Minor Medical Procedures Research Articles

Helping patients choose between pain control options for outpatient procedural abortion at less than 12 weeks' gestation

ObjectivesThis study aimed to identify predictors of patient satisfaction with their chosen pain control regimen for procedural abortion at <12 weeks' gestation in the outpatient setting. Study designIn this prospective cohort study, we developed an instrument to evaluate predictors of satisfaction with pain control regimens among patients choosing local anesthesia alone (paracervical block with 20 mL of 1% buffered lidocaine) or local anesthesia plus intravenous (IV) moderate sedation with 100 mcg of fentanyl and 2 mg of midazolam. Our primary outcome was to identify predictors of satisfaction with both anesthesia cohorts as measured on a 4-point Likert scale, but due to high satisfaction levels in the IV group, we focused our analysis on the local anesthesia group. ResultsWe enrolled 149 patients in the local anesthesia group and 155 in the moderate IV sedation group. The mean procedure pain scores were 6.9 (±2.1) out of 10 in the local group and 4.0 (±2.7) in the IV group (p < 0.0001). More women in the IV group (92%) were satisfied or very satisfied with the amount of pain relief they experienced compared to the local group (66%; p < 0.0001). In the univariable model, only being afraid of a minor medical procedure was predictive of less satisfaction with local anesthesia for pain control (relative risk 0.8 [95% CI, 0.6–0.9]). Age, gestational age, anticipated pain, self-reported pain tolerance, self-reported anxiety, discomfort with the abortion decision, and history of prior vaginal or cesarean delivery or induced abortion did not predict satisfaction levels. ConclusionsFear of minor medical procedures was the only variable that predicted decreased satisfaction with local anesthesia alone for procedural abortion under 12 weeks. ImplicationsReliable predictors for satisfaction with local anesthesia alone for procedural abortion in the outpatient setting remain elusive. Fear of minor medical procedures may serve as an indicator of decreased satisfaction and could be incorporated into patient counseling. Moderate IV sedation is associated with high satisfaction levels.

Factors and scenarios influencing Arab Americans’ preference for male versus female physicians

As the Arab American community sees an increase in female physicians, knowledge of patients' perceptions is necessary to foster the physician-patient relationship. The objective of this study was to better understand physician gender preference among Arab Americans when given a range of selected medical scenarios. An anonymous survey was distributed electronically through social media. The survey elicited gender preferences of Arab Americans given different scenarios. Data was collected from 325 participants. No physician gender preference was noted for 6 out of 7 scenarios with the exception for sensitive medical issues. Same-sex gender preference was noted in the cases of sensitive medical issues, routine medical visits, medical emergencies, and minor medical procedures. Predominant visitations to male physicians across specialties was found. The current study shows that although most Arab Americans expressed no preference for physician gender, the majority currently visit male physicians. The study highlights similarities to other populations in terms of same-sex physician gender preference when it comes to patient choices. Our study shows, however, that physicians’ experience and empathy were leading criteria as opposed to gender or Arab identity when it came to physician selection by Arab American patients.

Children's feelings and attitude towards medical contacts

Introduction and purpose&#x0D; Medical procedures can be physically harmful and cause psychological trauma among young children, possibly resulting in certain lifelong aversion. The aim of the study was to evaluate children's feelings while undergoing minor medical procedures depending on age, gender and previous experience and to compare it with university students.&#x0D; Material and methods&#x0D; We conducted a survey among 382 primary school children, as well as 334 university students. Questions concerned the frame of mind at the moment of examination, during dentist and general physician appointment, vaccination, hospitalization and condition of sore throat.&#x0D; Results&#x0D; The experience of hospital stay resulted in better feelings about possible future hospitalization in both groups, and about dentist appointment in the group of children. Girls and women declared lower mood during general physician appointment. Interestingly, in the group of children boys felt worse at the moment of survey, while in the group of students women felt so. The current frame of mind correlated with an appraisal of all other situations among students, whereas only with physician appointment and vaccination among children. All of above were statistically significant. For both groups, the most unpleasant condition was sore throat. However, in regards to medical procedures exclusively, vaccination appeared to be the most traumatic for children and hospitalization for students.&#x0D; Conclusion&#x0D; Earlier experience and gender of children can affect their feelings about medical procedures. Presented analysis suggests that every medical should do their best to provide pleasant atmosphere for every child during medical contacts.

Splenic rupture following synchronised direct current cardioversion

Atraumatic rupture of the normal spleen is a rare entity. Often, a triggering factor or minor physical event can be ascribed as the aetiology for rupture, including coughing, vomiting or...

What weighs more-low compliance with self-deferral or minor medical procedures? Explaining the high rate of hepatitis C virus window-period donations in Poland.

