Sylvie Le May

Patient satisfaction with anesthesia services.

Purpose: The evaluation of services by patients is an essential component of continuous quality improvement in anesthesiology. Little is known, however, about how to achieve this objective. Our goal was to conduct a systematic review of all available studies on patient satisfaction with anesthesia services, thereby ascertaining the present level of knowledge in this field and suggesting ways of improving current measurement methodologies.Source: We reviewed relevant major data banks - Medline, Dissertation Abstract, Psyclit and Cochrane -between 1980 and 2000 and bibliographies from primary sources. We used the following keywords for our search: quality improvement, anesthesia, quality, patient perceptions, consumer satisfaction, continuous quality improvement, outcome measures.Principal findings: The review yielded 14 pertinent studies. Studies were divided into two groups (A & B), according to the quality of the psychometric evaluation (tests performed to verify the reliability and validity of an instrument). While all studies reported high levels of patient satisfaction with anesthesia services, many used methods of questionable value. None of the 14 studies controlled for any confounding variables, such as social desirability. Four studies had seriously biased their data collection and the majority of the studies lacked rigour in the development of the instrument used to measure patient satisfaction. Only one study presented a definition of the concept measured, and none provided a conceptual model of patients’ satisfaction with anesthesia services.Conclusion: The currently available studies of patient satisfaction are of questionable value. Only rigorous methods and reliable instruments will yield valid and clinically relevant findings of this important issue in anesthesiology.RésuméObjectif: L’évaluation de la qualité des services, par les patients, est une composante essentielle de l’amélioration de la qualité des services en anesthésiologie. Cependant, nos connaissances dans ce domaine sont limitées. Nous proposons une évaluation systématique de la littérature sur ce sujet dans le but d’améliorer la méthodologie reliée à la mesure de ce concept.Source des références: Nous avons procédé à une revue systématique de plusieurs banques de données -Medline, Dissertation Abstract, Psyclit, et Cochrane - pour la période de 1980 à 2000 ainsi que les bibliographies des références primaires. Les mots-clés suivants ont été utilisés: amélioration de la qualité, anesthésie, qualité, perceptions des patients, satisfaction de la clientèle, amélioration continue de la qualité, mesure des résultats.Principaux résultats: La revue systématique de la littérature a permis de recenser 14 études pertinentes. Elles ont été divisées en deux groupes (A & B) selon la qualité de l’évaluation psychométrique (vérification de la fidélité et de la validité des instruments). Toutes ces études présentent des taux élevés de satisfaction des patients à l’égard des services anesthésiques. Cependant, les méthodes choisies pour l’évaluation de la satisfaction des patients présentent des biais importants. Aucune de ces études n’a présenté de moyens de contrôle des variables confondantes telles que la désirabilité sociale. Il y a présence de biais dans la collecte de données de quatre études et la majorité démontre peu de rigueur dans le développement de l’instrument utilisé. Une seule étude a fourni une définition du concept mesuré et aucune n’a proposé de cadre conceptuel.Conclusion: Les études publiées à ce jour sur la satisfaction des patients sont d’une valeur douteuse. Il est essentiel d’employer des méthodes rigoureuses ainsi que des instruments fiables, afin de générer des résultats valides et cliniquement pertinents sur ce domaine important en anesthésiologie.

Prevalence and Management of Back Pain in Adolescent Idiopathic Scoliosis Patients: A Retrospective Study

Back pain is significantly more common among adults compared with children; however, it still represents an important issue in the pediatric population, and back pain in childhood is a predictor for back pain in adulthood. One potential predictor of back pain in childhood is adolescent idiopathic scoliosis. The authors of this article conducted a retrospective chart review involving 310 patients with adolescent idiopathic scoliosis. The prevalence of back pain and management of the pain/scoliosis were assessed, as well as the relationship between the severity of scoliosis and intensity of the pain.

