Colonoscopy — how difficult,how painful?

Colonoscopy is sometimes painful for the patient and often difficult for the endoscopist, but it is hard to predict how difficult or painful the examination will be. The purpose of this study was to identify factors that influence difficulty and pain during colonoscopy.Some 1,284 consecutive patients undergoing office colonoscopy by three endoscopists were prospectively studied. A standard questionnaire was completed by the nursing staff, who assessed the degree of difficulty and pain associated with each exam on a four-point scale.There were 682 men and 551 women (sex not recorded in 51). There was no pain in 27%, mild pain in 39%, moderate pain in 25%, and severe pain in 9%. There was no difficulty in 25%, mild difficulty in 33%, moderate difficulty in 28%, and severe difficulty in 14%. Colonoscopy was significantly easier (P<0.001, chi square) and less painful (P<0.001, chi square) in patients after sigmoidectomy. It was more painful after hysterectomy (P<0.05, chi square) and more difficult and painful in women than in men (P<0.01, chi square). There were significant differences between endoscopists in the assessment of pain associated with colonoscopy.Most colonoscopies are associated with little or no pain (66%) and are easy or only mildly difficult to perform (58%). Patients who have had sigmoid resection are especially easy and painless to examine while women, especially after hysterectomy, are at higher risk of having a painful experience. Colonoscopy technique can influence the amount of pain experienced by the patient.     

Nurse or surgeon follow‐up after rectal cancer: a randomized trial

Aim Follow‐up programmes consume a large amount of resources with less time for the surgeon to take on new patients. The aim of this randomized study was to compare patient satisfaction, resource utilization and medical safety in patients curatively operated for rectal cancer who were followed up by either a surgeon or a nurse. Method The nurse was trained by the colorectal surgeon before the start of the study. Curatively operated patients were asked to give their consent to participate. Randomization was performed by the stoma therapist. After each consultation, the patient completed a questionnaire. Results A total of 110 patients (58 men) age 68 (range 41–87) years were included between 2002 and 2005. Only three patients refused participation. Patient satisfaction was high according to the Visual Analogue Scale (VAS): 9.4 for the surgeon and 9.5 for the nurse (NS). Consultation time was longer for the nurse: 24 vs 15 min (P = 0.001), with more blood samples being taken (29%vs 7%, P = 0.002). Radiological investigations exceeding the routine were made in 11%vs 4% (NS) cases. Surgical assistance was needed in 13 of 182 consultations with the nurse [mean 6 (1–15) min, total 75 min]. Distant metastases were detected in seven patients in the surgeon group and eight in the nurse group (P = 0.953). Total costs of follow‐up did not differ. Conclusion Patient satisfaction was equally high for the specialist nurse as for the colorectal surgeon. On only a few occasions was surgical assistance necessary and total costs for the follow‐up showed no difference. Medical safety appeared uncompromised. Nurse‐led follow‐up is encouraged.     

Patient satisfaction with a rapid diagnosis of suspicious breast lesions: Association with distress and anxiety

Few studies have explored with standard measures patient satisfaction with care at the time of the diagnosis through rapid diagnostic pathways. This study aimed to assess satisfaction levels at the time of the diagnosis in a One‐Stop Breast Unit and to examine associations with psychological states. An anonymous cross‐sectional survey was conducted at a single center's One‐Stop Breast Unit, to assess patient satisfaction regarding several aspects of the Unit. Two days after the diagnosis, 113 participants completed self‐reported questionnaires evaluating satisfaction (Out‐Patsat35), anxiety (State Anxiety Inventory), and psychological distress (Distress Thermometer). Overall, patients were very satisfied (80.7±20.7) with the One‐Stop Breast Unit. The highest mean satisfaction scores concerned nurses' technical skills, interpersonal skills and availability. The lowest mean scores concerned physicians' availability, waiting time, and the provision of information. The results revealed a significant association between high state anxiety levels, lower levels of satisfaction with doctors' interpersonal skills (r =?.41, P <.001) and lower levels for information provided by nurses (r =?.38, P <.001). Moreover, greater psychological distress was associated with less satisfaction with the different aspects of care (doctors' interpersonal skills, doctors' availability and waiting‐time). The results of regression models showed that doctor‐related satisfaction scales explained 20% of the variance in anxiety (P <.01). Facing cancer diagnosis remains a stressful situation. However, our study suggested that a substantial part of this anxiety is sensitive to the quality of the patient‐doctor relationship. Consequently, further efforts should be expended on adapting patient‐doctor communication to improve patient reassurance.     

