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PubMedDate not supplied

"See one, do one, teach one, have one": a novel variation on regional anesthesia training.

INTRODUCTION: Is it possible to determine the number of nerve blocks needed for residents to become competent in regional anesthesia? Several studies have focused on this question, and the Residency Review Committee (RRC) for Anesthesiology has now defined a "minimum clinical experience" for some aspects of regional anesthesia training. In our experience, personally being a regional block recipient can also serve to enhance training. METHODS: Many residents at Virginia Mason Medical Center have received regional anesthetics as volunteers in research projects. We designed questionnaires to define their perceptions in both performing and receiving regional anesthesia. RESULTS: Twenty-one residents were recipients of a total of 72 regional anesthetic procedures. Many residents' comments focused on the discomfort of local anesthesia infiltration, the value of sedation, a better appreciation of the patients' perspectives, and improved preoperative consultation. Residents experiencing paresthesias were more likely to consider paresthesias as bad (P =.0098). CONCLUSION: The lessons learned from personally receiving a regional anesthetic are invaluable and can improve the quality of training, as well as the relationship between anesthesiologist and patient.

Adult↗
PubMed2001

The mental health nurse: contributing to improved outcomes for patients in the emergency department.

Fundamental changes to health-care policy in Australia have led to an increase in the extent to which emergency department staff come into contact with patients experiencing mental health problems. This has been problematic for nurses, many of whom perceive themselves as lacking the skills and expertise to provide appropriate care and treatment to this client group. Psychiatric/mental health consultation-liaison nursing within the emergency department is becoming established as a means to overcome some of the problems identified. Despite this growth there is a paucity of literature evaluating the effectiveness of this position. This paper presents the results of an evaluation of the mental-health consultation-liaison nurse role in an inner city teaching hospital in Sydney Australia. The survey involved a three stage approach to data collection. The data collected at the commencement of the position included focus groups to ascertain the needs of emergency department nurses and a questionnaire designed to measure the skills, confidence and perceived knowledge of emergency department nursing and medical staff. An evaluation of the satisfaction of nurses and doctors was conducted towards the end of the three month pilot programme. The results confirmed the need for positions of this type and suggested a high level of satisfaction with the service provided.

Adult↗
PubMedDate not supplied

Dyslexia in adults is associated with clinical signs of fatty acid deficiency.

Developmental dyslexia is a complex syndrome whose exact cause remains unknown. It has been suggested that a problem with fatty acid metabolism may play a role, particularly in relation to the visual symptoms exhibited by many dyslexics. We explored this possibility using two self-report questionnaires, designed on the basis of clinical experience, to assess (1) clinical signs of fatty acid deficiency; and (2) symptoms associated with dyslexia in known dyslexic and non-dyslexic subjects. Dyslexic signs and symptoms included the auditory-linguistic and spoken language difficulties traditionally associated with the disorder, as well as visual problems (both with reading and more generally) and motor problems. Fatty acid deficiency signs were significantly elevated in dyslexic subjects relative to controls, particularly within males (P<0.001). In addition, the severity of these clinical signs of fatty acid deficiency was strongly correlated with the severity of dyslexic signs and symptoms not only in the visual domain, but also with respect to auditory, linguistic and motor problems. The pattern of relationships differed somewhat between dyslexic and control groups, and sex differences were also observed. Our findings support the hypothesis that fatty acid metabolism may be abnormal in developmental dyslexia, and indicate the need for further studies using more objective measures.

Adult↗
PubMed2001

[Quality management in German rehabilitation clinics - a stratified representative survey].

