Evaluation Rating Scale Research Articles

Assessing psychosocial vulnerability and care needs of pretransplant patients by means of the INTERMED.

We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation. One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Åsberg Depression Rating Scale (MADRS), and Hospital Anxiety & Depression Scale (HADS). We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS,MADRS, and mental and physical health scores of the SF-36 Health Survey. The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.

Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease

Retrospective study. For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative spine disease. A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0±3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5-S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous spine surgeries, or postoperative complication rate. The incidence of L5-S1 pseudarthrosis after 1year in the S1, iliac, and plate groups was 19, 0, and 29%, respectively (p<0.05 iliac vs. plate). The incidence of screw loosening after 1year in the S1, iliac, and plate groups was 22, 4, and 43%, respectively (p<0.05 iliac vs. plate). Average Oswestry scores after 1year in the S1, iliac, and plate groups were 40±18, 42±20, and 58±18, respectively (p<0.05 both S1 and iliac vs. plate). The surgical treatment of multilevel degenerative spine disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.

Performance analysis on physical simulator of four different instrument setups in laparo-endoscopic single-site (LESS) surgery

Over the past decades, minimally invasive surgery has undergone continuous development due to the demand for scarless results, with laparo-endoscopic single-site (LESS) surgery constituting one of today's most favored alternatives. In this study, we aim to assess the relative technical difficulty and performance benefits of dynamic articulating and pre-bent instruments, either combined with conventional laparoscopic tools or not, during the completion of two basic tasks hands-on simulator. A total of 20 surgeons were included and performed two basic simulator tasks-coordination and cutting-carried out using four different combinations of LESS-designed and straight conventional laparoscopy instruments. Assessment took place before and after the completion of a 14-week training program. Performance data were objectively analyzed over video recordings with an adapted global rating scale (a-GRS) for performance evaluation, combined with a registry of total trial completion time. In the coordination task, the worst performance scores (p < 0.001) and longest completion times (p < 0.001 on first assessment and p < 0.01 on last assessment) were obtained with the two dynamic articulating tip instruments. On the cut trials, no significant differences between the different setups were found in a-GRS scores. The two dynamic articulating tip instruments also constituted the most time-demanding setup on both assessment trials (p < 0.05). The use of two dynamic articulating tip instruments showed significant improvement with training in all measured parameters except for performance in the cut task, in which the increase in a-GRS score was not significant. We conclude that the least adequate instrument set for initiation in LESS surgery is the one that combines two dynamic articulating tip instruments, as this has consistently obtained the worst results in all trials. Further data on more complex tasks and on a complete learning and skills-acquisition program must be obtained to confirm these findings.

Board 348 - Research Abstract Validation of the Mayo High Performance Team Work Scale and Ottawa Crisis Resource Management Global Rating Scale for Evaluation of Crisis Team Training (Submission #472)

Board 348 - Research Abstract Validation of the Mayo High Performance Team Work Scale and Ottawa Crisis Resource Management Global Rating Scale for Evaluation of Crisis Team Training (Submission #472)

A Comparison of the Autism Treatment Evaluation Checklist (ATEC) and the Childhood Autism Rating Scale (CARS) for the Quantitative Evaluation of Autism

The purpose of this study was to evaluate scores generated from the Autism Treatment Evaluation Checklist (ATEC), a parent–rated measure, and those derived from professionally completed Childhood Autism Rating Scale (CARS) evaluations. A cohort of 56 participants diagnosed with an autism spectrum disorder was used for the study, and each child was evaluated independently by the parent using the ATEC and a health care professional using the CARS. The Spearman's rank correlation statistic ρ was used to evaluate the correlation between ATEC and CARS scores. It was observed that there was a significant correlation between total ATEC and CARS scores (ρ = .71). Specific domains in the ATEC evaluation significantly correlated with CARS scores. Sensitivity, specificity, and receiver operating characteristic confirmed the association between CARS and ATEC domains. The results help to validate the utility of the parentally completed ATEC in comparison with an established, professional-related measure of autism.

