Decrease Patient Anxiety Research Articles

YouTube Videos to Create a "Virtual Hospital Experience" for Hip and Knee Replacement Patients to Decrease Preoperative Anxiety: A Randomized Trial.

BackgroundWith declining reimbursement to health care systems, face-to-face time between patients and providers to optimize preoperative education and counseling may be challenging.ObjectiveBecause high patient anxiety prior to surgery has been linked to more severe and persistent pain after joint replacement surgery, the Orthopedic Surgery Department at Mayo Clinic in Florida created a playlist of 16 YouTube videos aimed at creating a virtual hospital experience for primary total hip and knee joint replacement patients. A randomized trial was then performed to evaluate the potential impact of viewing this playlist on preoperative anxiety.MethodsEach patient completed a Generalized Anxiety Disorder (GAD) score assessment at the time of the routine preoperative clinic visit and then randomized based on his/her gender, type of surgery, and initial GAD score to either the control group of standard education (education at face-to-face clinical visits as well as printed educational materials) or the treatment group (standard education plus access to the YouTube playlist). On the morning of the patient’s surgery, the same survey was repeated. Of the 65 patients who consented to participate in the study, 53 completed the study (82%) with 28 of 29 (97% completed) in the control group and 25 of 36 (69% completed) in the treatment group.ResultsOverall, the results showed a trend toward less anxiety in patients who viewed the YouTube videos; this was exhibited by a reduction in the median GAD score by 1 point. This trend is more clearly present in patients with high preoperative anxiety (predominantly women), as seen in the reduction of the median GAD score by 6 points in the treatment group.ConclusionsAlthough our experience is limited, our results indicate that a series of tailored videos may decrease patient anxiety preoperatively. We recommend further exploration of both this concept and the use of social media tools in preoperative patient education.Trial RegistrationClinicaltrials.gov NCT02546180; http://clinicaltrials.gov/ct2/show/NCT02546180 (Archived by WebCite at http://www.webcitation.org/6f6y0Dw7d).

The West German Study Group Breast Cancer Intrinsic Subtype study: a prospective multicenter decision impact study utilizing the Prosigna assay for adjuvant treatment decision-making in estrogen-receptor-positive, HER2-negative early-stage breast cancer

Purpose: The West German Study Group (WSG) Breast Cancer Intrinsic Subtype (BCIST) study was designed to assess the influence of Prosigna gene signature assay results on physicians’ adjuvant treatment recommendations by determining the extent of change in pre-test treatment recommendations following assay results. Secondary objectives were to assess the influence of Prosigna results on physicians’ confidence in their therapeutic recommendations and on patients’ decisional conflict status, anxiety levels, and functional status. Methods: This prospective, observational, decision impact study enrolled consecutive postmenopausal patients with estrogen-receptor (ER)-positive, HER2-negative, lymph-node-negative early-stage breast cancer in 11 centers in Germany. Physicians based their pre-test adjuvant treatment recommendations on standard clinico-pathological parameters. Tumor specimens were assayed using the Prosigna test in a WSG central pathology laboratory following manufacturer’s guidelines. An independent pathology laboratory performed subsequent Prosigna assays on tumor sections to assess assay result concordance with the central laboratory. Physicians completed treatment confidence questionnaires prior to and after receiving Prosigna test results. Patients completed standardized questionnaires on decisional conflict, anxiety, and health status both before and after Prosigna testing. Results: The present study population consisted predominantly of low-to-intermediate risk patients (N = 198). Prosigna had 29.3% discordance in intrinsic subtyping with local immunohistochemistry test results. After Prosigna test results, a change in the adjuvant therapy recommendation occurred in 36 (18.2%) patients; 22 (11.1%) patients switched from no chemotherapy to chemotherapy. After Prosigna test results, physicians expressed increased confidence in their prognostic assessment in 87.9% of patients, and increased confidence in their treatment recommendation in 89.4%. Patients reported improved anxiety and emotional/functional well-being after receiving Prosigna test results. Conclusions: Use of the Prosigna assay led to a change in 18.2% of adjuvant treatment decisions. Prosigna testing was associated with increased patient and physician confidence in treatment decisions, and with decreased patient anxiety and improved well-being. Any comparison of the therapeutic decision-making impacts of different genomic assays must account for potential confounding factors.