Since the introduction of nucleic acid testing (NAT) for routine blood donor screening, hepatitis C virus (HCV) RNA-only detection rates reported from Poland have been higher than in most other European countries. To examine factors that likely contribute to these window-period donations, we conducted a case-control study among 47 recently HCV-infected blood donors (cases), who gave blood between July 2002 and June 2014, and 141 controls matched by age, sex, and donation dates. Firth-corrected, conditional logistic regression models were fitted to estimate adjusted odds ratios and 95% confidence intervals. Adjusted population-attributable fractions were calculated based on the distribution of exposure among the cases. On multivariate analysis, recent exposures in health care environments not routinely ascertained through predonation questionnaires were strongly associated with recently acquired HCV infection. These exposures included minor medical and dental procedures in the preceding 6 months (adjusted odds ratio, 5.77; 95 % confidence interval, 2.01-18.53). However, based on the population-attributable fraction, more important were behavioral deferrable risks that went unreported at the time of donation, such as high-risk sexual behaviors in the preceding 6 months (population-attributable fraction, 34%) or lifetime histories of drug use (population-attributable fraction, 28%). This study raises questions about the effectiveness of deferral policy in excluding high-risk individuals. In addition, it provides further evidence supporting short, temporal deferrals for small medical procedures and dental treatments in Poland.

"Is it going to hurt?": the impact of the diagnostic odyssey on children and their families.

The pediatric diagnostic odyssey is a period of uncertainty and emotional turmoil for families, often characterized by multiple minor medical procedures (such as venipuncture) that children may find distressing. Interventions to reduce distress are rarely offered, despite evidence that this is crucial both for avoiding anticipatory anxiety before future procedures and for improving healthcare compliance in adulthood. We interviewed ten mothers of children with neuromuscular disorders, asking about their perceptions of their child's experiences with different medical procedures, the emotional impact of the diagnostic odyssey, implications of obtaining a diagnosis, and interactions with healthcare providers. We coded interviews in ATLAS.ti (version 7.0) based on a priori and emergent themes, and analyzed them based on the principles of interpretive description. We found that predicting and assessing children's reactions to procedures is challenging; parents reported non-invasive procedures such as x-rays were distressing for some children, and that providers did not detect subtle indicators of distress. Parents valued obtaining a diagnosis because it validated their concerns, enabled planning for the child's future healthcare needs, and allowed access to established support networks. This study suggests that healthcare providers can improve the experience of the diagnostic odyssey by validating family concerns and connecting them to support services that are available without a diagnosis.

Caregivers' willingness-to-pay for a topical anesthetic cream for minor medical procedures in children.

Topical anesthetic cream (TAC) is not in use in pediatric practice in Sub-saharan regions. Knowledge of Caregivers' willingness-to-pay (WTP) for the cream is necessary for its deployment. To determine the WTP for TAC for minor pediatric painful procedures. The study was a questionnaire-based conducted in two tertiary health institutions in southeast Nigeria. WTP was elicited using the contingent valuation method. The respondents were caregivers to children that attended out-patient clinics and in-patient. Data analysis was by Statistical Package for the Social Sciences software (SPSS) and STATA11. Majority (94%) of the respondents were willing to pay for TAC. The mean maximum WTP was US$8.31. Multivariate analysis showed no statistically significant association between many variables with WTP for TAC. Their average WTP was higher than the market price of topical anesthetic cream. Therefore, there is a good prospect for TAC if deployed in Nigeria.

Medical procedures and the risk of iatrogenic hepatitis C infection: case-controlled study in north-eastern Poland

Many hepatitis C virus (HCV)-infected individuals do not have any obvious risk factors and one of the putative sources of infection may be inadvertent exposure to infected blood or body fluids in the clinical setting. The aim of this study was to assess the role of medical procedures in transmission of hepatitis C in north-eastern Poland. In total, 194 patients with chronic hepatitis C were eligible for the study. The control group consisted of 275 age- and sex-matched individuals. Patients with a history of intravenous drug use were excluded. On multivariate analysis, transfusions [odds ratio (OR)=3.7, 95% confidence interval (CI) 2.2–6.3], minor surgery (OR=3.2, 95% CI 1.5–6.7) and dental care (OR=2.3, 95% CI=1.4–4.0) were independently associated with HCV infection. We conclude that apart from transfusion, minor medical procedures and dental care may carry a significant risk of hepatitis C infection. Improvements in basic hygiene routines and strict adherence to universal precautions may be essential to prevent iatrogenic transmission of the infection.

EMLA Cream Does Not Blunt Immune Responses to Vaccines

EMLA (lidocaine-prilocaine) is a topical analgesic cream that decreases pain associated with minor medical procedures, such as venipunctures and lumbar