BACKGROUND: As of January 1, 2000 rehabilitation clinics in Germany are obliged to implement and develop a quality management system. OBJECTIVE: This study aims to depict the implementation of quality management (QM), to trace the preferred QM models, identify the reasons for and experience with the introducing quality management, and inquire into the quality tools used in rehabilitation clinics. METHODS: Postal study of a representatively selected random sample of 298 rehabilitation clinics, stratified along the criteria state, number of beds and financially responsible agency, using six questions with nominally scaled items. Questionnaire design provided no clues as to the responding clinics. The study was designed along the Total Design Method. RESULTS: 89 % of the responding clinics have implemented a QM system, or are about to or planning to do so. Only 11 % reject quality management. 59 % implemented their system in 1998, 1999 or 2000. Among the reasons for implementing a QM system, items related to potentials of quality management predominate, whereas demands by third parties are given only very rarefy. DISCUSSION: The response rate was 59 %, i. e., the study can be considered representative. The high share of clinics taking a positive view on quality management is however somewhat modified by the fact that 40.4 % of the clinics have adopted or are planning far traditional quality assurance methods. Whether these systems will satisfy the legal requirements in place (SGB V) is doubtful. Adjusted, responses show that 48.9 % of the clinics are running QM systems, are about to or planning to implement one. CONCLUSIONS: Many of the responding clinics have already implemented a QM system or are about to do so. A majority of the clinics however rely on traditional quality assurance methods. Whether quality assurance will satisfy the legal requirements in place (SGB V) re an internal quality management system must be awaited.

Germany↗
PubMed2001

The ten-minute examination of the dizzy patient.

Dizziness and postural instability are common presenting complaints in patients seen in otolaryngology practice. Unfortunately, these patients frequently do not receive optimal evaluation and therapy because of the difficulty in obtaining a thorough yet pertinent history and the perceived complexity of the physical examination. Over the last 10 years, we have utilized a standardized approach to evaluation of the dizzy patient that is user friendly and maximizes the time and effort spent by the clinician. First, a thorough history is taken from the patient in two forms: (1) a specially designed questionnaire filled out well before the examination and (2) a direct interview using the answers on the questionnaire as a guide. During the physical examination, emphasis is placed on the following subtests: (1) spontaneous nystagmus; (2) central oculomotor function; (3) the vestibulo-ocular reflex (VOR) battery--headshake, head thrust, dynamic visual acuity, and Hallpike positioning; (4) coordination; (5) posture; (6) gait; and (7) special examinations. This neurotologic examination is completed in about 10 minutes and is performed as a battery of tests following the routine otolaryngologic and/or neurologic examination. We feel that this test sequence is thorough yet easy to perform and ideally will demystify the examination of these challenging patients.

Diagnosis, Differential↗
PubMed2003

[What Expectations do Mental Disordered People have about the Treatment in an Psychiatric Hospital?]

Patiens are mostly passive utilizer of the health-care-system. They are confronted with a supply of medical service and they are allowed to show their satisfaction with it retrospectively. Our medical system has in future to develope itself from an effective perspective to an utilizer orientated medicine. Orientation to the utilizers means to ask for the expectations of the patients for supply (at customer's option). Aim of our investigation was to check the subjective expectations of the patients before the beginning of in-patient treatment: 1. What is their opinion about the label of the disorder, they are suffering. 2. Of what therapeutic measures do they expect help for theirselves. 3. Do they want to play a part in planning of therapeutic measures. 209 of 344 (61 %) of the patients were at admission ready for answering a self designed questionnaire. Only 4 % of the patients said, that their disorder is called insanity. They preferred labels like mental illness (45 %), somatic illness (43 %) and mental health problem (42 %). A pharmacological therapy expected in totally 61 % of the patients. Mostly were expected drugs against depressive disorders (32 %), drugs against addiction (31 %) and tranquilizers (29 %). Only 10 % of the patients expected to get antipsychotic drugs. A verbal therapeutic intervention expected 76 % of the patients. To have a speak with the doctor is with 69 % a first rank desire, followed by speaking with the psychologist (60 %), the nurses (58 %) and the patients comrades (56 %). Psychotherapy in a narrower sense expect only 40 % of the patients. Furthermore there are privacy and recreation throug promenades in front of the expectations (69 %), followed by relaxation (59 %), occupational therapy (55 %) and sports or acitive exercise therapy (54 %). 75 % of the patients want to be informed about the therapy. 69 % want to cooperate with planning of the therapy. Only 21 % commit the therapy to the doctor. About one third of the patients expect a consultation with their relatives, the custodians and their family doctor.

