The Effects of Scapulothoracic Bursa Injections in Patients With Scapular Pain: A Pilot Study

Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.

Objective

To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.

Design

Prospective open-label unicenter trial with a 3-month follow-up.

Setting

University rehabilitation hospital.

Participants

Twenty-two cases of suspected scapulothoracic bursitis.

Intervention

Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.

Main Outcome Measures

Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.

Results

Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.

Conclusions

Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis.     

Evolution of the concept of self-care and implications for nurses: A literature review

Background

Worldwide, the increasing prevalence of chronic disease evokes concern on a number of levels, including quality of life, health care costs and workforce issues to meet increasing demands on services. One response has been a shift in governmental health policy to encourage greater involvement of the chronically ill individual in their health care through participation in self-management programmes. Embedded in self-management programmes is the underlying concept of self-care, a complex and multidimensional phenomenon.

Objective

This paper explores the development of the concept of self-care through health related literature and reviews the factors that have shaped the concept.

Design

A comprehensive search of the literature was undertaken drawing principally on key electronic databases of the health literature, augmented with reference list searching.

Data sources

English language publications indexed in CINAHL, EMBASE, AMED, MEDLINE and PsycInfo with no limit on date of publication.

Review methods

Abstracts were reviewed against the inclusion criteria and quality appraisal undertaken. Twenty-two studies were reviewed.

Results

Many definitions of self-care exist and a consensual definition has not been reached. The current concept of self-care has been shaped by many different social, economic and political factors and is embedded in diverse theoretical perspectives and paradigms.

Conclusion

An understanding of the underlying theoretical perspectives and paradigms embedded within acute and chronic disease management will facilitate nurses’ engagement in the debate, practice within appropriate ethical boundaries and support individuals, families and communities more effectively in managing chronic disease.     

Processes underlying adherence to leg ulcer treatment: A qualitative field study

Background

Non-adherence to leg ulcer regimen is a major problem. Reasons for non-adherent behaviour are not fully understood. Literature about processes underlying adherence in leg ulcer patients is scarce.

Objectives

To explore the processes underlying adherent behaviour in patients with leg ulcers who received an intervention to enhance adherence to leg ulcer lifestyle advice.

Design

A qualitative field study was conducted among patients receiving an adherence-promoting intervention.

Settings

The study was carried out in a home care setting in Belgium.

Participants

Twenty-six patients with venous leg ulcers were included and received the intervention from five tissue viability nurses in a community healthcare organisation.

Methods

Semi-structured interviews with open-ended questions were held with patients and nurses after the end of the intervention. Data were also collected by means of participant observation. Data collection and data analysis took place iteratively and analysis was validated by means of researcher triangulation.

Results

Trust in the nurse was central to leg ulcer treatment adherence. Patients who had a trusting relationship with their nurse showed better adherence to the recommended lifestyle modifications. Trust was facilitated by nurses spending meaningful time with the patient, which means they took time to talk with the patient. Trust was also established because nurses provided care beyond patients’ expectations, taking time for wound care and being attentive to pain and other problems. A trusting relationship promoted ‘compliance’ even if patients were not convinced of the benefits of the leg ulcer lifestyle advice. Perceived physical improvement and diminished discomfort after following the lifestyle advice convinced patients of the importance and positive effect of the regimen, which they doubted at first.Self-efficacy for performing leg exercises was often much higher than self-efficacy for being physically active and elevating the legs. Physical impediments, co-morbidities and socio-structural impediments influenced the patient's ability to adhere to leg ulcer advice.

Conclusions

A conceptual framework to understand adherence to leg ulcer treatment was developed. Nurses should be aware of how nurse-related factors can affect adherence. Aspects that foster trust could be incorporated into leg ulcer care.     

Balance-Based Torso-Weighting May Enhance Balance in Persons With Multiple Sclerosis: Preliminary Evidence

Widener GL, Allen DD, Gibson-Horn C. Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence.

Objective

To determine whether weight placed on the trunk in response to directional balance loss would enhance function and stability in people with multiple sclerosis (MS).

Design

Quasi-experimental study in which subjects served as their own controls.

Setting

Research laboratory.

Participants

Subjects (N=16) age 20 to 65 years with MS recruited through the Northern California Chapter of the National Multiple Sclerosis Society.