A retrospective observational study for the outcomes of women presenting to a colposcopy clinic with a high-grade Pap smear - Implications for a 'see and treat' approach to management.

The current Australian National Health and Medical Research Council guidelines discourage the use of 'see and treat' colposcopic management due to concerns regarding over-treatment. However, this approach has been shown to have benefits in several studies, including cost savings, elimination of loss to follow up and decreased patient anxiety. To provide Australian data on treatment outcomes for women presenting with a high-grade Pap smear to a large metropolitan colposcopy unit and to determine whether a 'see and treat' approach would meet specified standards. Retrospective review of women referred to the Royal Prince Alfred Hospital colposcopy unit with a high-grade smear. Patient data, colposcopy findings, treatment and pathology results were collated and analysed to determine treatment outcomes using the current 'biopsy and treat' approach. The feasibility of 'see and treat' was assessed by determining which women with high-grade colposcopy findings had high-grade disease confirmed on biopsy or excisional specimens. One hundred and thirty-seven women underwent either excisional or ablative treatment. Of those undergoing excisional procedures, 81.3% had high-grade dysplasia or invasive cancer, 11.6% had CIN1 and 7.1% had no dysplasia on histopathology. One hundred and twenty-one with high-grade colposcopy findings had histopathology results available. Using a 'see and treat' approach, 92.6% would have had confirmed dysplasia of any grade, while 91.7% had confirmed high-grade dysplasia. 'See and treat' colposcopy is feasible in the Australian setting when applied to selected patients with high-grade cytology and high-grade colposcopic findings.

Comparing the Patient’s Satisfaction With Educational Performance of the Physicians and the Nurses

Background:: Patient education is one of the most basic patient rights. It has multiple benefits including decreased patient anxiety, increased patient adherence to treatment programs, and ultimately improvement of healthcare service quality. Patients, especially those with chronic conditions, make daily decisions about illness self-management. Given the nature of their professions, physicians and nurses have more responsibility regarding patient education. Objectives:: This study compared patient's satisfaction with educational performance of physicians to that of nurses at Mashhad University of Medical Sciences. Patients and Methods:: This descriptive cross-sectional study was performed in 2013 with 231 patients hospitalized in Mashhad-based hospitals affiliated with Mashhad University of Medical Sciences. Sampling was performed nonrandomly using quota sampling. Data collection tools were a demographic information questionnaire and separate questionnaires for satisfaction with educational performance of physicians and nurses. Data were analyzed in SPSS (11.5) using t- and Wilcoxon’s tests. Results:: There were 231 participants (men: 55.3%). Of them, 58.9% of the patients were satisfied with educational performance of nurses and 50.6% were satisfied with that of physicians. To compare satisfaction with physicians’ (66.2 ± 23.4) and nurses’ (74.1 ± 24.1) educational performances, mean total satisfaction points out of 100 were obtained. Independent t-test showed a significant difference in this regard (P = 0.02). Conclusions:: Nurses and physicians’ educational roles should be examined in the authors’ healthcare system. Further surveys are needed to find and assess individual and organizational approaches to improve physicians’ and nurses’ educational performances.

Alternative Therapies for the Prevention of Postoperative Nausea and Vomiting.

Postoperative nausea and vomiting (PONV) is a complication affecting between 20 and 40% of all surgery patients, with high-risk patients experiencing rates of up to 80%. Recent studies and publications have shed light on the uses of alternative treatment for PONV through their modulation of endogenous opioid neuropeptides and neurokinin ligands. In addition to reducing PONV, hypnosis was reported to be useful in attenuating postoperative pain and anxiety, and contributing to hemodynamic stability. Music therapy has been utilized to deepen the sedation level and decrease patient anxiety, antiemetic and analgesic requirements, hospital length of stay, and fatigue. Isopropyl alcohol and peppermint oil aromatherapy have both been used to reduce postoperative nausea. With correct training in traditional Chinese healing techniques, acupuncture (APu) at the P6 acupoint has also been shown to be useful in preventing early PONV, postdischarge nausea and vomiting, and alleviating of pain. Electro-acupuncture (EAPu), as with APu, provided analgesic and antiemetic effects through release and modulation of opioid neuropeptides. These non-pharmacological modalities of treatment contribute to an overall patient wellbeing, assisting in physical and emotional healing.