Journal Article↗
PubMedDate not supplied

[Arthroscopic menisectomy in older patients: assessing health-related quality of life].

AIM: Little information is available on partial arthroscopic menisectomy in patients 60 years of age or older. Due to the co-morbidity of meniscal tears and osteoarthritis in this age group, the effectiveness of this procedure is controversial. The purpose of this study was to evaluate the outcome of this procedure in terms of function and mobility in patients 60 years of age or older. METHOD: Between 1990 and 1999, 1920 arthroscopies of the knee were performed in a single primary care institution, and 51 patients, 60 years of age or older, had a partial arthroscopic menisectomy done. Outcomes were rated using the SF-36 Health Survey and a specially designed questionnaire including items of published scores. RESULTS: The mean age at surgery was 67 years (range: 60.3 - 78.9) and the mean follow-up was 5 years (range: 2 - 12). Due to persistent pain, 4 patients underwent a second operation including knee replacement in 3 cases and a high tibial osteotomy in 1 case. 41 patients (87.1 %) stated the arthroscopy had improved their quality of life. In terms of pain and daily life activities, the majority of the subjects showed an improvement after surgery. The SF-36 showed no clinically relevant difference compared to the control in all but one subscale. CONCLUSION: Despite of the presence of osteoarthritis in this age group, arthroscopic partial menisectomy can improve pain, function and mobility in the mid-term course.

Aged↗
PubMed2006

Results of surgical treatment of myelomeningocele.

UNLABELLED: The aim of this study was to analyse the long-term outcome of children and adolescents born with myelomeningocele. MATERIAL AND METHODS: Sixty-six children aged from 3 to 21 years old, all patients of the Paediatric Surgery Clinic of the Medical Academy in Białystok, were evaluated. The hospital records were reviewed and data was obtained from parents, using a questionnaire designed by authors. The material was classified with respect to the degree of disability using Lagergren's scale. RESULTS: 15 (23 %) patients had no physical or mental handicap, 18 (27 %) were moderately handicapped, 20 (30 %) were severely handicapped, 13 (20 %) were very severely handicapped. CONCLUSIONS: A higher spinal cord lesion, hydrocephalus and complications due to its surgical management had a negative influence on development of children born with myelomeningocele.

Adolescent↗
PubMed1989

[Injuries and damage caused by excess stress in body building and power lifting].

A questionnaire, designed to elict information about training programs, experience and injury profile, was administered to 358 bodybuilders and 60 powerlifters. This was followed by a clinical orthopedic and radiological examination. The upper extremity, particulary the shoulder and elbow joint, showed the highest injury rate. More than 40% of all injuries occurred in this area. The low back region and the knee were other sites of elevated injury occurrences. Muscular injuries (muscle pulls, tendonitis, sprains) were perceived to account for 83.6% of all injury types. Powerlifting showed a twice as high injury rate as bodybuilding, probably of grounds of a more uniform training program. Weight-training should be associated with a sports-related medical care and supervised by knowledgeable people, who can instruct the athletes in proper lifting techniques and protect them from injury which can result from incorrect weight-training.

Adult↗
PubMed1987

[Functional disorders of the lower urinary tract following radical abdominal and vaginal surgery of cervix cancer].