Interventions

Balance-based torso-weighting where up to 1.5% body weight was placed in a garment on the trunk. Subjects were tested at baseline and then in randomly ordered balance-based torso-weighting and nonweighted garment conditions.

Main Outcome Measures

Sharpened Romberg, eyes open (SREO) and Sharpened Romberg, eyes closed, computerized dynamic platform posturography (CDPP), Timed Up & Go (TUG), and 25-foot timed walk.

Results

Significant improvement (P<.014) was found with SREO in the balance-based torso-weighting compared with nonweighted conditions. CDPP eyes open and TUG showed improvements (P<.03) from baseline to balance-based torso-weighting and nonweighted conditions.

Conclusions

Improved performance in a group of adults with MS was seen when light weights were placed on the torso to counteract balance loss. Placement of weights may have the potential to produce immediate improvements in balance in this population.     

Can four key psychosocial risk factors for chronic pain and disability (Yellow Flags) be modified by a pain management programme?: A pilot study

Objectives

To identify the extent to which an adapted pain management programme is successful in modifying pain beliefs, psychological distress, locus of control and self-efficacy using both qualitative and quantitative approaches.

Design

Prospective, observational study with questionnaires at baseline and following completion of a pain management programme.

Setting

Outpatient pain management programme in a district general hospital.

Participants

Fifteen participants experiencing chronic pain, referred from pain and rheumatology clinics within the hospital.

Outcome measures

Pain beliefs, self-efficacy, locus of control and psychological distress.

Results

Wilcoxon signed ranks tests demonstrated significant improvements in pain beliefs, self-efficacy and psychological distress. However, changes in locus of control were not found to be significant. The qualitative data supported these findings.

Conclusions

The pilot study suggested that the pain management programme successfully modified three out of four of the psychosocial risk factors (Yellow Flags) in a population with established pain and disability. A larger scale project replicating this pilot study including a comparison group, and further research to assess the extent to which modifying Yellow Flags generalises to affect quality of life and disability, are underway.     

Learning to Control Opening and Closing a Myoelectric Hand

Bouwsema H, van der Sluis CK, Bongers RM. Learning to control opening and closing a myoelectric hand.

Objective

To compare 3 different types of myoelectric signal training.

Design

A cohort analytic study.

Setting

University laboratory.

Participants

Able-bodied right-handed participants (N=34) randomly assigned to 1 of 3 groups.

Interventions

Participants trained hand opening and closing on 3 consecutive days. One group trained with a virtual myoelectric hand presented on a computer screen, 1 group trained with an isolated prosthetic hand, and 1 group trained with a prosthetic simulator. One half of the participants trained with their dominant side, and the other half trained with their nondominant side. Before and after the training period, a test was administered to determine the improvement in skill. Participants were asked to open and close the hand on 3 different velocities at command.

Main Outcome Measures

Peak velocity, mean velocity, and number of peaks in the myoelectric signal of hand opening and closing.

Results

No differences were found for the different types of training; all participants learned to control the myoelectric hand. However, differences in learning abilities were revealed. After learning, a subgroup of the participants could produce clearly distinct myoelectric signals, which resulted in the ability to open and close the hand at 3 different speeds, whereas others could not produce distinct myoelectric signals.

Conclusions

Acquired control of a myoelectric hand is irrespective of the type of training. Prosthetic users may differ in learning capacity; this should be taken into account when choosing the appropriate type of control for each patient.     

Psychometric properties of a Korean version of the summary of diabetes self-care activities measure

Background

The summary of diabetes self-care activities (SDSCA) questionnaire is one of the most widely used self-report instruments for measuring diabetes self-management in adults.

Objectives

This study aimed to examine the psychometric properties of a Korean version of the SDSCA questionnaire.

Methods

The 11-item English version of the SDSCA was translated into Korean following the standard translation methodology. The questionnaire was administered to 208 patients with type 2 diabetes. Exploratory and confirmatory factor analyses (EFA and CFA) were carried out for construct validity. Content validity index (CVI), internal consistency and a diabetes management self-efficacy scale (DMSES) were assessed.

Results

The CVI of a Korean version of the SDSCA was .83. The EFA yielded a 9-item measure with a four factor solution with the same labels for original scales. The results of CFA showed the goodness of fit in the 9-item Korean SDSCA version (SDSCA-K). The internal consistency of SDSCA-K was moderate (Cronbach's α = .69) and the positive correlation between the SDSCA-K and the DMSES was identified.

