Perceived professional support and the use of blocking behaviours by hospice nurses

A prospective study of the impact of training 41 hospice nurses in assessment skills was used to test hypotheses that blocking behaviours would be used more when patients disclosed feelings and used less when nurses perceived that they had satisfactory professional support Each nurse was asked to assess a patient's current problems before and after feedback training and 8 months later Audiotape recordings of these interviews were rated by trained raters They determined the frequency of nurses' responses which had the function of blocking patient disclosure and the emotional level of patient disclosure Before each patient assessment each nurse was interviewed and questionnaires administered to measure her perceptions of the support she received Blocking behaviours were most evident when patients disclosed their feelings (Kendalls r=0 36, P < 0 001) In interviews containing most patient disclosure of feeling, blocking was significantly less (r= - 0 24, P < 0 5) when the nurse felt that practical help would be available if needed and when the nurse felt that her direct supervisor was concerned about the nurse's own welfare (r= -0 37, P < 0 005)     

Validity of geographically modeled environmental exposure estimates

Geographic modeling is increasingly being used to estimate long-term environmental exposures in epidemiologic studies of chronic disease outcomes. However, without validation against measured environmental concentrations, personal exposure levels, or biologic doses, these models cannot be assumed a priori to be accurate. This article discusses three examples of epidemiologic associations involving exposures estimated using geographic modeling, and identifies important issues that affect geographically modeled exposure assessment in these areas. In air pollution epidemiology, geographic models of fine particulate matter levels have frequently been validated against measured environmental levels, but comparisons between ambient and personal exposure levels have shown only moderate correlations. Estimating exposure to magnetic fields by using geographically modeled distances is problematic because the error is larger at short distances, where field levels can vary substantially. Geographic models of environmental exposure to pesticides, including paraquat, have seldom been validated against environmental or personal levels, and validation studies have yielded inconsistent and typically modest results. In general, the exposure misclassification resulting from geographic models of environmental exposures can be differential and can result in bias away from the null even if non-differential. Therefore, geographic exposure models must be rigorously constructed and validated if they are to be relied upon to produce credible scientific results to inform epidemiologic research. To our knowledge, such models have not yet successfully predicted an association between an environmental exposure and a chronic disease outcome that has eventually been established as causal, and may not be capable of doing so in the absence of thorough validation.     

Cosmetic Result and Overall Satisfaction after Minimally Invasive Video-assisted Thyroidectomy (MIVAT) versus Robot-assisted Transaxillary Thyroidectomy (RATT): A Prospective Randomized Study

Background

No studies have compared robot-assisted transaxillary thyroidectomy (RATT) and minimally invasive video-assisted thyroidectomy (MIVAT) regarding cosmetic outcome and satisfaction

Methods

Patients matching the inclusion criteria (benign nodule less than 4 cm and thyroid volume less than 30 mL) were randomly allotted to undergo MIVAT (group A) or RATT (group B). Cosmetic result, overall satisfaction, operative time, and complications were evaluated.

Results

A total of 62 patients underwent hemithyroidectomy (30 in group A and 32 in group B). All patients were women, with the exception of one man in each group. The mean patient age was 36.9 years (group A) and 32.5 years (group B). Total operative time (intubation–extubation) was shorter in group A (71.6 min) than in group B (120.4 min). Complications included one transient laryngeal nerve injury in each group and one subcutaneous hematoma in group B. Postoperative hospital stay was longer in group B (1.85 days) than in group A (1.15 days). On the PASQ questionnaire, “scar appearance” and “satisfaction with appearance” scores were better in group A than in group B. In the Short Form (SF-36) 36-Item Health Survey Questionnaire, domains of “social activity” and “general health” were better in group B than in group A, whereas “bodily pain” scored higher in group B than in group A.

Conclusions

RATT seems not to supersede MIVAT in terms of satisfaction when comparing two groups of patients undergoing thyroidectomy for benign disease.     

The sensory thalamus and cerebral motor cortex are affected concurrently during induction of anesthesia with propofol: a case series with intracranial electroencephalogram recordings

Purpose

Brain imaging studies suggest that loss of consciousness induced by general anesthetics is associated with impairment of thalamic function. There is, however, limited information on the time course of these changes. We recently obtained intracranial electroencephalogram (EEG) recordings from the ventroposterolateral (VPL) nucleus of the thalamus and from the motor cortex during induction of anesthesia in three patients to study the time course of the alterations of cortical and thalamic function.

Clinical features

The patients were American Society of Anesthesiologists physical status I-II males aged 33-57 yr with intractable central pain caused by brachial plexus injury (patient 1 and 2) or insular infarct (patient 3). Anesthesia was induced with propofol (2.5-3.1 mg·kg^?1 over 30-45 sec) followed, after loss of consciousness, by rocuronium for tracheal intubation. The data retained for analysis are from one minute before the start of propofol to 110 sec later during ventilation of the patients’ lungs before tracheal intubation. Spectral analysis was used to measure absolute EEG power. Propofol caused significant increases of cortical and thalamic power in the delta to beta frequency bands (1-30 Hz). These increases of cortical and thalamic power occurred either concomitantly or within seconds of each other. Propofol also caused a decrease in cortical and thalamic high-gamma (62-200 Hz) power that also followed a similar time course.

Conclusion

We conclude that induction of anesthesia with propofol in these patients was associated with concurrent alterations of cortical and sensory thalamic activity.     

The influence of anesthesia-controlled time on operating room scheduling in Dutch university medical centres

Background

Predicting total procedure time (TPT) entails several elements subject to variability, including the two main components: surgeon-controlled time (SCT) and anesthesia-controlled time (ACT). This study explores the effect of ACT on TPT as a proportion of TPT as opposed to a fixed number of minutes. The goal is to enhance the prediction of TPT and improve operating room scheduling.

Methods

Data from six university medical centres (UMCs) over seven consecutive years (2005-2011) were included, comprising 330,258 inpatient elective surgical cases. Based on the actual ACT and SCT, the revised prediction of TPT was determined as SCT × 1.33. Differences between actual and predicted total procedure times were calculated for the two methods of prediction.

Results

The predictability of TPT improved when the scheduling of procedures was based on predicting ACT as a proportion of SCT.

Conclusions

Efficient operating room (OR) management demands the accurate prediction of the times needed for all components of care, including SCT and ACT, for each surgical procedure. Supported by an extensive dataset from six UMCs, we advise grossing up the SCT by 33% to account for ACT (revised prediction of TPT = SCT × 1.33), rather than employing a methodology for predicting ACT based on a fixed number of minutes. This recommendation will improve OR scheduling, which could result in reducing overutilized OR time and the number of case cancellations and could lead to more efficient use of limited OR resources.