Objective psychomotor skills assessment of experienced and novice flexible endoscopists with a virtual reality simulator

The objective of this study was to determine whether the GI Mentor II virtual reality simulator can distinguish the psychomotor skills of intermediately experienced endoscopists from those of novices, and do so with a high level of consistency and reliability. A total of five intermediate and nine novice endoscopists were evaluated using the EndoBubble abstract psychomotor task. Each subject performed three repetitions of the task. Performance and error data were recorded for each trial. The intermediate group performed better than the novice group in each trial. The differences were significant in trial 1 for balloons popped (P = .001), completion time (P = .04), and errors (P = .03). Trial 2 showed significance only for balloons popped (P = .002). Trial 3 showed significance for balloons popped (P = .004) and errors (P = .008). The novice group showed significant improvement between trials 1 and 3 (P < 0.05). No improvement was noted in the intermediate group. Measures of consistency and reliability were greater than 0.8 in both groups with the exception of novice completion time where test-retest reliability was 0.74. The GI Mentor II simulator can distinguish between novice and intermediate endoscopists. The simulator assesses skills with levels of consistency and reliability required for high-stakes assessment. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18-22, 2003 (oral presentation).     

Synthetic late gadolinium enhancement cardiac magnetic resonance for diagnosing myocardial scar

Objectives. Late gadolinium enhancement (LGE) is the in vivo reference standard for assessing focal myocardial fibrosis. Post-contrast T1-mapping by Modified Look-Locker Inversion recovery (MOLLI) can be used to generate synthetic late gadolinium enhancement (SynLGE) images with an image contrast similar to conventional LGE images. We hypothesized that SynLGE has an accuracy that approaches conventional LGE for diagnosing focal myocardial fibrosis. Methods. Consecutive patients (n = 109, mean ± SD age 50 ± 16 years, 63% male) referred for clinical cardiac magnetic resonance imaging underwent LGE and post-contrast MOLLI starting 10–15 and 20–25 minutes post contrast, respectively. A cardiac short-axis stack and three long-axis views were acquired for SynLGE and LGE. SynLGE were generated from post-contrast T1-maps. Only LGE and SynLGE images were analyzed by two blinded observers for agreement regarding localization and origin of focal myocardial fibrosis on a per-patient basis. Results. Consensus identified focal fibrosis by LGE in 44/109 (40%) patients. Compared to LGE, SynLGE yielded a diagnostic sensitivity of 34/44 (77%), specificity of 64/65 (98%), positive predictive value of 34/35 (97%), negative predictive value of 64/74 (86%), and an overall accuracy of 98/109 (90%). In cases where SynLGE missed focal fibrosis (n = 10), these were either small non-ischemic focal fibrosis (n = 8) or infarction in a thin myocardial wall (n = 2). In one case, SynLGE identified midmural non-ischemic focal fibrosis not identified by LGE. Discussion. Overall, SynLGE showed good agreement with LGE. SynLGE derived from post-contrast T1-maps may provide the complementary ability to increase confidence in assessment of LGE images for focal myocardial fibrosis.     

Micronized Flavonoids in Pain Control After Hemorrhoidectomy: A Prospective Randomized Controlled Study