Conclusion

The current study provides the initial psychometric properties of SDSCA-K modified to 9 items and supports SDSCA-K as a reliable and valid measure of diabetes self-management in Korean patients.     

Pressure ulcers: Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP)

Background

Pressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking.

Aims and objectives

Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP).

Design

Prospective psychometric instrument validation study.

Methods

A literature review was performed to design the instrument. Content validity was evaluated by nine European pressure ulcer experts and five experts in psychometric instrument validation in a double Delphi procedure. A convenience sample of 258 nurses and 291 nursing students from Belgium and The Netherlands participated in order to evaluate construct validity and stability reliability of the instrument. The data were collected between February and May 2008.

Results

A factor analysis indicated the construct of a 13 item instrument in a five factor solution: (1) attitude towards personal competency to prevent pressure ulcers (three items); (2) attitude towards the priority of pressure ulcer prevention (three items); (3) attitude towards the impact of pressure ulcers (three items); (4) attitude towards personal responsibility in pressure ulcer prevention (two items); and (5) attitude towards confidence in the effectiveness of prevention (two items). This five factor solution accounted for 61.4% of the variance in responses related to attitudes towards pressure ulcer prevention. All items demonstrated factor loadings over 0.60. The instrument produced similar results during stability testing [ICC = 0.88 (95% CI = 0.84-0.91, P < 0.001)]. For the total instrument, the internal consistency (Cronbachs α) was 0.79.

Conclusion

The APuP is a psychometrically sound instrument that can be used to effectively assess attitudes towards pressure ulcer prevention in patient care, education, and research. In further research, the association between attitude, knowledge and clinical performance should be explored.     

Factors associated with recurrence of venous leg ulcers: A survey and retrospective chart review

Background

Chronic venous leg ulcers have a significant impact on older individuals’ well-being and health care resources. Unfortunately after healing, up to 70% recur.

Objective

To examine the relationships between leg ulcer recurrence and physical activity, compression, nutrition, health, psychosocial indicators and self-care activities in order to provide information for preventive strategies.

Design

Survey and retrospective chart review.

Settings

Two metropolitan hospital and three community-based leg ulcer clinics.

Subjects

A sample of 122 community living patients with leg ulcer of venous aetiology which had healed between 12 and 36 months prior to the survey.

Methods

Data were collected from medical records on demographics, medical history and previous ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer recurrences and history, compression and other self-care activities. All variables clinically or statistically significantly associated with recurrence at the bivariate level were entered into a logistic regression model to determine their independent influences on recurrence.

Results

Median follow-up time was 24 months (range 12-40 months). Sixty-eight percent of participants had recurred. Bivariate analysis found recurrence was positively associated with ulcer duration, cardiac disease, a body mass index ≤ 20, scoring as at risk of malnutrition and depression; and negatively associated with increased physical activity, leg elevation, wearing Class 2 (20-25 mmHg) or Class 3 (30-40 mmHg) compression hosiery, and higher self-efficacy scores. After adjusting for all variables, an h/day of leg elevation (OR = 0.04, 95% CI = 0.01-0.17), days/week in Class 2 or 3 compression hosiery (OR = 0.53, 95% CI = 0.34-0.81), Yale Physical Activity Survey score (OR = 0.95, 95% CI = 0.92-0.98), cardiac disease (OR = 5.03, 95% CI = 1.01-24.93) and General Self-efficacy scores (OR = 0.83, 95% CI = 0.72-0.94) remained significantly associated (p < 0.05) with recurrence.

Conclusions

Results indicate a history of cardiac disease is a risk factor for recurrence; while leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence.     

Self-rated coping styles and registered sickness absence among nurses working in hospital care: a prospective 1-year cohort study

Background

Sickness absence is an important problem in healthcare that affects the quality of care. Sickness absence has been related to coping strategies. Problem-focused coping was shown to be associated with low sickness absence and emotion-focused coping with high sickness absence among postal workers.

Objectives

This study investigated the relationship between coping styles and sickness absence in healthcare.

Design

Prospective study linking self-rated coping styles at baseline with the number of episodes of sickness absence during one year of follow-up.

