falen. Voor veel patienten met een vasculaire aandoening en soms ook met een oncologische aandoening, betekent een amputatie afscheid nemen van (een deel van) het been, maar ook afscheid nemen van een leefpatroon met veel pijn en problemen.