Braces Optimized With Computer-Assisted Design and Simulations Are Lighter, More Comfortable, and More Efficient Than Plaster-Cast Braces for the Treatment of Adolescent Idiopathic Scoliosis

STUDY DESIGN Feasibility study to compare the effectiveness of 2 brace design and fabrication methods for treatment of adolescent idiopathic scoliosis: a standard plaster-cast method and a computational method combining computer-aided design and fabrication and finite element simulation. OBJECTIVES To improve brace design using a new brace design method. SUMMARY OF BACKGROUND DATA Initial in-brace correction and patients compliance to treatment are important factors for brace efficiency. Negative cosmetic appearance and functional discomfort resulting from pressure points, humidity, and restriction of movement can cause poor compliance with the prescribed wearing schedule. METHODS A total of 15 consecutive patients with brace prescription were recruited. Two braces were designed and fabricated for each patient: a standard thoracolumbo-sacral orthosis brace fabricated using plaster-cast method and an improved brace for comfort (NewBrace) fabricated using a computational method combining computer-aided design and fabrication software (Rodin4D) and a simulation platform. Three-dimensional reconstructions of the torso and the trunk skeleton were used to create a personalized finite element model, which was used for brace design and predict correction. Simulated pressures on the torso and distance between the brace and patients skin were used to remove ineffective brace material situated at more than 6 mm from the patients skin. Biplanar radiographs of the patient wearing each brace were taken to compare their effectiveness. Patients filled out a questionnaire to compare their comfort. RESULTS NewBraces were 61% thinner and had 32% less material than standard braces with equivalent correction. NewBraces were more comfortable (11 of 15 patients) or equivalent to (4 of 15 cases) standard braces. Simulated correction was simulated within 5° compared with in-brace results. CONCLUSIONS This study demonstrates the feasibility of designing lighter and more comfortable braces with correction equivalent to standard braces. This design platform has the potential to further improve brace correction efficiency and its compliance.

Patients’ perceptions of cardiac anesthesia services: a pilot study

PurposeTo develop an instrument to measure patients’ perceptions of the services provided by anesthesiologists, an important indicator of quality for which little information is available.MethodsThe scale of patients’ perceptions of cardiac anesthesia services (SOPPCAS) is composed of 17 Likert-type and sociodemographic questions. Data collection was conducted on T-1 (fourth postoperative day) and T-2 (15 days postoperatively). In addition, we employed the Marlow-Crowne scale and a short form of the Psychological Symptoms Index to verify the influence of social desirability and psychological distress respectively. Data analysis included a principal component analysis (PCA).ResultsOne hundred seventy patients answered the questionnaires at T-1 and 133 patients at T-2. Cronbach alpha of the SOPPCAS was 0.58. PCA revealed four perioperative factors: patient/anesthesiologist interactions, preoccupations related to anesthesia, experience with anesthesia and pain management. Global mean satisfaction was 4.45 ± 0.64 (maximum score 6.0). Main items related to satisfaction were: satisfaction with premedication, empathy from anesthesiologists, pain management. Main items related to dissatisfaction were: lack of information on blood transfusion and recall of endotracheal intubation. A score of 14/20 was obtained for social desirability. Social desirability did not influence the construct of the SOPPCAS.ConclusionWe developed, using rigorous methods, an instrument to measure patients’ perceptions of the quality of cardiac anesthesia services. Global mean satisfaction with anesthesia services was moderately high contrary to previous studies where it was high. Finally, the SOPPCAS should allow anesthesiologists to improve the quality of the care they provide.RésuméObjectifPrésenter un nouvel instrument de mesure des perceptions de patients en regard de la qualité des services anesthésiques, un indicateur important de la qualité pour lequel peu d’informations sont disponibles.MéthodeL’échelle des perceptions de patients face aux services anesthésiques cardiaques (EPPAC) est composée de 17 items Likert et de questions sociodémographiques. La collecte de données s’est déroulée en deux temps: T-1 (quatrième jour postopératoire) et T-2 (15e jour postopératoire, par la poste). De plus, l’échelle de Marlow-Crowne et une forme abrégée du Psychological Symptoms Index ont été utilisées pour vérifer la désirabilité sociale et la détresse psychologique. L’analyse statistique comprenait une analyse en composantes principales (ACP).RésultatsCent soixantedix patients ont répondu à T-1 et 133 patients à T-2. L’alpha de Cronbach de l’EPPAC était de 0,58. L’ACP a révélé la présence de quatre facteurs: interactions patient/anesthésiologiste, préoccupations reliées à l’anesthésie, expérience de l’anesthésie, gestion de la douleur. La moyenne globale de satisfaction était 4,45 ± 0,64. Les aspects satisfaisants étaient: satisfaction face à la prémédication, empathie de l’anesthésiologiste, gestion de la douleur. Les aspects insatisfaisants étaient: manque d’information sur les transfusions sanguines et souvenir de l’intubation endotrachéale. Un score de 14/20 a été obtenu au Marlow-Crowne mais la désirabilité sociale n’influençait pas la validité de construit de l’EPPAC.ConclusionUtilisant une méthodologie rigoureuse, nous avons mis au point un instrument de mesure des perceptions de patients en regard de la qualité des services anesthésiques cardiaques. Contrairement aux résultats des études antérieures, la satisfaction globale moyenne n’était que modérément élevée. Finalement, l’EPPAC devrait permettre aux anesthésiologistes d’améliorer la qualité des services qu’ils offrent.

Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.

Background. Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods. Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0–18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results. Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions. Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention.

Case report of atopic dermatitis with refractory pruritus markedly improved with the novel use of clonidine and trimeprazine.

Abstract:  We report a 6‐year‐old boy with severe atopic dermatitis and refractory pruritus. The novel use of clonidine, an adrenergic agonist, along with trimeprazine, led to dramatic improvement. This represents the first case report of clonidine’s effect in relieving pruritus in atopic dermatitis.

Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis: A Cross-sectional Study

Study Design. A cross-sectional study. Objectives. The aim of this study was to investigate spinal pain prevalence in adolescents with idiopathic scoliosis (AIS) and to explore associations between pain intensity and pain-related disability with scoliosis site, severity, and spinal bracing. Summary of Background Data. The causal link between spinal pain and AIS remains unclear. Spinal asymmetry has been recognized as a back pain risk factor, which is a known cause of care-seeking in adolescents. Methods. Participants were recruited from an outpatient tertiary-care scoliosis clinic. Pain intensity and pain-related disability were measured by the Brief Pain Inventory questionnaire and the Roland-Morris Disability Questionnaire. Scoliosis severity estimation was performed using Cobb angles. Associations were explored using multiple linear regressions and reported with unstandardized beta coefficients (&bgr;) adjusted for age and sex. Results. We recruited 500 patients (85% female) with mean (SD) age of 14.2 (1.8) years. Means (SD) of thoracic and lumbar Cobb angle were 24.54(9.77) and 24.13 (12.40), respectively. Spinal pain prevalence was 68% [95% confidence interval (95% CI): 64.5–72.4] with a mean intensity of 1.63 (SD, 1.89). Spinal pain intensity was positively associated with scoliosis severity in the main thoracic (P = 0.003) and lumbar (P = 0.001) regions. The mean (SD) disability score was 1.73 (2.98). Disability was positively associated with scoliosis severity in the proximal thoracic (P = 0.035), main thoracic (P = 0.000), and lumbar (P = 0.000) regions. Spinal bracing was associated with lower spinal pain intensity in the thoracic (P = 0.000) and lumbar regions (P = 0.009). Bracing was also related with lower disability for all spinal areas (P < 0.045). Conclusion. Spinal pain is common among patients with AIS, and greater spinal deformity was associated with higher pain intensity. These findings should inform clinical decision-making when caring for patients with AIS. Level of Evidence: 3

Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review

BackgroundAdolescent idiopathic scoliosis is the most common spinal deformity occurring in adolescents and its established prevalence varies from 2 to 3%. Adolescent idiopathic scoliosis has been identified as a potential risk factor for the development of low back pain in adolescents. The purpose of this study was to systematically review studies of the prevalence of low back pain in adolescents with idiopathic scoliosis in order to establish the quality of the evidence and determine whether the prevalence estimates could be statistically pooled.MethodsSystematic electronic searches were undertaken in PubMed, CINAHL, and CENTRAL without any restrictions. Studies were eligible for inclusion if they reported the prevalence of low back pain in adolescents with idiopathic scoliosis. Studies were excluded if they detailed the prevalence of pain in post-surgical subjects or were published in languages other than English or French. Data were reported qualitatively, since there was insufficient evidence for statistical pooling.ResultsThe electronic search strategies yielded 1811 unique studies. Only two studies fulfilled the eligibility criteria. The prevalence of low back pain in adolescents with idiopathic scoliosis ranged from 34.7 to 42.0%. However, these prevalence estimates should be viewed cautiously as the included studies were at high risk of bias.ConclusionThe results of this systematic review indicate that adolescents with idiopathic scoliosis frequently experience low back pain. However, there was insufficient evidence to confidently estimate low back pain prevalence in adolescents with idiopathic scoliosis and further studies are needed in this area.

Oral Analgesics Utilization for Children With Musculoskeletal Injury (OUCH Trial): An RCT

This trial aimed to improve pain management for children with an MSK-I by studying the efficacy and safety of oral opioid and nonopioid medications. BACKGROUND: Musculoskeletal injuries (MSK-Is) are a common and painful condition among children that remains poorly treated in the emergency department (ED). We aimed to test the efficacy of a combination of an anti-inflammatory drug with an opioid for pain management of MSK-I in children presenting to the ED. METHODS: In this randomized, double-blinded, placebo-controlled trial, we enrolled children between 6 and 17 years presenting to the ED with an MSK-I and a pain score >29 mm on the visual analog scale (VAS). Participants were randomly assigned to oral morphine (0.2 mg/kg) + ibuprofen (10 mg/kg) (morphine + ibuprofen) or morphine (0.2 mg/kg) + placebo of ibuprofen or ibuprofen (10 mg/kg) + placebo of morphine. Primary outcome was children with VAS pain score <30 mm at 60 minutes postmedication administration. RESULTS: A total of 501 participants were enrolled and 456 were included in primary analyses (morphine + ibuprofen = 177; morphine = 188; ibuprofen = 91). Only 29.9% (morphine + ibuprofen), 29.3% (morphine), and 33.0% (ibuprofen) of participants achieved the primary outcome (P = .81). Mean VAS pain reduction at 60 minutes were −18.7 (95% confidence interval [CI]: −21.9 to −16.6) (morphine + ibuprofen), −17.0 (95% CI: −20.0 to −13.9) (morphine), −18.6 (95% CI: −22.9 to −14.2) (ibuprofen) (P = .69). Children in the morphine + ibuprofen group (P < .001) and in the morphine group (P < .001) experienced more side effects than those in the ibuprofen group. No serious adverse event was reported. CONCLUSIONS: Combination of morphine with ibuprofen did not provide adequate pain relief for children with MSK-I in the ED. None of the study medication provided an optimal pain management because most of children did not reach a mild pain score (NCT02064894).

Linguistic Validation of an Interactive Communication Tool to Help French-Speaking Children Express Their Cancer Symptoms:

Sisom is an interactive tool designed to help children communicate their cancer symptoms. Important design issues relevant to other cancer populations remain unexplored. This single-site, descriptive, qualitative study was conducted to linguistically validate Sisom with a group of French-speaking children with cancer, their parents, and health care professionals. The linguistic validation process included 6 steps: (1) forward translation, (2) backward translation, (3) patient testing, (4) production of a Sisom French version, (5) patient testing this version, and (6) production of the final Sisom French prototype. Five health care professionals and 10 children and their parents participated in the study. Health care professionals oversaw the translation process providing clinically meaningful suggestions. Two rounds of patient testing, which included parental participation, resulted in the following themes: (1) comprehension, (2) suggestions for improving the translations, (3) usability, (4) parental engagement, and (5) overall impression. Overall, Sisom was well received by participants who were forthcoming with input and suggestions for improving the French translations. Our proposed methodology may be replicated for the linguistic validation of other e-health tools.