Setting

Somatic hospital employing 1153 persons.

Participants

Convenience sample of 566 female nurses working in the hospital's clinical wards and outpatient clinic. Of these, 386 (68%) nurses had complete data for analysis.

Methods

The nurses completed a questionnaire at baseline with items on health, work, and coping styles. Three styles of coping were defined: problem-solving coping (i.e., looking for opportunities to solve a problem), social coping (i.e., seeking social support in solving a problem), and palliative avoidant coping (i.e., seeking distraction and avoiding problems). Sickness absence data were retrieved from the hospital's register in the following year. The association between the coping styles and the number of both short (1-7 days) and long (>7 days) episodes of sickness absence was assessed by Poisson regression analyses with age, work hours per week, general health, mental health, and effort-reward [ER] ratio as covariates.

Results

Problem-solving coping was negatively associated with the number of long episodes of sickness absence (rate ratio [RR] = 0.78, 95% confidence interval [CI] = 0.64-0.95). Social coping was negatively associated with the number of both short episodes (RR = 0.88, 95% CI = 0.79-0.97) and long episodes (RR = 0.79, 95% CI = 0.64-0.97) of sickness absence. After adjustment for the ER-ratio, the associations of coping with short episodes of sickness absence strengthened and associations with long episodes weakened, however, significance was lost for both types of sickness absence. Palliative avoidant coping was not associated with sickness absence among female hospital nurses.

Conclusion

Problem-solving coping and social coping styles were associated with less sickness absence among female nurses working in hospital care. Nurse managers may use this knowledge and reduce sickness absence and understaffing by stimulating problem-solving strategies and social support within nursing teams.     

Disparities in Utilization of Outpatient Rehabilitative Care Following Hip Fracture Hospitalization With Respect to Race and Ethnicity

Nguyen-Oghalai TU, Ottenbacher KJ, Kuo Y-F, Wu H, Grecula M, Eschbach K, Goodwin JS. Disparities in utilization of outpatient rehabilitative care following hip fracture hospitalization with respect to race and ethnicity.

Objective

To compare the prevalence of discharge home to self-care after hip fracture hospitalization among the elderly in 3 racial groups: whites, Hispanics, and blacks.

Design

Secondary data analysis.

Setting

US hospitals.

Participants

Patients (N=34,203) aged 65 and older with Medicare insurance discharged after hip fracture hospitalization between 2001 and 2005.

Interventions

Not applicable.

Main Outcome Measure

Discharge home to self-care.

Results

Bivariate analyses showed higher rates of discharge home to self-care among minorities, 16.4% for Hispanics, 8.7% for blacks, and 5.9% for whites. Hispanics had 3-fold higher odds of being discharged home to self-care, and blacks had about 50% higher odds of being discharged home to self-care after adjusting for age, sex, Klabunde's comorbidity index, income, year of admission, type of hip fracture, surgical stabilization procedure, and length of hospital stay.

Conclusions

The higher rate of discharge home to self-care among minorities underscores the risk of suboptimal outpatient rehabilitative care among minorities with hip fracture.     

Sleep quality, depression state, and health status of older adults after silver yoga exercises: cluster randomized trial

Background

Sleep disturbances, depression, and low perception of health status are commonly seen in elderly population; however, clinicians tend to underestimate or overlook the presence of these symptoms and assume them to be a part of normal aging. Non-pharmacological methods that promote a mind-body interaction should be tested to enhance the mental health of older adults.

Objective

To test the effects of 6 months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially their sleep quality, depression, and self-perception of health status.

Design

Cluster randomized trial.

Settings

Eight senior activity centers, southern Taiwan.

Participants

A sample of 139 participants was recruited, and 128 of them completed the study. Inclusion criteria: (1) community-dwelling older adults ages 60 and over, (2) no previous training in yoga, (3) able to walk without assistance, (4) cognitively alert based on the Short Portable Mental Status Questionnaire (SPMSQ) score of eight or higher, and (5) independent or mildly dependent in self-care based on a Barthel Index (BI) score of 91 or higher. The mean age of the participants was 69.20 ± 6.23 years, and the average number of chronic illness was 0.83 ± 0.90. The average BI score of the participants was 99.92 ± 0.62, and the mean SPMSQ score was 9.90 ± 0.30.