Purpose. We conducted a prospective randomized controlled study to evaluate the effect of micronized flavonoid fractions (MFF) on pain after hemorrhoidectomy. Methods. The subjects were 112 consecutive patients randomly assigned either to receive MFF (group 1) for 1 week or not to receive MFF, as a control (group 2), after hemorrhoidectomy, The severity of pain and the number of intramuscular analgesic injections required were recorded for the first 3 days, then 1 week after hemorrhoidectomy. The number of days that intramuscular analgesic injections were required, hospital stay, and patient satisfaction were also assessed. Results. On postoperative day (POD) 1, there were no significant differences between the parameters of the two groups, but on PODs 2 and 3, both the pain score (P = 0.033 and P = 0.011, respectively) and the number of patients who required intramuscular analgesic injections were significantly less in group 1 (P = 0.022 and P = 0.007, respectively). Moreover, the hospital stay was shorter and patient satisfaction was superior in group 1 (P = 0.001 and P = 0.001, respectively). After 1 week, the pain score and number of intramuscular analgesic injections given were significantly less in group 1 (P = 0.001 and P = 0.021). Conclusion. Using MFF after hemorrhoidectomy reduced the severity of pain and intramuscular analgesic requirement.     

Postanal repair – do the long‐term results justify the procedure?

Objective Early outcomes after postanal repair (PAR) demonstrated excellent results but subsequent reports showed an ever declining success rate in maintaining continence. The aim of this study was to document long‐term continence after PAR and relate this to patient satisfaction and quality of life. Method Patients with neurogenic incontinence who underwent PAR from 1986 to 2002 were interviewed by telephone, utilizing a questionnaire which assessed continence, patient satisfaction, overall improvement, and quality of life. Results One‐hundred one patients from four surgeons were identified. Fifty‐four patients were excluded because of loss to follow‐up. Three had a stoma (two for incontinence), four had undergone a graciloplasty, leaving 57 patients (F = 53), mean duration of follow‐up of 9.1 years (2.2–18.7 years). Mean CCS was 11.7 (SD 7.4). 26% (n = 15) scored none to minimal incontinence (CCS 0–5), 26% moderate (CCS 6–12), and 48% (n = 27) severe incontinence (CCS 13–24). 79% (n = 45) were satisfied with the outcome. A low CCS significantly correlated with good patient satisfaction, and was influenced by high QOL score (P < 0.0001). A high CCS significantly correlated with high bowel frequency (P = 0.0007). A favourable CCS was associated with a good QOL, a shorter duration of follow‐up, and being able to distinguish flatus and stool. Conclusions In patients with neurogenic faecal incontinence selected following anorectal physiology studies, PAR remains a useful treatment. It is associated with low morbidity and results in a satisfactory long‐term subjective outcome, despite the fact that many patients have a high incontinence score.     

Patientenakzeptanz gegenüber der patientenkontrollierten intranasalen Analgesie (PCINA)*

Patient-controlled intravenous analgesia (i.v.-PCA) represents the gold standard in the management of acute postoperative pain. However, in many countries i.v.-PCA is rarely used. Recent clinical studies demonstrated that intranasal fentanyl titration provides a rapid and safe form and pain management. In the present study we investigated patients' acceptance and assessment of patient-controlled intranasal analgesia (PCINA) and compared it to intravenous PCA and the customarily prescribed pain therapy. Material and Methods. After approval by the local ethics committee and written informed consent, 79 ASA physical status I or II patients were investigated on the first postoperative day following orthopaedic surgery. The patients were allocated either to the PCINA group (a maximum of 0.025?mg fentanyl over 6?min), to the i.v.-PCA group (0.025?mg fentanyl bolus, lockout interval 6?min) or to a group of patients who received the customarily prescribed pain management. Following the 8-h investigation period, the patients were questioned regarding their satisfaction with the pain therapy using a 6-point rating scale (ranging from 1=very good to 6=not acceptable). The patients were furthermore asked to name the advantages and disadvantages of their pain management. Results. Three patients in the i.v.-PCA group had to be excluded due to pain at the injection site and one patient in the PCINA group because of a surgical complication. Seventy-five patients were finally included, 25 patients per group. No statistically significant intergroup differences regarding age, weight, height and initial pain intensity (evaluated by a 101-point numeric rating scale) were demonstrated. The patients' satisfaction with the mode of pain management was significantly higher in the PCINA (median “good”) and in the i.v.-PCA group (median “good”) than in the group who received the customarily prescribed pain management (median “satisfactory”). This difference was statistically significant (P=0.0001). No statistically significant difference was demonstrated between the PCINA and i.v.-PCA groups. The patients in the PCINA and in the i.v.-PCA group stated as main advantages the rapid onset of action and good pain relief (n=25 and n=25, respectively), as well as their independence from the doctor or nurse (n=12 and n=13). The main disadvantages were pain on injection in the i.v.-PCA group and too frequent fentanyl administrations in the PCINA group (n=6). Discussion. The results demonstrate that the patients' satisfaction with PCINA is comparable to that with i.v.-PCA. Both PCINA and i.v.-PCA were assessed as superior to the customarily prescribed pain management (P=0.0001). Patients' acceptance of a given form of pain management is mainly related to its efficiency. However, side effects such as pain on injection with i.v.-PCA, or frequent opioid administration with PCINA, must be considered when assessing a method of pain control. Patients' global assessment includes both efficiency and side effects. PCINA represents an interesting alternative non-invasive method for postoperative pain management.     