To establish the prevalence and extent of lower urinary tract dysfunction after radical surgery for cervical cancer, we evaluated 121 patients who underwent surgery between 1978 and 1984. 91 women underwent radical abdominal hysterectomy for disease in stage Ib or IIb; 30 patients underwent radical vaginal hysterectomy for stage Ib disease. Evaluation, at 12-72 months postoperatively, included pelvic examination, urinary history (explored via a specially designed questionnaire), measurement of residual urine, urine culture, and urodynamic studies. All patients underwent urethrocystoscopy and intravenous urography. Results showed 36 patients completely free of complaints, namely, 17 (18.7%) after radical abdominal hysterectomy and 19 (64%) after the vaginal produce. 85 patients (70%) had complaints, most commonly difficult spontaneous micturition (81.4% after abdominal, 17% after vaginal surgery). Other pathologic conditions were identified as follows: stress incontinence in 52.8% of patients after abdominal and 24% after vaginal surgery; impaired bladder sensation in 48.4% after the abdominal procedure but in only 13% after the vaginal; residual urine volume exceeding 10% of maximum bladder capacity in 13.2% after abdominal surgery (range: 40-220 ml) and 24.2% after vaginal surgery (range: 30-200 ml); significant bacteriuria in 21 patients (23%) after abdominal hysterectomy and 3 patients (9%) after vaginal. Urodynamic studies showed that, after abdominal surgery, bladder compliance was normal in 41.8% of patients, high in 39.6%, and low in 18.7%. After vaginal surgery, bladder compliance was normal in 66% of patients and abnormal in 34%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Functional disorders of the lower urinary tract following a radical abdominal operation in cervical cancer].

196 women underwent radical abdominal hysterectomy with pelvic lymphadenectomy for cervical cancer of the clinical stages Ib to IIb, at the University Department of Obstetrics and Gynaecology in Graz during 1977 to 1982. 51 patients without recurring cancer and without subsequent radiotherapy were followed up for functional disturbances of the efferent urinary tract. The time interval between surgery and follow-up being 6 to 60 months. Follow-up examination consisted of palpation and, in addition, specific anamnesis based on a specially designed questionnaire, determination of residual urine, control of urine culture, and urodynamic measurement. Furthermore, urethro-cystoscopy and excretion urography were performed in all patients. 21.6% of the patients were completely free from complaints. In contrast, 78.4% of the women reported more or less pronounced signs and symptoms: first of all, delayed spontaneous micturition (78.4% of the cases), and, secondly, stress incontinence (58.8%) and a reduced desire to urinate (47.1%). Enhanced amounts of residual urine were measured in 35.3% of the women, whereas significant bacteriuria occurred in 31.4% of the women. Urodynamic measurement resulted in normal intravesical pressure values in 23 women (45.1%). On the other hand, hypotonic intravesical pressure was seen in 20 patients (39.2%) and hypertonic pressure in 8 women (15.7%). In all patients micturition was disturbed both in respect of urine flow and micturition time. 41 (80.4%) urethro-cystoscopic findings and 41 intravenous pyelography were in the normal range. The complaints reported by the patients were mostly not of special significance for them, since 34 women (66.6%) were greatly satisfied with their condition. The results are described in detail and are discussed.

Adult↗
PubMedDate not supplied

The importance of nurse caring behaviors as perceived by patients receiving care at an emergency department.

BACKGROUND: Increased workload at the emergency department (ED) and the shortage of nurses may leave some patients without proper care. The importance of patients' perceptions of caring is vital when organizing nursing practice under such circumstances. PURPOSE: The purpose of the study was to identify which nurse caring behaviors are perceived by patients in an ED as important indicators of caring. The nurse caring behaviors were categorized in terms of relative importance with respect to demographic variables and perceived illness. Watson's theory of caring was used as a theoretic framework for this quantitative and descriptive study. METHOD: A 61-item questionnaire designed on the basis of Cronin and Harrison's Caring Behaviors Assessment tool, which reflected the 10 carative factors of Watson's theory, was mailed to 300 ED patients. The response rate was 60.7%. RESULTS: Results showed that subjects scored the items "Know what they are doing", "Know when it is necessary to call the doctor", "Know how to give shots, IVs, etc.", and "Know how to handle equipment" as the most important nurse caring behaviors. The subscale "human needs assistance" was ranked highest. CONCLUSION: In line with several previous studies, subjects considered clinical competence to be the most important nurse caring behavior, which further emphasizes the notion of caring as a moral stance integral to all interactions with patients.