Survey Analysis of an Ambulatory Surgical Checklist for Patient Use

Although checklists are used as tools for providers, they have not been adequately explored as tools for patients. The purpose of this study was to survey the stakeholders on the usefulness of an ambulatory surgical checklist for patients. We performed a cross-sectional study through a survey designed to include both patients and providers. Descriptive analysis of the data was performed based on responses from 35 patients and 52 providers. Overall, 94% of patients and 83% of providers thought the checklist would be beneficial for patients. In addition, 37% of providers indicated potential barriers to checklist implementation, including fear of confusing the patient, making patients doubt the care they were receiving, taking too much time, and lack of resources. Based on survey responses, the study suggests that the ambulatory surgical checklist can potentially facilitate patient education, enable more active patient participation, increase patient satisfaction, and decrease patient anxiety.

Does Listening to Music During Office-Based Flexible Cystoscopy Decrease Anxiety in Patients: A Prospective Randomized Trial.

To validate the effect of listening to music on perceived anxiety and pain during office-based flexible cystoscopy using the State-Trait Anxiety Inventory (STAI) and the Visual Analog Scale (VAS), in a well-matched North American veteran patient population in a prospective, randomized fashion. A total of 137 veteran patients receiving routine urologic care in a North American Veterans Affairs (VA) healthcare system were recruited over a 2-year period (June 2011 to June 2013). All patients were prospectively randomized to undergo office-based flexible cystoscopy with or without music. The music group consisted of 73 patients who listened to the same excerpt of classical music at the time of flexible cystoscopy; the nonmusic group consisted of 64 patients. The median postprocedural STAI anxiety scores between the music and nonmusic groups were statistically significantly different: 30 (range 23-39) and 35 (range 28-49), respectively (P=0.0017). The median postprocedural pain VAS score between the music and nonmusic groups reached statistical significance: 0 (range 0-1) and 2 (range 1-2), respectively (P<0.0001). The median delta STAI anxiety score was statistically significantly different between the music and nonmusic groups: 0 (range -3-0) and 2 (range 0-4), respectively (P<0.0001). This study demonstrates that listening to music decreases anxiety and pain associated with flexible cystoscopy in a North American VA patient population. We recommend incorporating music as an effective adjunct to other maneuvers used at the time of flexible cystoscopy to reduce anxiety and pain.

Considerations for submucosal midazolam administration in combination with oral and inhaled medications for sedation of pediatric dental patients.

Sedation allows patients to maintain their airway independently and respond appropriately to physical stimulation and verbal command while maintaining a minimum depressed level of consciousness. Drugs commonly used for sedation of pediatric dental patients include a combination of chloral hydrate, hydroxyzine, and nitrous oxide-oxygen. Midazolam is a benzodiazepine and currently one of the most commonly used intravenous sedative agents. It can be easily titrated to provide a wide range of sedation, from conscious sedation to deep sedation, and exhibits a wide safety margin without severe respiratory and circulatory depression. At an appropriate dose, it also decreases patient anxiety and induces amnesia. We found that the submucosal administration of midazolam combined with chloral hydrate provided increased sedative effects and decreased the postoperative vomiting response compared with conventional chloral hydrate administration, with no significant difference in physiological responses. The depth of sedation can be titrated using this technique.

Subconjunctival hemorrhage after intravitreal injection of anti-vascular endothelial growth factor.

To investigate the risk factors for subconjunctival hemorrhage (SCH) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) and evaluate the relationship between hemodynamic status at the time of injection and SCH. We retrospectively reviewed the medical records of 598 cases of 173 patients who underwent intravitreal injection of ranibizumab whose hemodynamic status was monitored at the time of the injection. Cases with SCH after the injection were included in the SCH group. We compared systemic factors, including the hemodynamic status between the SCH group and the control group. The SCH group included 67 cases and the control group included 531 cases without SCH. Baseline hemodynamic status was not significantly related to development of SCH. However, systolic blood pressure (BP) at injection was a significant risk factors for SCH (P = 0.034). Elevated systolic BP, mean arterial pressure (MAP), and pulse rate from baseline to time of injection were significantly related to the development of SCH (P = 0.011, P = 0.014, P = 0.036, respectively). In multivariate analysis, hypertension, a large change in MAP, and a fewer previous injections were significant risk factors for SCH after intravitreal injection (P = 0.030, P = 0.032, P = 0.028, respectively). Hemodynamic risk factors exist for SCH after intravitreal injection of anti-VEGF. To reduce the risk of SCH, strategies should seek to decrease patient anxiety, especially in those with hypertension.