Reduced length of stay and convalescence in laparoscopic vs open sigmoid resection with traditional care: a double blinded randomized clinical trial

Aim The effect of a laparoscopic technique without a multi‐modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities. Method Eighteen patients with sigmoid cancer were randomly assigned to laparoscopic (n = 10) and open (n = 8) colonic resection in a double blinded trial. Length of hospital stay, fulfilment of discharge criteria, need for nursing care (information given to the patient, physical care and indirect care) and postoperative pain were recorded. Furthermore, the patients filled out a questionnaire regarding fatigue, need for sleep and return to daily activities 14 and 30 days postoperatively. Results The laparoscopic technique reduced length of hospital stay from 7 to 4.5 days (P = 0.006), although both groups met the discharge criteria on the third postoperative day. There were no significant differences in total need for nursing time during hospitalization between the two groups (P = 0.328). The laparoscopic group had less pain 24 hours after operation (P = 0.040), and reported less fatigue and reduced need for sleep during the day 30 days after surgery when compared with open surgery (P = 0.033 and P = 0.036, respectively). Furthermore, the laparoscopic group returned significantly faster to normal daily activities after surgery (P = 0.023). Conclusion Laparoscopic surgery per se reduced hospital stay, pain and convalescence compared with open surgery in patients undergoing colonic resection.These effects were obtained without a fast track programme and without an increase in nursing staff on the general surgical ward.     

Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial

To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic, intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty. Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients, and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best). Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO₂ and higher PO₂ at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary functions, patients feel less pain, and patient satisfaction is comparable to that with GA. Electronic Publication     

Acquiring basic endoscopy skills by training on the GI Mentor II

Background Achieving proficiency in flexible endoscopy requires a great amount of practice. Virtual reality (VR) simulators could provide an effective alternative for clinical training. This study aimed to gain insight into the proficiency curve for basic endoscope navigation skills with training on the GI Mentor II. Methods For this study, 30 novice endoscopists performed four preset training sessions. In each session, they performed one EndoBubble task and managed multiple VR colonoscopy cases (two in first session and three in subsequent sessions). Virtual reality colonoscopy I-3 was repeatedly performed as the last VR colonoscopy in each session. The assignment for the VR colonoscopies was to visualize the cecum as quickly as possible without causing patient discomfort. Five expert endoscopists also performed the training sessions. Additionally, the performance of the novices was compared with the performance of 20 experienced and 40 expert endoscopists. Results The novices progressed significantly, particularly in the time required to accomplish the tasks (p < 0.05, Friedman’s analysis of variance [ANOVA], p < 0.05, Wilcoxon signed ranks). The experts did not improve significantly, except in the percentage of time the patient was in excessive pain. For all the runs, the performance of the novices differed significantly from that of both the experienced and the expert endoscopists (p < 0.05, Mann–Whitney U). The performance of the novices in the latter runs differed less from those of both the experienced and the expert endoscopists. Conclusions The study findings demonstrate that training in both VR colonoscopy and EndoBubble tasks on the GI Mentor II improves the basic endoscope navigation skills of novice endoscopists significantly.     