Präoperative Evaluation des Körperkonzepts von Nierenlebendspendern und -empfängern

The psychosocial evaluation of the body concept of living kidney donors and recipients is part of a general psychosocial assessment as well as the early detection of organ integration disorders. From 2010 to 2011 we investigated the eligibility for living kidney donation in 36 living kidney donors and 36 recipients using a semistructured clinical interview and the German version of the Transplant Evaluation Rating Scale (TERS). In addition, we used the Fragebogen zum Körperbild (FKB-20) to evaluate body concept. Living kidney donors and recipients differed in their body concept. Living kidney recipients described a body-centered disturbance stemming from a reduction of body-intensive activities including destabilization of body concept. The psychological coping process involved in living kidney donation demands a reconstitution of the body self. The coping/health behavior and the affective state of living kidney recipients are protective factors that influence successful organ integration.

Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction

BackgroundSolid-organ transplantations (SOT) are usually life-saving high-tech medical procedures. The transplantation itself and the intensive care unit stay could be traumatic stressors triggering posttraumatic stress symptoms (PTSS). Our retrospective follow-up study aimed to explore preoperative risk factors of PTSS in a cohort of SOT recipients, and we investigated how PTSS are associated with health-related quality of life (HRQOL) and life satisfaction.Methods126 SOT recipients were enrolled in this investigation. Psychiatric examination of all SOT candidates based on the Transplant Evaluation Rating Scale was carried out before SOT, and after SOT, recipients completed the PTSS-10, the SF-36 and the FLZ.ResultsAfter the surgical intervention 19 (15.1%) SOT recipients had clinical significant PTSS. Preoperative risk factors for developing postoperative PTSS were: 1.) preexisting psychiatric morbidity, 2.) history of retransplantation, 3.) chronic benzodiazepine consumption, 4.) age, and 5.) type of transplantation.SOT-related PTSS were associated with maximal decrements in HRQOL and life satisfaction. The following HRQOL and life satisfaction domains were affected: Physical Functioning, Role Physical, Pain, General Health, Vitality, Social Functioning, Role Emotional, Mental Health, Occupation/Work and Character/Own Skills.ConclusionSOT recipients may face a major risk of transplantation- and treatment-related PTSS and the development of impairments to HRQOL and life satisfaction.

Overall mental distress and health-related quality of life after solid-organ transplantation: results from a retrospective follow-up study

BackgroundOur retrospective follow-up study aimed to explore the degree of overall mental distress in a cohort of solid-organ transplantation (SOT) recipients after liver, heart or lung transplantation. Furthermore, we investigated how overall mental distress is linked to health-related quality of life.Methods123 SOT patients treated during the study period were enrolled in this investigation at a mean of 24.6 months (SD=11.6) after transplantation. Before transplantation, the Transplant Evaluation Rating Scale (TERS) was used to classify the level of adjustment in psychosocial functioning among transplantation candidates. After transplantation, recipients completed a research battery, which included the SCL-90-R, and the SF-36.Results39 (31.7%) transplantation recipients had clinically significant overall mental distress as measured on the Global Severity Index of the SCL-90-R. Obsessive-compulsive symptoms (92.3%), somatization symptoms (87.2%), anxiety symptoms (84.6%), depression symptoms (82.1%) and phobic anxiety symptoms (69.2%) were a frequent finding.Transplantation recipients with overall mental distress had significant lower levels of adjustment in psychosocial functioning before transaplantation than those without overall mental distress as measured in the TERS. Transplantation-related overall mental distress symptomatology was associated with maximal decrements in health-related quality of life.ConclusionTransplantation recipients may face major transplantation- and treatment-related overall mental distress and impairments to their health-related quality of life. Further, overall mental distress is a high-risk factor in intensifying impairments to patients’ overall quality of life.

