Previous Surgery Experience Research Articles

A STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY IN CONTROLLING POSTOPERATIVE PAIN AND ANXIETY AMONG SURGICAL PATIENTS (MAJOR ABDOMINAL SURGERY) IN RMMCH, ANNAMALAI UNIVERSITY

Pain is a universal human experience,yet no two individuals experience and respond to pain exactly the same way and also pain is the predominant complaint patients have after surgery. Anxiety is an emotional state characterized by feelings of apprehension, discomfort, restlessness, or worry. Music therapy is one of the non-pharmacological interventions to reduce postoperative pain and anxiety.AIM: To assess the effectiveness of music therapy in controlling postoperative pain and anxiety among surgical patients. MATERIAL AND METHODS: Quasi-experimental design Time series with multiple institutions of treatment) was adopted. A total of 40 patients 20 in experimental and 20 in control group chosen by convenient sampling technique. The instrument consisted of two sections: First section comprises of demographic and clinical variables of the patient. Second section was Speilberger State-Trait Anxiety Scale Form Y-1 and Numerical Pain Rating Scale.Reiki instrumental music was selected for intervention. Music therapy was provided through head phone on second and third postoperative day to the experimental group in two sessions in each day totaling four sessions lasting for 30 minutes each. Assessment was done periodically for two sessions at a interval of 2 hours per day after music therapy. RESULTS: The postoperative pain intensity score of the experimental group was significantly reduced from severe to mild level,where as in the control group pain intensity score was reduced from moderate to mild level. (p< 0.001).The postoperative anxiety level reduction for experimental group was from moderate to mild level, where as in the control group anxiety level remained constantly at moderate level. (p< 0.001). There was no significant association between preoperative anxiety with previous experience of surgery. CONCLUSION:Music therapy is a simple,safe and effective method for reducing postoperative pain and anxiety

Preoperative Anxiety in Cardiac Surgery Patients

Introduction: People with high level of anxiety experience significant distress & impairment in interpersonal as well as social functioning. There are many medical conditions where patients develop high levels of anxiety. Anxiety with surgery is associated with autonomic changes, supplementary doses of anesthetic drugs, increased level of postoperative pain & more chances of postoperative nausea & vomiting. To prevent & treat anxiety effectively, one must assess level of anxiety accurately. A nurse can assess anxiety & reduce it to a manageable & comfortable level. Aims: A study was conducted to anticipate preoperative anxiety among patients undergoing cardiac surgeries & to identify dimensions of anxiety. Methodology: A quantitative approach was used for this cross-sectional study. Content validity of the tool was done&reliability was calculated using Karl Pearson’s coefficient of correlation. The sample was calculated by 80 % confidence level with 5% error. Total sample was 80 patients admitted in cardiothoracic ward. Samples were selected by convenient sample technique. Anxiety level was identified with the help of Amsterdam Preoperative Anxiety & Information Scale. Along with anxiety level, researcher also tried to find the possible causes of anxiety. Result: Descriptive data was analyzed & association between variables was identified. 82.5% of patients were males & 17.5 % were females. Most of them i.e., 86.3 % underwent coronary artery bypass graft (CABG) & 13.8% underwent valvular surgeries. It was seen that 16.3% of patients had high level of anxiety related to anesthesia, 27.5% of patients had high level of anxiety related to surgery & overall high anxiety level was seen in 21.3% of patients. The association was seen with gender, previous experience of surgery & duration of hospitalization. Most common causes of anxiety identified were worry about postoperative pain & family concern. Conclusion: Nurses can identify triggers of anxiety, recognize the symptoms of onset of anxiety & intervene before patient reaches to panic stage

Treatment preferences for medication or surgery in patients with deep endometriosis and bowel involvement - a discrete choice experiment.