Patient satisfaction following day surgery

Study ObjectiveTo evaluate patient satisfaction at discharge and 30 days after day surgery, and to identify predictive factors of patient satisfaction.DesignObservational, prospective study.SettingDay surgery unit of a university hospital.Patients251 consecutive patients, aged 43 ± 15 years (56.6% women), scheduled for day surgery.InterventionsPatients were asked to answer a questionnaire.MeasurementsPatients' level of satisfaction was recorded in relation to different variables, using questions of demographics, logistics, and those relating to surgery.Main ResultsOver 95% of patients were satisfied with their care at both interviews; 74.5% of patients were completely satisfied at the discharge time; and only 62.4% had the same opinion 30 days after the surgery (P < 0.01). Postoperative pain control [odds ratio (OR) = 1.6], waiting time for surgery (OR = 1.4), and patient changing room conditions (OR = 1.3) were the most important factors influencing patient satisfaction at the time of discharge. Clinical outcome (OR = 3.2), clinical information (OR = 1.6), and postoperative pain control (OR = 1.3) were the main factors affecting patient satisfaction 30 days after surgery.ConclusionsOverall satisfaction following day surgery was at least 95% at discharge and at 30 days. However, complete satisfaction was present only in 75% at discharge and decreased to 62% at 30 days. Clinical outcome was strongly related to patient satisfaction at 30 days after surgery. Factors directly controlled by anesthesiologists such as postoperative pain and information provided, also had a significant impact on patient satisfaction.     

RANDOMIZED CONTROLLED TRIAL COMPARING SAME-DAY DISCHARGE WITH HOSPITAL STAY FOLLOWING HAEMORRHOIDECTOMY

Background: A randomized controlled trial was conducted to compare traditional hospital stay haemorrhoidectomy (STAY) with same-day discharge haemorrhoidectomy (DAY) with regard to costs, clinical outcome and patient satisfaction. Methods: A total of 54 consecutive patients were randomized to either STAY or DAY groups. A standardized excision of three piles was performed and the wounds were left open. The DAY patients went home on the same day but the STAY patients remained in hospital until their bowels had opened. A linear analogue pain score and patient satisfaction questionnaire were administered. During a mean follow-up of 60.5 (standard error of mean =1.2) weeks, the complications and the total medical costs were recorded. Results: There were no differences in the age and sex distributions in both groups (STAY: 11 men, 16 women; mean age 40.6 (± 1.8) years; DAY: 10 men, 17 women; mean age 40.6 (± 1.9) years). Despite accounting for any readmissions, the DAY patients accumulated shorter total hospitalization stays (P < 0.001) and incurred less total medical costs (P= 0.04). The pain scores, analgesia requirements, postoperative complications, patient satisfaction and time taken off work were not different between the two groups. However, more patients in both groups preferred to stay after surgery if they should need another haemorrhoidectomy. Conclusions: Haemorrhoidectomy (with excision of three piles) can be safely performed as a day procedure, with reduced hospitalization and medical costs.     

Comparison of solvent-dehydrated allograft dermis and autograft rectus fascia for pubovaginal sling: questionnaire-based analysis

Objectives To evaluate the efficacy of pubovaginal sling using human cadaveric dermis processed by solvent dehydration and compare results to those of another group in which autograft rectus fascia was used. Material and methods The efficacy of autologous rectus fascia (group 1, n = 25) or solvent-dehydrated cadaveric dermis (group 2, n = 24) for pubovaginal sling were compared in women with stress urinary incontinence (SUI). Surgical outcome, patient satisfaction and quality of life was assessed by the urogenital distress inventory (UDI-6) and the incontinence impact questionnaire (IIQ-7). Results Mean follow-up for patients in group 1 and group 2 were 18 and 13 months, respectively. Our questionnaire-based assessment revealed that SUI was either cured or improved in a total of 21 (84%) patients in group 1 and 19 (79%) patients in group 2. No statistically significant difference was found for the overall success (P < 0.05) and no major complications were encountered in both groups. Conclusions Use of allograft dermis as an alternative to autologous rectus fascia for pubovaginal sling had comparable improvement in patient satisfaction and quality of life at intermediate term.     