Heart-Transplantation: Psychiatric Comorbidity, Adherence, Coping and Qol in Patients and their Spouses - Results of a Prospective Longitudinal Study

Introduction: Lack of adherence to medication is the second most common reason for organ failure in patients after heart-transplantation (HTx). Aim of the current study is to identify possible predictors of post TX non-adherence at a pre-transplant stage that refer to psychological variables in patients and their spouses. Methods: Patients listed for HTx were evaluated pre HTx every three months, immediately after HTx and six months thereafter. Adherence pre HTx was measured by TERS (Transplant Evaluation Rating Scale) and a structured interview. Coping with illness was assessed using the “Trierer Skalen zur Krankheitsbewältigung”. Depression, anxiety, and QoL in patients and spouses were assessed by PHQ-D, HADS-D and SF-36. Furthermore, we assessed “dyadic coping”, repressive coping (SDS), protective buffering (BSSS), alexithymia (TAS-20) and social support. Adherence post HTx was assessed using the Medication Experience Scale for Immunosuppressants (MESI). Results: To date, n=33 patients have been evaluated. There is a high correlation between the TERS and the MESI (.85; p= .034). Especially patients listed as “highly urgent” can be categorized as “risk patients” or “patients with concern” regarding non-adherence measured by TERS. Further results, including results on the spouses, will be presented at the symposium. Conclusion: These results indicate that TERS pre HTx is a powerful predictor of post HTx adherence measured by MESI. Further longitudinal data will allow to identify additional predictive variables for non-adherence post HTx, and to determine adequate screening-instruments to identify risk patients. Furthermore, this will allow to design tailored early-stage perioperative psychosomatic interventions for patients and their spouses.

A Rating Scale for Gait Evaluation in Cognitive Deterioration (RSGE-CD): Validation Study

A relationship between decline in mobility and walking performance and cognitive impairment exists in the elderly. Therefore, clinical assessment of gait and mobility may be relevant for diagnostic and therapeutic purposes. However, the rating scales used for evaluation of gait disorder in the context of cognitive deterioration were not designed or validated for that setting. The present study was aimed at checking the clinimetric properties of the Rating Scale for Gait Evaluation in Cognitive Deterioration (RSGE-CD), specifically developed for assessment of gait dysfunction across all stages of cognitive decline. Two hundred fifty six subjects were included in the study and classified according to the Global Deterioration Scale (control, subjective/mild cognitive impairment, or dementia). Patients with dementia had a diagnosis of probable Alzheimer's disease (73%) or dementia of combined etiology (27%). Cognitive and functional evaluations, the Tinetti scale, and timed tests were simultaneously applied with the tested scale, which is composed of two subscales: Functional ability and Examination. Exploratory factor analysis showed one factor (70% of the variance). Floor effect and skewness were observed in the control group, whereas internal consistency (Cronbach's alpha = 0.88-0.95), inter-observer and test-retest reliability (intraclass correlation coefficients ≥ 0.97) were satisfactory. Convergent validity with the other measures was ≥ 0.60 and the discriminant validity according to classification of subjects by cognitive state and other aspects was also satisfactory (p = 0.0001). The RSGE-CD showed low standard errors of measurement. In this first validation study, the RSGE-CD showed satisfactory clinimetric attributes for assessing gait and mobility across the complete range of cognitive state.

Comparison between the spastic paraplegia rating scale, Kurtzke scale, and Osame scale in the tropical spastic paraparesis/myelopathy associated with HTLV

The objective of this study was to compare Osame's scale of motor incapacity and the expanded scale of the state of incapacity of Kurtzke with the spastic paraplegia rating scale for the clinical evaluation of patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Patients with the diagnosis of infection by HTLV-I/HTLV-II and with the clinical suspicion of HAM/TSP were included in the study. There were 45 patients who were evaluated. When analyzing the results of the scales, the researchers found the following averages of 21.08 points for the spastic paraplegia rating scale, 4.35 points for Osame's scale, and 4.77 points for Kurtzke's scale. The relation between the scale of paraplegia with Osame's was very significant with p < 0.0001, and regarding Kurtzke's scale, there was a similar result of p < 0.0001. When comparing Osame's, Kurtze's, and the spastic paraplegia rating scale with the time of disease, the researchers found a significant result of p = 0.0004 for the scale of spastic paraplegia, p = 0.0018 for Osame's scale, and p < 0.0001 for Kurtzke's scale. The spastic paraplegia rating scale has a good relation with Osame's and Kurtzke's scales showing a p index that is very significant that indicates that, although the scale was not initially made to be applied to patients with HAM/TSP because of the infection by HLTV, it showed to be as efficient as Osame's and Kurtzke's scales in evaluating the patients' neurological conditions.