Methods

Participants were randomly assigned into either the experimental (n = 62) or the control (n = 66) group based on attendance at selected senior activity centers. A 70-min silver yoga exercise program was implemented three times per week for 6 months as the intervention for the participants in the experimental group.

Results

Most of the mental health indicators of the participants in the experimental group had significantly improved after the silver yoga interventions, and many of the indicators improved after 3 months of intervention and were maintained throughout the 6 months study. The mental health indicators of the participants in the experimental group were all better than the participants in the control group (all p < .05).

Conclusions

After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.     

Point prevalence of patients fulfilling MET criteria in ten MET equipped hospitals. The methodology of the RESCUE study

Objective

The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study.

Design and Setting

A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings.

Patients

All inpatients were eligible except intensive care and psychiatric patients.

Measurement and main results

On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment.

Conclusion

In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.     

Validation and comparison of two quantitative real-time PCR assays for direct detection of DMD/BMD carriers

Objectives

To develop a robust and reliable assay for direct identification of female carriers of deletions in the dystrophin gene.

Design and methods

We compared two quantitative real-time PCR approaches for the detection of the deletions of exons 4, 17, 47, and 50 in DMD/BMD carriers. One hundred and ten individuals from 26 unrelated families, including 8 large pedigrees characterized by having at least two DMD affected males, were studied. Carrier status of the subjects was also evaluated by MLPA.

Results

The results showed the gene dosage ratio of 0.99 ± 0.14 and 1.09 ± 0.19 for normal individuals and 0.48 ± 0.06 and 0.50 ± 0.10 for carriers in SYBR green and TaqMan probe assays, respectively. Carrier status was accurately attributed in 100% of cases and confirmed by MLPA.

Conclusion

Quantitative real-time PCR can be used as a direct method for carrier detection in female relatives of DMD patients with known deletions. The results are comparable to the MLPA data.     

Comparison of procalcitonin measurement by a semi-quantitative method and an ultra-sensitive quantitative method in a pediatric emergency department

Objective

To compare procalcitonin measurements between semi-quantitative and quantitative assays.

Method

Procalcitonin was measured with the PCT-Q® and the Kryptor® assays in a pediatric emergency department.

Results

Among the 359 pairs of results, 103 had discordant results. The linear weighted kappa was 0.44 (95% CI 0.36, 0.51). The concordant/discordant results distribution varied depending on the laboratory technician (p = 0.018).

Conclusion

Agreement between procalcitonin measured semi-quantitatively and quantitatively was moderate. This is probably due to a subjective interpretation of the assay result.     

Pulmonary rehabilitation for chronic obstructive pulmonary disease: a pilot study evaluating a once-weekly versus twice-weekly supervised programme

Objectives

To compare the effectiveness of a once-weekly supervised pulmonary rehabilitation programme with a standard twice-weekly format.

Design

Randomised trial of equivalency.

Setting

Pulmonary rehabilitation service of a primary care trust delivered at two physiotherapy outpatient departments.

Participants

Thirty patients with chronic obstructive pulmonary disease.

Outcome measures

Primary outcomes were the Incremental Shuttle Walking Test (ISWT), Endurance Shuttle Walking Test (ESWT) and St George's Respiratory Questionnaire (SGRQ), assessed at baseline and at completion of the supervised programme. Secondary outcomes were home-exercise activity, attendance levels and patient satisfaction with the programme.

Interventions

The once-weekly group (n = 15) received one supervised rehabilitation session per week, and the twice-weekly group (n = 15) received two sessions per week, both for 8 weeks, together with a home-exercise plan.

Results

After pulmonary rehabilitation, the groups showed similar improvements in exercise tolerance (median values: ISWT once-weekly 60 metres, twice-weekly 50 metres; ESWT once-weekly 226 seconds, twice-weekly 109 seconds). However, for health-related quality-of-life, the once-weekly group's score did not change (SGRQ 0), whereas an improvement was seen for the twice-weekly group (SGRQ 3.7). The number of home-exercise sessions and attendance levels were similar between the groups. Patient satisfaction with both formats was high and almost identical between the groups.

Conclusions

This pilot provides data to inform a larger study and shows that the methodology is feasible. The findings suggest that once-weekly supervision may be capable of producing equivalent improvements in exercise tolerance as a twice-weekly programme, but the health-related quality-of-life outcome appeared to be poorer for once-weekly supervision.     