Clinical Competence↗
PubMed2002

Radiation dose-reduction techniques in North American dental schools.

OBJECTIVE: The purpose of this investigation was to describe the extent to which dental schools use materials, equipment, and quality-assurance protocols that reduce radiation exposure to patients. STUDY DESIGN: Questionnaires soliciting information regarding intraoral and extraoral radiographic practices and quality-assurance procedures were sent to the directors of oral and maxillofacial radiology (OMR) at the 65 schools of dentistry in the United States and Canada. RESULTS: The response rate was 100%. E-speed film is used at 86% of institutions. Direct digital radiography is used at 58% of institutions for intraoral imaging and 11% for extraoral radiography. Other dose-reducing techniques include long source-film distances (88%), rectangular beam limitation (47%), leaded aprons (95% for extraoral films; 85% with thyroid collars for intraoral films), and rare earth intensifying screens (100%). The most commonly used tube potential is 70 kVp (88%). The director of OMR is solely responsible for radiographic policies at approximately 75% of institutions. Regular tests for film fog, speed, and contrast are done at roughly 75% of schools, while over 90% test darkroom lighting and x-ray equipment. CONCLUSIONS: Some dose-reducing strategies are commonly used in dental schools, while others have not gained wide acceptance.

Canada↗
PubMed2001

Sleep position and the use of soft bedding during bed sharing among African American infants at increased risk for sudden infant death syndrome.

UNLABELLED: Soft bedding increases the risk for death among prone infants. We compared the softness of beds and bedding and infant sleep position for infants sleeping alone and for those bed sharing. STUDY DESIGN: Questionnaires were used to record the bedding and sleep practices of 218 consecutive African American infants. Enrollment was prospective. Mechanical models were used in the homes of a subgroup to measure the softness of bedding and its propensity to cause rebreathing. Results were compared by using the Student t test, Mann-Whitney U test, and chi(2) analysis. RESULTS: In a cross-sectional sample of infants, at 8.2 +/- 3.3 weeks of age, 61% (133 of 218) had bed shared > or =1 of the previous 14 nights and 48.6% (106 of 218) had bed shared the night before. Breast-feeding rates were not different for bed sharers and those sleeping alone. The rates of maternal smoking for both groups were low (13.6% vs 11.8%). Comforters, pillows, and waterbeds were more commonly used beneath bed-sharing infants. Bed sharers were twice as likely to habitually be placed prone for sleep (18% vs 9%). In the subgroup studied in their homes (13 bed sharing, 19 alone), the shared beds were softer (P <.0001) and could cause more rebreathing (P =.007). CONCLUSIONS: Infants at increased risk for sudden infant death syndrome, by sociodemographic criteria, who also bed share are more likely to sleep prone and to use softer beds. These findings may explain part of the risk associated with bed sharing among US infants, a risk that appears to be independent of the effects of maternal smoking.

Black or African American↗
PubMed2001

Inversion of the circadian rhythm of melatonin in the Smith-Magenis syndrome.