Stapled haemorrhoidopexy: 6 years’ experience of a referral centre

Aim To prospectively evaluate the long‐term results and assess patient satisfaction after stapled haemorrhoidopexy (HS). Method A total of 150 patients (121 male patients) with symptomatic grade II (n = 50) or III (n = 100) haemorrhoids underwent stapled HS. Patients were followed up during consultations at regular intervals, allowing prospective data collection. A final telephone follow up was also undertaken. Results Follow up data were obtained for 130 of 150 patients (86.6%). After a median follow up of 39 months (range, 12‐72), 90% of the patients were fully satisfied and 92% were free of haemorrhoidal symptoms. There were no intraoperative complications. Postoperative bleeding that required operation was observed in five patients (3.3%). Most late postoperative complications were benign and easily resolved: unexplained pain for over a month (n = 1), external haemorrhoidal thrombosis (n = 2), anal fissure (n = 6) one with hypertrophic papilla, anal fistula (n = 1), rectal stenosis (n = 1), anal incontinence for (n = 1). Eight patients needed rubber band ligation to treat persistent or recurrent symptomatic prolapse. Four patients (2.6%) were reoperated on during the follow up period but none for haemorrhoidal pathology. Conclusion Stapled HS procedure is effective and has low morbidity, high patient satisfaction and provided good long‐term control of haemorrhoidal symptoms in the treatment of second and third‐degree haemorrhoids.     

Type of anaesthesia and patient acceptance in groin hernia repair: A multicentre randomised trial

Background Groin hernia repair can be performed under general (GA), regional (RA), or local (LA) anaesthesia. This multicentre randomised trial evaluates patient acceptance, satisfaction, and quality of life with these three anaesthetic alternatives in hernia surgery. Methods One hundred and thirty-eight patients at three hospitals were randomised to one of three groups, GA, RA, or LA. Upon discharge, they were asked to complete a specially designed questionnaire with items focusing on pain, discomfort, recovery, and overall satisfaction with the anaesthetic method used. The global quality-of-life instrument EuroQol was used for estimation of health perceived. Results Significantly more patients in the LA group than in the RA group felt pain during surgery (P<0.001). This pain was characterised as light or moderate and for the majority of LA patients was felt during infiltration of the anaesthetic agent. Postoperatively, patients in the LA group first felt pain significantly later than patients in the other two groups (P=0.012) and significantly fewer LA patients consumed analgesics more than three times during the first postoperative day (P=0.002). The results concerning nausea, vomiting, and time to first meal all favour LA. No difference was found among the three groups concerning overall satisfaction and quality of life.Conclusion In a general surgical setting, we found LA to be well tolerated and associated with significant advantages compared to GA and RA.     

Factors predicting patient satisfaction 2 years after total knee arthroplasty for osteoarthritis

Objective

To identify factors predicting patient satisfaction 2 years after total knee arthroplasty (TKA) for osteoarthritis.

Methods

Prospective multicenter study of patients followed up for 2 years after TKA for osteoarthritis. We evaluated pain and function (Lequesne index and WOMAC) at baseline and after 2 years. After 2 years, the patients rated their satisfaction as a percentage, with values greater than 50% defining good satisfaction. Factors associated with good satisfaction were identified by univariate analyses followed by multivariate analysis.

Results

Of 299 patients, 264 completed the study (26 were lost to follow-up, six died, and three refused the 2-year evaluation), including 237 (89.8%) with satisfaction scores greater than 50%. Highly significant improvements were found after 2 years versus baseline in the Lequesne index (7.9 vs. 14.5, P < 0.0001) and WOMAC index (26.3 vs. 51.3, P < 0.0001). There were 26 (9.8%) complications. Factors significantly associated with good satisfaction in the multivariate model were absence of complications (P = 0.004), body mass index less than 27 kg/m² (P = 0.015), high radiological joint narrowing score (P = 0.038), age greater or equal to 70 years (P = 0.038), and absence of depression at the 2-year evaluation (P = 0.002).

Conclusion

We report the first prospective multicenter study done in France to assess pain and function in a large number of patients treated with TKA for osteoarthritis. Our results indicate a high success rate. We identified three factors that predict patient satisfaction and can be assessed before surgery (age greater than 70 years, absence of obesity, and severe joint space narrowing).     