The Role of Cognitive Impairment in the Use of the Diskus Inhaler

Drugs delivered by metered-dose inhalers and dry powder inhalers (DPIs) are a mainstay in the treatment of chronic lung disease; however, previous studies suggest cognitive impairment hinders proper use of inhalers. The purpose of this study was to determine the relationship between the score on the Mini-Mental State Exam (MMSE) and the ability of nursing facility residents to complete the steps required for proper use of a multiunit-dose DPI (Diskus). Nursing facility residents who had never used a multiunit-dose DPI (Diskus), who scored between 10 and 24 inclusive on the MMSE, and who were able to hold a breath for 10 seconds were recruited for an observational study to test their ability to use a placebo-loaded Diskus when supervised and assisted by personnel trained in the proper use the Diskus. Ability to use the DPI was assessed by the Diskus Evaluation Rating Scale (DERS), an instrument developed specifically for this study. Possible scores on the DERS ranged from 0 to 19, with a score of 0 indicating no limitations in any of the steps involved in using the Diskus and 19 indicating inability to do any of the steps after 3 supervised attempts. Forty Diskus-naïve nursing facility residents (86 ± 9 years of age; 32 women) with MMSE scores between 10 and 24 inclusive and the ability to hold a breath for 10 seconds were enrolled in the study. Mean MMSE scores were 17.4 ± 4.2, whereas the mean score on the DERS was 5.1 ± 3.2 (range 1-16). After controlling for age, gender, and education, a significant inverse relationship was noted between scores on the MMSE and the DERS such that for every 1-point increase on the MMSE, the subject's DERS score decreased by 0.345 points (P = .003). Overall, 38 of the 40 subjects with MMSE scores between 10 and 24 inclusive were able to use the Diskus successfully. For MMSE scores, the better the performance on the MMSE, the better the performance on the DERS. More important, 95% of the subjects in this study could use the Diskus successfully when properly supervised. In contrast to earlier studies, these findings suggest that a multiunit-dose DPI can be prescribed as one component of the regimen for chronic lung disease in patients with substantial cognitive impairment.

Relations between dental and somatic pain in children

To study relations between somatic and dental pain complaints among children who attend a university pediatric dental clinic. Forty-seven boys, 32 girls aged 4-13 years (mean age 8.41 +/- 2.29 years) participated in the study. Demographic information was obtained from the parents. Children were asked if they had experienced any dental pain during the previous week, the time of day the dental pain had appeared, and their actions when pain had been felt. Then, children were asked to complete a Pain Rating Scale for subjective evaluation of pain regarding various potentially painful organs. The majority of the children suffered headaches, stomachaches, and leg pains, regularly. The younger children, aged 4-7 years, significantly reported more ear and stomach pains than the older group, aged 8-13. Significantly, more children who suffered from dental pain also reported more stomachaches. Firstborn and second children had significantly less current dental pain, compared with third children or more. The results of our study suggest that children with dental pain suffer more often of stomachaches than children without dental pain. This may occur because these children are possibly more anxious about a potential treatment.

Measuring Collaborative Consultation Practices in Natural Environments

This article describes the development of the Triadic Intervention and Evaluation Rating Scale (TIERS), a 33-item instrument designed to evaluate patterns of parent, service provider, and child interactions during early intervention sessions conducted in natural environments. Twenty-eight parent—provider—child triads were videotaped in home and playgroup settings, quarterly over a 15-month period. Segments representing complete routines were selected and rated by service providers and research personnel. Scoring and scaling models were developed to evaluate the quality of triadic interactions during early intervention sessions. The TIERS (a) measured differences in providers’ use of collaborative consultation strategies and parents’ level of participation with service providers and their children; (b) distinguished features inherent in different sessions; (c) was easy to administer; and (d) showed appropriate psychometric properties. With additional validation efforts, this instrument may be used to evaluate the implementation of collaborative interactions between parents and early intervention service providers in natural environments.