Do patients with neurologically isolated ocular motor cranial nerve palsies require prompt neuroimaging?

Do patients with neurologically isolated ocular motor cranial nerve palsies require prompt neuroimaging?

Surgeon-Performed Ultrasound-Guided Fine-Needle Aspiration Cytology (SP-US-FNAC) Shortens Time for Diagnosis of Thyroid Nodules

Ultrasound-guided fine-needle aspiration cytology (US-FNAC) of thyroid nodules is an important diagnostic procedure. In most hospitals, patients are referred to radiologists for US-FNAC, but this often results in a long waiting time before results are available. Surgeon-performed US-FNAC (SP-US-FNAC) during the initial patient consultation attempts to reduce the waiting time but it is not known whether this is as accurate as radiologist-performed US-FNAC (RP-US-FNAC). The aim of this study is to compare the clinical efficiency between SP-US-FNAC and RP-US-FNAC. A retrospective study was performed on patients from the Department of General Surgery, Tan Tock Seng Hospital (TTSH) who underwent an US-FNAC from August 2011 to May 2012. All cases of SP-US-FNAC were performed by a single surgeon. This study compared the rates of positive diagnoses achieved by SP-US-FNAC and RPUS- FNAC as well as the time interval to reach a cytological diagnosis by each group. A total of 40 cases of SP-US-FNAC and 72 cases of RP-US-FNAC were included in the study. SP-US-FNAC resulted in 28 (70%) positive diagnoses and 12 (30%) nondiagnoses while RP-US-FNAC resulted in 47 (65.3%) positive diagnoses and 25 (34.7%) non-diagnoses. These results were comparable (P=0.678). The median time taken to reach a cytological diagnosis was 1 working day for SP-US-FNAC and 29.5 working days for RP-US-FNAC resulting in a shorter interval to reaching a cytological diagnosis for SP-US-FNAC (P<0.001). In the workup of thyroid nodules, SP-US-FNAC is as accurate as RP-US-FNAC but significantly reduces the time taken to reach a cytological diagnosis. This leads to greater clinical efficiency in the management of patients with thyroid nodules, which in turn leads to other benefits such as decreased patient anxiety and increased patient satisfaction.

Early Discussion of Breast Density and Supplemental Breast Cancer Screening: Is it Possible?

The purpose of this study is to determine whether it is possible to make breast cancer screening more efficient in those with dense breasts. Over 12 states require that patients with dense breasts receive notification about their breast density in lay letters that are sent after the screening mammogram. Some of these letters advise patients to speak with their primary care providers about the possibility of supplemental breast cancer screening. We sought to determine whether primary care providers can discuss breast density and recommend supplemental breast cancer screening using the density of the previous mammography. This would reduce the burden of additional appointments and might increase the number of patients choosing to have supplemental screening. The mammographic breast density of 250 consecutive patients from May 2011 to September 2011 was compared with the immediate prior mammogram. Patients whose prior mammograms were more than 36months prior or less than 8months prior to the current exam were excluded, leaving 217 patients. The proportion of patients with breast density change was analyzed. The concordance of breast density between the two exams was assessed and the effects of patient age and the length of time between mammograms were examined. The breast density of the current and most recent prior mammogram was stable for 86.6% of patients. Neither age nor length of time between mammograms affected concordance. Primary care providers can decrease the need for multiple appointments and decrease patient anxiety by discussing breast density and screening choices prior to the patient's screening mammography. The great majority of patients will receive the correct information about their breast density by using a prior report.