OBJECTIVE: The objective was to determine the circadian rhythm of melatonin in the Smith-Magenis syndrome (SMS), which causes behavioral problems and sleep disturbance. STUDY DESIGN: Questionnaires, sleep consultations, and sleep diaries were obtained in 20 children with SMS (9 girls, 11 boys aged 4 to 17 years). Actigraphy, electroencephalography, and the circadian variations of plasma melatonin, cortisol, and growth hormone were recorded in 8 patients. Early sleep onset, early sleep offset, and sleep attack indicated sleep disturbance. RESULTS: All children with SMS had a phase shift of their circadian rhythm of melatonin. Time at onset of melatonin secretion was 6 AM +/- 2 (control group: 9 P.M. +/- 2). Peak time was 12 PM +/- 1 (control group: 3:30 AM +/- 1:30), and melatonin offset was at 8 PM +/- 1 (control group: 6 AM +/- 1). Behavioral problems correlated with the inverted circadian rhythm of melatonin. CONCLUSION: Considering that clock genes mediate the generation of circadian rhythms, we suggest that haploinsufficiency for a circadian system gene mapping to chromosome 17p11.2 may cause the inversion of the circadian rhythm of melatonin in SMS.

Abnormalities, Multiple↗
PubMed2002

Parental anxiety associated with referral of a child to a pediatric cardiologist for evaluation of a Still's murmur.

OBJECTIVE: We assessed factors contributing to parental anxiety when children are referred to a cardiology clinic for evaluation of a Still's murmur. METHODS: Parents of 95 children completed questionnaires designed to assess family and patient characteristics, parents' ratings of their anxiety and the reassurance they received from their pediatrician, and current (state) and general anxiety levels. RESULTS: Parents reported anxiety about multiple issues including the need for medication (49%), sports restrictions (41%), cardiac surgery (29%), cardiac risk for siblings (20%), and premature death (13%). Of reporting mothers, 19% felt the murmur resulted from something they did wrong during pregnancy. Although 54% of parents were extremely reassured by their pediatrician, only 17% had no anxiety associated with the specialty visit. After reassurance from the cardiologist, 7% of parents had persistent anxiety. In multivariable analysis, 2 features, both related to the referring pediatrician, were significantly related to parental anxiety level. High parental anxiety was associated with lower pediatrician reassurance ratings and greater pediatrician practice years. CONCLUSIONS: Parental anxiety is common among parents of children referred for specialty evaluation. Educational strategies to improve pediatrician communication skills with parents may improve quality of care.

Adolescent↗
PubMed1988

Research policy and review 23. The view of academic social scientists on the 1991 U.K. Census of Population: a report of the Economic and Social Research Council Working Group.

This is a report on the survey conducted for the United Kingdom Census Office by the Economic and Social Research Council (ESRC) concerning the 1991 census. "The primary task was to solicit views on the priority which [academic social scientists] attached to the proposed topics to be covered by the Census and to ascertain their views on the changes in question wording which are under consideration.... Views were also sought on different methods for giving academics access to individual-level data from the 1991 Census."

Attitude↗
PubMed1982

Diet and health of people with an ileostomy. 1. Dietary assessment.

1. People with an ileostomy experience digestive problems with some foods. Why those foods are avoided is not known nor is it certain whether this interferes with the nutritional adequacy of their diet. 2. A detailed dietary assessment has therefore been made of thirty-seven subjects with ileostomies and a similar number of age- and sex-matched healthy controls. All food and drink eaten over 1 week was weighed and recorded. In addition. A larger group of seventy-nine ileostomy subjects and seventy matched controls answered a questionnaire designed to identify foods which upset them and which they avoided. 3. Total nutrient and energy intakes were similar in the two groups but the subjects with an ileostomy ate less dietary fibre (g/d; mean + SD: ileostomy subjects 18.0 +/- 5.9, controls 20.9 +/- 5.5; P less than 0.05) mainly due to lower fruit and vegetable intakes. Iron and vitamins A and C intakes were also less. 4. A majority of ileostomy subjects had a pattern of food intake different from the controls, taking more of their energy in the morning and less at night. A variety of food items upset more than half of them including nuts, pips, seeds, skins, onions, beetroot, lettuce, raw cabbage and carrot, peas, sweetcorn, mushrooms and dried fruit. 5. On the basis of the results it is possible to formulate general dietary advice for people with an ileostomy.

Adult↗