Reliable assessment of sedation level in routine clinical practice by adding an instruction to the Ramsay Scale

Objective

The level of sedation in mechanically ventilated patients is most often assessed with the Ramsay Scale. Its reliability, however, has never been evaluated in a large group of professionals using the Ramsay Scale in daily clinical practice, while differences in interpretations among professionals have been indicated. We developed a written stepwise instruction to optimize the inter-observer reliability of the Ramsay Scale within a large group of Intensive Care (IC) nurses.

Design

Reliability study.

Setting

The Intensive Care Cardiology (ICC) and the Intensive Care Thoracic surgery (ICT) units of a university hospital.

Patients and participants

The study population comprises randomly selected mechanically ventilated patients and IC nurses with a bachelor's degree in Nursing and an IC certification. In total 2x105 Ramsay measures were performed in 45 patients by 24 nurses.

Measurement and results

Analysis of 105 paired Ramsay scores showed an almost perfect agreement between observers (weighted K (K_w) = 0.90). In both ICC patients and ICT patients, agreement between Ramsay scores was high (K_w = 0.95 and K_w = 0.86, respectively).

Conclusion

By using a written stepwise instruction with the Ramsay Scale, the inter-observer reliability of the level of sedation measurements, performed in daily clinical practice within a large team of IC nurses, proved to be almost perfect.     

The Hyperemesis Impact of Symptoms Questionnaire: Development and validation of a clinical tool

Background

The Hyperemesis Impact of Symptoms Questionnaire is a clinical tool designed to assess holistically the impact of the physical and psychosocial symptoms of hyperemesis gravidarum (HG) on individuals. Its purpose is to aid planning and implementation of tailored care for women with HG. To our knowledge no similar tool exists.

Objective

To assess the validity and reliability of the HIS questionnaire.

Design

As no similar tool exists, we compared the HIS with three tools that reflect its key areas: physical impact (Pregnancy Unique Quantification of Emesis - PUQE score and markers of severity of HG), psychological impact (Hospital Anxiety and Depression Score - HADS) and social impact (SF12 quality of life score).

Setting

A large regional referral, women and children's hospital in the North West of England.

Participants

The HIS was evaluated on 50 women admitted to hospital with HG and 50 women recruited from ante-natal clinic without severe nausea and vomiting of pregnancy and with an uncomplicated pregnancy.

Results

Good criterion validity was demonstrated by strong significant correlations with all three scores (PUQE, r = 0.75, p < 0.001, HADS, depression r = 0.76, p < 0.001, and SF12, mental component r = −0.65, p < 0.001). The HIS showed good internal consistency, Cronbach alpha 0.87, split half 0.80.

Conclusions

There is evidence for the validity and reliability of the HIS to assess the impact of the physical and psychosocial symptoms of HG. Further research is currently underway to establish the clinical utility of the HIS questionnaire in the care of women hospitalised with HG.     

The effects of providing pre-gastrointestinal endoscopy written educational material on patients’ anxiety: A randomised controlled trial

Background

Endoscopy is a frequently applied operation in health institutions which may cause anxiety in patients.

Objective

The objective of this study is to determine the effects of written educational material related to the endoscopy procedure on the anxiety level of the patient before gastrointestinal endoscopy.

Design

A randomised controlled trial design with two groups: case and control groups.

Participants

140 patients assigned randomly who applied for gastrointestinal endoscopy.

Methods

Intervention: the control group in our study consisted of 70 people who were briefly informed by the relevant unit about pre-endoscopy preparation. The case group consisted of 70 people who were also given brief information about the pre-endoscopy preparation by the relevant unit. Only the case group were also given written educational material and told orally by the researcher about the content. Measurements: for the collection of the data, a questionnaire form and Spielberger's State-Trait Anxiety Inventory were used.

Results

A significant difference in the average state anxiety scores was found between the case and the control group (p < 0.05). An important difference was found in the average state anxiety scores between the case and the control group who had not undergone endoscopy before our study (p < 0.05).

Conclusions

Use of written material including detailed information to inform the patient before endoscopy was useful in lessening their anxiety level. Health professionals should evaluate the anxiety level of patients before endoscopy and educational material should be given to them to read.