Satisfying the needs of Japanese cancer patients: A comparative study of detailed and standard informed consent documents

Simplified informed consent forms have been successful in improving patient satisfaction and decreasing patient anxiety. However, unsolved problems remain about whether these documents improve comprehension and satisfaction of patients with standard literacy skills. s To investigate whether a detailed consent form explaining the key elements of informed consent, in comparison to a standard consent form, would increase the comprehension and satisfaction of adult cancer patients. Patients who were eligible for the National Surgical Adjuvant Study of Breast Cancer (protocol 01(N-SAS/BC-01)) were randomly selected to receive one of the following four versions: detailed document with graphics, detailed document without graphics, standard document with graphics, and standard document without graphics. The forms were written in plain language from the patients' point of view. A total of 85 patients were administered questionnaires via interview to assess levels of comprehension, satisfaction, and anxiety. Patients demonstrated a strong understanding of information regarding treatment and research. Patient comprehension did not differ significantly between the detailed document arms and the standard document arms. Patient satisfaction level increased according to the amount of information presented in the consent form; most patients preferred the detailed document with graphics. Anxiety and accrual rates in the parent study were not affected by informed consent procedures. Findings were limited to adults who had standard literacy skills and may not be generalizable to a population with lower literacy. Informed consent can be a significant experience for a population with standard literacy skills, as long as the document is easily comprehensible. Such information should be provided in a format that corresponds with patient needs, education levels, and preferences.

Interactive Web-Based Tool for Pelvic Organ Prolapse: Impact on Patient Understanding and Provider Counseling

To compare standard counseling (SC) versus an interactive patient/provider counseling process using a web-based tool (iPad™) on patient understanding, anxiety, and satisfaction regarding prolapse symptoms. Randomized controlled trial. University of North Carolina Hospital. Ninety women with vaginal bulge symptoms presenting for a new patient visit were needed to detect a 30% difference in improvement in understanding using SC versus SC plus iPad™. Women completed a questionnaire before and after a new patient visit regarding satisfaction with pelvic organ prolapse knowledge and related anxiety. After a new patient visit, subjects were randomized to SC, or SC plus use of an iPad™ interactive application. After counseling, women were surveyed on satisfaction with the counseling method. Ninety women were randomized to either SC (n=44) or SC with iPad™ (n=46). At baseline, 47% of women reported being satisfied/extremely satisfied with their understanding of bulge symptoms (50% SC vs 43.5% SC plus iPad™, p=.5). After counseling, both groups reported increased satisfaction with understanding of bulge symptoms (p<.0001) with no difference seen between counseling methods (42/44 (95.5%) SC vs. 45/46 (97.8%) SC with iPad™, p=.5). Baseline anxiety regarding bulge symptoms was high, with 65.9% and 73.9% of women in the SC and SC with iPad groups respectively reporting moderate/extreme anxiety (p=.4). After counseling, rates of moderate/extreme anxiety decreased significantly in both groups (p<.0001) with similar improvement between groups (31.8% SC vs 28.3% SC plus iPad, p=.7). Women were equally satisfied with either counseling method (43/44 SC vs 46/46 SC plus iPad™, p=.3). Use of iPad™ did not significantly change counseling time (9.5 min. SC vs. 8.9 min. SC plus iPad, p=.4). Interactive patient/provider counseling, with or without iPad™ use, was significantly associated with increased patient satisfaction with understanding of bulge symptoms and decreased patient anxiety. The iPad™ was easily integrated into the counseling sessions.

Randomized Controlled Trial Demonstrates a Web-based Multimedia Program Used Prior to First-Time Colonoscopy Decreased Patient Anxiety, Sedation Requirement, and Procedure Time While Increasing Knowledge