Prospective Quality-of-Life Monitoring of Simultaneous Pancreas and Kidney Transplant Recipients Using the 36-Item Short Form Health Survey

Few risk factors for quality-of-life outcomes of simultaneous pancreas and kidney transplant recipients are known because of a paucity of data from prospective studies. Pretransplant assessment and prospective 3-year follow-up. Consecutive potential recipients at a university teaching hospital assessed by Liaison Psychiatry. Demographic data; pretransplant Transplant Evaluation Rating Scale scores; current, past 12 months, and prior lifetime psychiatric disorder. 36-Item Short Form Health Survey (SF-36) scores. 37 simultaneous pancreas and kidney transplant recipients were assessed pretransplant and at 4 months posttransplant. Posttransplant at 1 year, 29 (81% of survivors); at 2 years, 26 (79% of survivors and those reaching 2 years); and at 3 years, 22 (92% of survivors and those reaching 3 years) patients were assessed. SF-36 Mental Component Summary (MCS) scores (mean pretransplant, 46.8 +/- 8.2 [SD]; 4 months, 51.7 +/- 8.5; 1 year, 50.1 +/- 9.7; 2 years, 51.8 +/- 8.9; and 3 years, 50.8 +/- 13.8) and Physical Component Summary (PCS) scores (pretransplant, 40.6 +/- 10.6; 4 months, 43.6 +/- 12.0; 1 year, 45.6 +/- 11.3; 2 years, 48.1 +/- 10.2; and 3 years, 46.8 +/- 9.1) showed sustained improvement posttransplant. MCS scores became similar to population norms. Functionally significant decreases in MCS and PCS scores were seen in 4%-21% and 8%-30% at times posttransplant. Male sex predicted higher scores at 4 months for the MCS (P = 0.003; regression coefficient, -8.28 [95% CI, -13.6 to -2.9]; effect size, 0.22) and PCS (P = 0.05; regression coefficient, -6.91 [95% CI, -13.9 to 0.9]; effect size, 0.08). Current psychiatric disorder at pretransplant evaluation predicted higher PCS scores at 4 months (P = 0.002; regression coefficient, -15.42 [95% CI, -24.6 to -6.2]; effect size, 0.22) and 1 year (P = 0.002; regression coefficient, -17.3 [95% CI, -27.9 to -6.7]; effect size, 0.29). Psychiatric disorder before the 12 months before the pretransplant evaluation predicted lower PCS scores at 4 months posttransplant (P < 0.001; regression coefficient, 14.98 [95% CI, 7.1-22.8]; effect size, 0.29). Cohort size. Although half experienced sustained quality-of-life improvement, up to one-third experienced a decrease. Past psychiatric disorder is a risk factor. Patients should be educated and monitored appropriately.

Psychosocial Factors As Measured By The Transplant Evaluation Rating Scale (TERS) Predict Length Of Hospitalization And Infectious Complications Following Hematopoietic Stem Cell Transplantation

Although psychological and social factors are recognized as being important in the evaluation of patients for hematopoietic stem cell transplantation (HSCT), no standard approach to psychosocial assessment currently exists. In solid organ transplantation, psychosocial assessments have been integrated into the selection of appropriate candidates, and certain psychosocial variables, such as active substance abuse, have been shown to negatively impact outcomes in solid organ transplant patients. To determine whether similar factors impact outcomes in patients undergoing HSCT, we prospectively conducted psychosocial assessments on 155 consecutive patients undergoing autologous HSCT primarily initiated in an outpatient setting.