ObjectiveTo study the preferences of women with deep endometriosis (DE) with bowel involvement when they have to choose between conservative (medication) or surgical treatment.DesignLabelled discrete choice experiment (DCE).SettingDutch academic and non‐academic hospitals and online recruitment.Population or SampleA total of 169 women diagnosed with DE of the bowel.MethodsBaseline characteristics and the fear of surgery were collected. Women were asked to rank attributes and choose between hypothetical conservative or surgical treatment in different choice sets (scenarios). Each choice set offered different levels of all treatment attributes. Data were analysed by using multinomial logistic regression.Main Outcome MeasuresThe following attributes – effect on/risk of pain, fatigue, pregnancy, endometriosis lesions, mood swings, osteoporosis, temporary stoma and permanent intestinal symptoms – were used in this DCE.ResultsIn the ranking, osteoporosis was ranked with low importance, whereas in the DCE, a lower chance of osteoporosis was one of the most important drivers when choosing a conservative treatment. Women with previous surgery showed less fear of surgery compared with women without surgery. Low anterior resection syndrome was almost equally important for patients as the chance of pain reduction. Pain reduction had higher importance than improving fertility chances, even in women with desire for a future child.ConclusionsThe risk of developing low anterior resection syndrome as a result of treatment is almost equally important as the reduction of pain symptoms. Women with previous surgery experience less fear of surgery compared with women without a surgical history.Tweetable First discrete choice experiment in patients with deep endometriosis.

The Prevalence of Pain in the First 24 Hours After Surgery: A Multicenter Study

This study was conducted to determine the prevalence and severity of postoperative pain in the first 24 hours after surgery and to emphasize the importance of postoperative pain assessment. A descriptive study. This study was carried out on May 21, 2019 with 898 patients who had completed the postoperative 24th hour in the surgical clinics of 10 training and research hospitals in Istanbul, the capital of Turkey. Point prevalence was used in the study. Data were collected using a questionnaire developed by the researchers and the Revised American Pain Society Patient Outcome Questionnaire. Descriptive statistics were presented as frequency, percentage, mean, and standard deviation. Nonparametric tests were used for data without normal distribution (Kolmogorov-Smirnov Test, P < .05). Two-group comparisons were performed using the Mann-Whitney U test. The Kruskal Wallis-H test was used for the comparison of three or more groups. Statistical significance was set as P < .05. The three main types of surgery were general surgery with 31.8%, gynecologic surgery with 12.9%, and orthopedic surgery with 12.7%. The mean lowest level of pain felt by the patients included in the study in the first 24 hours was 3.90 ± 2.94, and the mean highest level of pain was 6.38 ± 4.45. Postoperative pain is a subjective phenomenon and may be affected by factors such as type of surgery, previous experience of surgery, duration of surgery, the length of the surgical incision, the type of anesthesia, the quality of postoperative care, individual characteristics and experiences, and fear anxiety; thus, the experience of pain may vary from person to person.

A Smartphone App Designed to Empower Patients to Contribute Toward Safer Surgical Care: Qualitative Evaluation of Diverse Public and Patient Perceptions Using Focus Groups.

BackgroundMySurgery is a smartphone app designed to empower patients and their caregivers to contribute toward safer surgical care by following practical advice to help reduce susceptibility to errors and complications.ObjectiveThe aim of this study is to evaluate service users’ perceptions of MySurgery, including its perceived acceptability, the potential barriers and facilitators to accessing and using its content, and ideas about how to facilitate its effective implementation. The secondary aim is to analyze how the intended use of the app might differ for diverse patients, including seldom-heard groups.MethodsWe implemented a diversity approach to recruit participants from a range of backgrounds with previous experience of surgery. We aimed to achieve representation from seldom-heard groups, including those from a Black, Asian, and minority ethnic (BAME) background; those with a disability; and those from the lesbian, gay, bisexual, transgender, queer (LGBT+) community. A total of 3 focus groups were conducted across a 2-month period, during which a semistructured protocol was followed to elicit a rich discussion around the app. The focus groups were audio recorded, and thematic analysis was carried out.ResultsIn total, 22 individuals participated in the focus groups. A total of 50% (n=11) of the participants were from a BAME background, 59% (n=13) had a disability, and 36% (n=8) were from the LGBT+ community. There was a strong degree of support for the MySurgery app. The majority of participants agreed that it was acceptable and appropriate in terms of content and usability, and that it would help to educate patients about how to become involved in improving safety. The checklist-like format was popular. There was rich discussion around the accessibility and inclusivity of MySurgery. Specific user groups were identified who might face barriers in accessing the app or acting on its advice, such as those with visual impairments or learning difficulties and those who preferred to take a more passive role (eg, some individuals because of their cultural background or personality type). The app could be improved by signposting further specialty-specific information and incorporating a calendar and notes section. With regard to implementation, it was agreed that use of the app should be signposted before the preoperative appointment and that training and education should be provided for clinicians to increase awareness and buy-in. Communication about the app should clarify its scientific basis in plain English and should stress that its use is optional.ConclusionsMySurgery was endorsed as a powerful tool for enhancing patient empowerment and facilitating the direct involvement of patients and their caregivers in maintaining patient safety. The diversity approach allowed for a better understanding of the needs of different population groups and highlighted opportunities for increasing accessibility and involvement in the app.