Purpose: Colonoscopy for colorectal cancer screening is an elective and voluntary medical procedure with participation, quality, and success dependent in part on patient understanding and cooperation. We explored the impact of a web-based multimedia patient engagement program on patient anxiety, perception, and knowledge about the colonoscopy in addition to procedure outcomes. Methods: We conducted a randomized controlled trial comparing a control group that received our institution's standard pre-procedure colonoscopy packet with an experimental group that watched a web-based multimedia patient engagement program (Emmi Solutions) in addition to receiving the same pre-procedure packet. All patients over age 18 scheduled for first-time colonoscopy on an elective outpatient basis were eligible. Patients were required to have watched the educational program prior to their scheduled procedure in order to participate in the experimental arm. On the day of colonoscopy, participants in both groups were asked to fill out the same survey prior to their procedure. The survey included questions to assess demographics and knowledge of colonoscopy, in addition to the State Trait Anxiety Inventory (STAI), a validated assessment of anxiety. We also collected procedure specific data including conscious sedation medication doses, quality of prep, and cecal/ileal intubation rates. Statistical comparisons were performed using the Mann-Whitney U and Fisher's exact test. Results: The control (n=51) and experimental (n=52) groups were demographically similar with the exception that a greater proportion of the experimental group had a graduate degree (p<0.005). More than half (58%) of patients in the experimental group reported that the intervention reduced their anxiety about the procedure. The STAI score was significantly lower in the experimental group compared to the control group (35.4 vs 40.4, p=0.026). Patients in the experimental group correctly answered the knowledge questions more often than the control group (82% vs 74% correct, p<0.001). There was no statistical difference in the rate of cecal or ileal intubation or the quality of preparation. Patients who viewed the web-based program required less midazolam on average (3.66 mg vs 4.46 mg, p=0.0035) and procedures were overall shorter (24.8 vs 29 minutes, p=0.024). Conclusion: A web-based multimedia patient engagement program watched prior to colonoscopy significantly decreased patient anxiety, sedation medication requirements, and procedure time while increasing knowledge. This easy intervention could not only help patients understand and feel more comfortable about colonoscopy, but increase efficiency and decrease cost by saving time and using lower doses of sedative medications. Disclosure - Dr. Siegel - Advisor: Emmi Solutions, LLC.

La efectividad de una intervención enfermera sobre la ansiedad del paciente ante la transfusión de concentrado de hematíes

To evaluate the effectiveness of an educational intervention regarding anxiety and satisfaction in patients requiring a red blood cell transfusion. Randomised, controlled, single-blind clinical trial in patients requiring a packed red blood cell transfusion. alpha=.05, beta=.10, to detect a 10% difference, 70 subjects in each group. The sampling recruitment was randomised to the intervention group (IG) and the control group (CG). an intervention protocol with oral and written information using a published guide on the safety, risks and benefits of haemotherapy for the IG, and an equivalent one on general health topics for the CG. pre- and post-anxiety state; Spielberger's validated questionnaire: STAI. Satisfaction, by an ad hoc questionnaire. Sociodemographic and clinical variables: description, reason for transfusion, prescription knowledge, incidents, records. There was a total of 144 subjects, 73 (50.69%) in the IG, and 71 (49.31%) in the CG. The mean age was 55.80 years, with 56.94% males, and a first transfusion in 52.08%. Comparability between the IG and the CG was tested and confirmed. The decrease in anxiety after the intervention for the IG was 19.99, compared to 25.48 in CG. The difference was greater than the proposed 10%, and was statistically significant. The preference for information was 98.60% in IG, compared to 43.70% in CG. The hypothesis was confirmed; a protocolised nursing educational intervention protocol increased patient satisfaction with nursing care, and decreased patient anxiety, thus preventing complications and providing greater safety to the users.

Eliminating Visiting Hour Restrictions in Hospitals

Hospitals typically restrict visiting hours to ensure a restful environment for patients and to allow clinical staff to work. With increased public reporting focused on patient satisfaction and renewed efforts to improve patient and family engagement, hospitals may want to consider evaluating their current restrictions on visitation. Liberal visitation practices can decrease patient anxiety and benefit patients and families. Morristown Medical Center, a 690-bed tertiary acute care facility and a 78-bed rehabilitation hospital, initiated a 24-h visitation policy. With input from nurses, physicians, administrators, and security, we developed a policy that emphasizes patient and staff safety and places the patient at the center of decision making. Comparison of patient satisfaction scores before and after the open visitation policy was implemented, which was made using the chi-square test. In the first 8 months of the open visitation policy, the medical center received 14,444 "after-hours" (8:00 p.m. to 5:00 a.m.) visitors. During this period, there was no increase in the number of complaints from patients or visitors. Incidence of security events did not change, despite the higher number of visitors. Patient satisfaction scores rose on both a commercial satisfaction survey and on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Unit staff received fewer phone calls for patient updates and acknowledged that the experience had been positive. Our experience suggests that implementation of open visitation at acute care and long-term care institutions can be accomplished with little disruption, is well utilized by visitors, improves the patient and family experience, and is generally accepted by hospital staff.

