Margaret Daly

Comparative study of electronic vs. paper VAS ratings: a randomized, crossover trial using healthy volunteers

&NA; The visual analogue scale (VAS) is an established, validated, self‐report measure usually consisting of a 10 cm line on paper with verbal anchors labeling the ends. Palmtop computers (PTCs also known as personal digital appliances) have incorporated VAS entry by use of a touch screen. However, the validity and psychophysical properties of the electronic VAS have never been formally compared with the conventional paper VAS. The aim of this study is to determine the agreement between the electronic (eVAS) and paper (pVAS) modes. Twenty‐four healthy volunteers were recruited for this study. Each study participant provided input using both measurement methods by marking the eVAS and pVAS in response to two kinds of stimuli, cognitive and sensory. A verbal rating scale of seven descriptors of intensity represented the cognitive stimuli. Participants were asked to mark the location that best corresponded to the pain intensity described by each word on scales from ‘no pain’ to ‘worst possible pain’. The sensory stimuli used were a set of test weights consisting of plastic containers ranging from 7 to 129 g. The VAS for sensory stimuli ranged from 0 (no weight) to ‘reference weight’ (the heaviest weight outside the range of test weights). There were two types of input stimuli and two modes for recording responses for a total of four experimental conditions. Two evaluators independently measured and recorded all the pVAS forms to the nearest millimeter. A total of 2016 stimuli were rated. The overall correlation for ratings of both sensory and cognitive stimuli on eVAS and pVAS was r=0.91. For paired verbal stimuli the correlation was r=0.97. For paired sensory stimuli the correlation was r=0.86. The correlation between group eVAS and pVAS ratings to common verbal stimuli was r=0.99. For common sensory stimuli the group correlation was r=0.99. The median of correlations comparing eVAS and pVAS ratings was 0.99 for verbal stimuli and 0.98 for sensory stimuli. Multivariate analyses showed equivalent stimuli to be rated much the same whether entered on paper VAS or PTC touch screen VAS (P<0.0001). Support was found for the validity of the computer version of the VAS scale.

Assessment of postoperative pain management: patient satisfaction and perceived helpfulness.

OBJECTIVE Increasing attention has been given to the assessment of patient satisfaction as a way to monitor quality of care in hospital settings. Postoperative patient satisfaction has been thought to be related to level of pain intensity, expectations of outcome, perceived concern by the staff, and helpfulness of treatments. The aim of this study is to develop a simple, reliable measure to assess pain and satisfaction in postsurgical patients and to examine factors related to patient satisfaction. DESIGN A satisfaction questionnaire was developed for this study and administered to 119 patients who had undergone a major orthopedic surgical procedure. The majority of the patients were diagnosed with osteoarthritis and reported moderate to severe preoperative pain. The 13-item measure was found to be reliable (test-retest r = .86; interexaminer r = .98), valid (exploratory factor analyses; intercorrelations), and easy to administer. RESULTS Results showed that the majority of the patients were satisfied with their care (91%), postoperative pain intensity (94%), and the way they were treated by the physicians and nurses (98%). Patients with low postoperative pain ratings who perceived that the physicians and nurses showed concern with how much pain they were feeling reported greatest satisfaction with their care (p < .001). In general, lower postoperative pain ratings were the best predictors of satisfaction and helpfulness of treatment. Preoperative pain status, expected level of postoperative pain, and time waiting for pain medication after a request was made were not significantly correlated with ratings of postoperative pain or satisfaction. CONCLUSIONS These results highlight the important influence of adequate treatment of postoperative pain and perceived concern by the hospital staff on patient satisfaction.

Recurrence of myomas after myomectomy in women pretreated with leuprolide acetate depot or placebo

The recurrence of myomas and myoma-related symptoms was evaluated in women participating in a randomized, double-blind, P-controlled study of the efficacy of LA depot before myomectomy. After 27 to 38 months of follow-up, the recurrence of myomas was found to be greater when at least four myomas were resected. Myoma recurrence was not associated with pretreatment or preoperative uterine volume, resected myoma mass, or preoperative medical therapy.

Predictors of uterine volume reduction in women with myomas treated with a gonadotropin-releasing hormone agonist*

A retrospective analysis of 104 women with leiomyomata uteri treated with LA for at least 12 weeks demonstrated a negative correlation between the percent reduction in uterine volume and serum E2 concentration at treatment week 12. The patients age, height, or pretreatment uterine volume were not correlated with the degree of uterine shrinkage.

RENAL 1,25‐DIHYDROXYVITAMIN D, PHOSPHATURIC, AND CYCLIC‐AMP RESPONSES TO INTRAVENOUS SYNTHETIC HUMAN PARATHYROID HORMONE‐(1‐34) ADMINISTRATION IN NORMAL SUBJECTS

The exogenous administration of bovine parathyroid hormone or parathyroid extract has been used to differentiate states of parathyroid hormone resistance and parathyroid gland secretory failure, and in recent years to test renal 1,25‐dihydroxyvitamin D (1,25‐(OH)2‐D) secretion. We evaluated the effect of synthetic human parathyroid hormone (hPTH‐(1–34)) administration on the renal 1,25‐(OH)2‐D, phosphaturic and cyclic‐AMP responses in eleven normal young adults. The intravenous administration of 200 units of hPTH‐(1–34) over 10 min produced a 1.3‐5.4 fold increase (P <0.01) in renal phosphate clearance and a 19–75 fold increase (P < 0.0001) in urinary cyclic‐AMP excretion. Serum 1,25‐(OH)2‐D levels showed a small and insignificant change at 2‐5 h and a significant (P <0.05) but small (21 ± 24 pmol/1) increase at 7 h after the first injection. In eight subjects a second injection of hPTH‐(1–34) was given at 7 h. In these individuals serum 1,25‐(OH)2‐D levels at 24 h were 40 ± 14 pmol/1 (44%) higher than baseline (P <0.01), but were variable over the 24 h period. The present study shows that hPTH‐(1–34) produces renal phosphaturic and cyclic‐AMP responses in normals similar to those produced by bovine PTH preparations. However, the serum 1,25‐(OH)2‐D response to one or two intravenous injections of hPTH‐(1–34) is small, variable, and inconsistent and, therefore, will not provide a consistent way of stimulating renal 1,25‐(OH)2‐D secretion.