A New Rating Scale for Open-Field Evaluation of Behavioral Recovery after Cervical Spinal Cord Injury in Rats

The Basso, Beattie, Bresnahan (BBB) locomotor rating scale has proven a reliable tool to evaluate impairments of hindlimb locomotor skills after thoracic spinal cord injury (SCI). With the increasing use of cervical SCI rat models, there is a critical need to develop scoring scales designed to more precisely examine alteration and recovery of forelimb functions. The main goal of the present study was to elaborate and evaluate a new rating scale for open-field testing of the fore- and hindlimb locomotor functions after cervical SCI. We also assessed the effectiveness of this rating scale for discriminating the functional consequences of dorsolateral (Hdl group), lateral (Hl group), or complete C4 unilateral hemisections (Hc group). Our findings show that the new rating scale can be considered as a sensitive and reliable descriptor of the postoperative time course of deficits affecting differentially the fore- and hindlimb sensorimotor functions following injuries of various severities. This new method provides reproducible data and can be used reliably by non-expert examiners. The proposed rating scale appears to be a useful tool for the assessment of various treatments designed to promote functional recovery after SCI. See online Supplementary Material (scoring spreadsheet and videotape recordings) at www.liebertonline.com.

Psychosomatic Evaluation of Patients Awaiting Lung Transplantation

Levels of psychosocial functioning were assessed according to Transplantation Evaluation Rating Scale (TERS) in 113 patients prior to lung transplantation. The prevalence of mental disorders was 20%; in addition impaired mental status was observed in 12 (11%) patients. The most frequent diagnoses were dependence on tobacco (9%), adjustment disorders (4%), and dependence on alcohol (2%). In the clinical interview, 87 patients (77%) were assessed as eligible, 20 (18%) as risky, and 6 (5%) as high-risk candidates. The TERS total scores between the eligibility groups differed significantly (F = 19.5; df = 112; P < .001). There were no significant effects of gender and age. Significant inverse correlations were estimated between the TERS score and educational status (r = -.291; P = .002). TERS allows a standardized evaluation of lung transplant candidates with good discrimination into eligibility groups. General psychosocial adaptation is mainly based on the educational level, a factor that should be examined in psychosomatic assessments.

Douleur périnéale du post-partum : intérêt de l’infiltration locale de ropivacaïne

To assess efficiency of local ropivacaine infiltration in perineal pain after episiotomy and perineal tear during the first 24 h after vaginal delivery. Case control survey, including 62 consecutive patients with episiotomy and/or perineal tear during two consecutive periods: the ropivacaine group from February 2, 2008 to March 27, 2008 (n=31) and the control group from December 27, 2007 to January 1, 2008 (n=31). In the ropivacaine group, patients received 10 ml of ropivacaine 7,5mg/ml as a local infiltration along the perineal damage. In the control group no injection was done. A numerical pain rating scale (0-10) at four (H4), eight (H8), 12 (H12) and 24 h (H24) was used to evaluate patients post-partum perineal pain. A numerical rating scale was used to evaluate patients satisfaction (0: no satisfied, 5: very satisfied). Numerical pain rating scale for perineal pain evaluation was significantly lower in the ropivacaine group than in the control group at H4 (1.9+/-0.3 versus 3.6+/-0.5, p=0.006), H8 (3.3+/-0.4 versus 5.2+/-0.4, p=0.003), H12 (2.8+/-0.4 versus 5.2+/-0.4, p=0.0001) and H24 (2.6+/-0.4 versus 4.3+/-0.4, p=0.006). Numerical rating scale for satisfaction evaluation was significantly higher in the ropivacaine group (4.2+/-0.2 versus 3.5+/-0.2, p=0.004). Local ropivacaine infiltration in episiotomy and/or perineal tear reduce post-partum perineal pain within the first 24 h.

An Electric Scooter Simulation Program for Training the Driving Skills of Stroke Patients with Mobility Problems: A Pilot Study

This paper describes an electric scooter simulation program and a first evaluation study in which we explored if it is possible to train the driving skills of future users of electric mobility scooters by means of an electric scooter simulation program in addition to conventional electric scooter training. Within this explorative study,10 stroke survivors were randomly assigned to either the control (n=5) or the electric scooter simulation intervention group (n=5). Participants were assessed twice on the functional evaluating rating scale. During the followup measurement, subjective experiences regarding both forms of electric scooter training were elicited by a questionnaire. After a training period of 5 weeks, both groups improved on the Functional Evaluation Rating Scale. It can be concluded that the patients with stroke were satisfied with the electric scooter simulation training.