Evaluation of a cystic fibrosis transition program from pediatric to adult care

As the cystic fibrosis (CF) patient population median survival increase, the need for transitioning their care to adult care centers increase as well. We have a structured transition program since the early 1980s. The purpose of this study is to evaluate the experiences and opinions of patients in our adult CF center who went through a formal transition versus those who did not, in an attempt to evaluate the overall process and to identify means for improvement. A questionnaire was given to adult CF patients at the University of Michigan during a clinic visit or inpatient hospitalization, after consent was obtained. Inclusion criteria included diagnosis of CF in childhood, previous care in a pediatric center, and current participation in our adult CF clinic. A total of 91 patients completed the questionnaire. 44 went through our structured transition program. On average, patients who participated in a formal transition process had higher satisfaction with both CF programs, perceived health status, and independence but no differences in their level of anxiety about transferring to the adult program. Patient opinions regarding when to transfer care were considered more often in patients who participated in a transition program (88% vs. 62% and P = 0.02). Although structured transitions programs do not appear to decrease patient anxiety during this stressful period, it does appear to improve patient satisfaction, perceived health status, and independence. These findings suggest that establishing a transition program could be important in optimizing patient health, continuity of care and improving adherence.

The Blitz Anesthesia Technique in Non-English Speaking Patients Undergoing Glaucoma Surgery.

AimTo describe a less invasive method of providing anesthesia in non-English speaking patients undergoing glaucoma surgery.Settings and designProspective observational study conducted in a tertiary Care Eye Institute, Wills Eye Institute, Philadelphia, PA, USA.Materials and methodsThe blitz anesthesia technique was applied to 15 non-English speaking patients (Vietnamese, Mandarin, Russian and Korean) during glaucoma surgery. With input from family members, a diagram was created for each patient. The diagram consisted of a translation and phonetic guide to pronunciation of common words or phrases in the patient’s native language that might be used by the surgical team during the operation.ResultsThe blitz anesthesia technique worked well to provide patient comfort during the procedures. All patients reported adequate pain control and described their experience as comfortable. Additionally, patients reported feeling reassured that they were able to understand basic information from the surgical team during their case. This technique decreased patient anxiety prior to and during the surgical procedure.ConclusionBlitz anesthesia provided adequate pain control with no complications.Key messageBlitz anesthesia with a phonetic language diagram, a less invasive technique of providing anesthesia in non-English speaking patients undergoing glaucoma surgery.How to cite this article Almodin J, Ichhpujani P, Prasad A, Fudemberg SJ, Moster MR. The Blitz Anesthesia Technique in Non-English Speaking Patients Undergoing Glaucoma Surgery. J Current Glau Prac 2012;6(2):91-93.

Treatment of Hammertoe Deformity Using a One-piece Intramedullary Device: A Case Series

Hammertoes are common deformities that are often surgically treated using arthrodesis or arthroplasty of the proximal interphalangeal joint with percutaneous, temporary Kirschner wire fixation. However, percutaneous Kirschner wire fixation is associated with potential complications, including wire migration, breakage, and pin tract infection. Furthermore, the complications of pseudoarthrosis and nonunion are seen using this technique owing to a lack of rotational control of the Kirschner wire. Another drawback of this implant is the need for wire removal and the associated patient anxiety with this in-office procedure. In the present series of 7 toes in 3 patients, we describe an alternative method of hammertoe fixation using a permanently implanted, 1-piece intramedullary device used to stabilize the proximal interphalangeal interface. The potential advantages of this prosthesis include elimination of wire migration and breakage, enhanced control and stability of the digit, elimination of potential pin tract infection, and decreased patient anxiety since hardware removal is not required. The patients were followed up for approximately 1 year after the surgery, and no intraoperative or postoperative complications were observed. The implant maintained proper clinical and radiographic alignment throughout the observation period, without implant failure or breakage. All patients were satisfied with the cosmetic appearance of their surgically corrected toes and were able to perform all activities of daily living without the use of assistive devices. Also, their postoperative pain and function were acceptable. The implant used in the patients described in the present report appears to be a viable alternative for the treatment of hammertoe.