Patient's satisfaction with perioperative care: development, validation, and application of a questionnaire

Background: Measuring patient satisfaction after anaesthesia care is complex.The existing patient satisfaction questionnaires are limitedand omit aspects of patient satisfaction, such as professionalcompetence, information provision, service, and staff–patientrelationship. The aim of our study was to develop a valid andreliable self-reported multidimensional questionnaire assessingpatient satisfaction that included these issues. Methods: The development of the Leiden Perioperative care Patient Satisfactionquestionnaire (LPPSq) was as follows: expert consultation, constructionof the pilot questionnaire, pilot study, statistical analysisof the results of the pilot study (validity, reliability, andfactor analysis), compilation of the definitive questionnaire,main study, and repeated statistical analysis (validity, reliability,and factor analysis). The overall patient satisfaction is expressedby the mean satisfaction score. Results: Three hundred and eighty-two patients consented to participatein the study; 80.4% of the patients (n=307) completed the questionnaire.The LPPSq isolated three dimensions: information (Cronbach’s=0.82), fear and concern (Cronbach’s =0.69), and staff–patientrelationship (Cronbach’s =0.94). Patient satisfactionwith perioperative care was not directly dependent on the outcomesof anaesthesia but how patients were approached and the amountof information they received. Age (P=0.001), gender (P=0.001),work situation (P=0.003), and specialty (P=0.017) were the characteristicsmost influencing patient satisfaction. Conclusions: We developed the LPPSq questionnaire to measure patient satisfactionwith perioperative care, of which anaesthesia care is an importantelement. In this study, information provision and the relationshipbetween staff and patient were the major determinants of patientsatisfaction.     

How good are newly qualified doctors at digital rectal examination?

Aim Digital rectal examination (DRE) is an essential skill which all newly qualified doctors should have. There is evidence in the literature that junior doctors lack this important examination technique. The aim of our study was to determine, with the help of a questionnaire, the abilities of foundation year 1 (FY1) doctors to perform DRE. Method A questionnaire was developed and sent to newly qualified FY1 doctors qualified in two universities (Nottingham and Sheffield) within the first 4 weeks of starting as a FY1 doctor. Results Ninety (75%) out of 120 questionnaires were completed. Most FY1 doctors had very little experience in performing DRE on a patient, and 68 (76%) had performed less than 10 procedures prior to qualification. Very few of these doctors had their clinical findings on DRE checked by a senior doctor (n = 7, 8%). Comparing DRE with other forms of examination, newly qualified doctors were most confident at groin hernia examination followed by testicular examination. They were least confident with vaginal examination and DRE (ANOVA P = 0.0082). Conclusion Digital rectal examination is frequently performed by the most inexperienced doctor and may not be verified by a more senior colleague. More training and supervision of junior doctors are required both prior to qualification and during the early stages of their medical career.     

Unanswered and uncounted items of the illness behavior questionnaire count: a comparison between patients who answered all the items in the questionnaire and those who left one or more items unanswered in a pain management program

Purpose. This study aimed to understand the significance of unanswered and uncounted items on the illness behavior questionnaire (IBQ) in the setting of the Mayo Clinic pain management program for patients with chronic pain. Methods. Three hundred and seventy-eight patients who completed the questionnaire were studied. The data included (1) age, (2) IQs, (3) IBQ score profiles, (4) litigation status, (5) admission status (inpatient vs outpatient), and (6) dismissal status ("graduates" vs "dropouts"). Results. Comparison between patients who answered all the items (n = 272) and those who left one or more items unanswered (n = 106) showed a significant difference in the completion rate of the Wechsler Adult Intelligence Scale (P < 0.05), Scale 5 (affective disturbance) score (P < 0.05), and the rate of dropout from the program (P < 0.05). Also, those who dropped out of the pain management program had a significantly lower score on Scale 5 (P < 0.001) and a significantly greater number of unanswered items that were not counted toward the scale score (P < 0.05). Conclusion. Unanswered and uncounted items of the IBQ seem to count toward a better understanding of patients' pain behavior. Received: January 28, 2000 / Accepted: July 10, 2000