Does knowledge of medical risk influence patient decision for same day discharge following primary shoulder arthroplasty: a randomized control trial

IntroductionThe recent growth of same-day discharge following shoulder arthroplasty has been supported by studies supporting safe and cost-effective surgery. The Outpatient Arthroplasty Risk Assessment (OARA), initially developed for lower extremity arthroplasty, has recently been introduced as a screening tool for same-day discharge after shoulder arthroplasty. However, patients with low scores frequently still choose hospital admission, suggesting that factors beyond medical risk play an important role in this decision. The purpose of this study is to examine whether informing patients of their medical risk (OARA score) will influence their decision of same-day discharge (SDD) following shoulder arthroplasty. MethodsA prospective series of patients undergoing primary shoulder arthroplasty were randomized as to the knowledge of their preoperative medical risk using the OARA score. Patients were randomized into two cohorts based upon disclosure of the OARA score: knowledge (OARA Known) or blinded (OARA Unknown). As a standard practice, all patients were counseled regarding SDD and given the option to stay overnight. Chi-square and fisher's exact test were used to detect differences in SDD between the two cohorts. For those patients who chose to stay overnight, primary and secondary reasons for this decision were surveyed and described. ResultsSixty-six primary arthroplasty patients were randomized. Both the OARA Known (n = 34) and OARA Unknown (n = 32) cohorts were comparable, consisting of similar age (72.2 ± 9.2 vs. 71.7 ± 7.2; P = .82), BMI (29.8 ± 6.2 vs. 28.7 ± 5.2; P= .46), gender (P= .68), surgery type (P = .77), discharge destination (P = .58) and OARA score (47.6 ± 60.7 vs. 51.6 ± 46.3; P = .77). Incidence of SDD did not significantly change between the OARA Known and OARA Unknown groups for OARA scores ≤110 (P = .44) and for OARA scores >110 (P= .51). The most common factors that influenced patients’ decisions to stay overnight were lack of home support (18.4%), previous surgery experience (18.4%), and location of home (15.8%). Of those patients who chose overnight stay, 86% of patients reported they would make the same decision again. ConclusionPatient's knowledge of their medical comorbidity risk score does not influence the decision for same-day discharge following shoulder arthroplasty. Patient-specific, non-medical factors such as level of support at home, anxiety regarding the recovery, distance from home relative to the hospital, and experience during previous surgeries play an important role in patient decision making. Level of EvidenceLevel I; Study of Diagnostic Test

A Smartphone App Designed to Empower Patients to Contribute Toward Safer Surgical Care: Community-Based Evaluation Using a Participatory Approach.

BackgroundMySurgery is a smartphone app designed to increase patient and carer involvement in behaviors that contribute toward safety in surgical care.ObjectiveThis study presents a pilot evaluation of MySurgery in which we evaluated surgical patients’ perceptions of the app in terms of its content, usability, and potential impacts on communication and safety.MethodsA participatory action research (PAR) approach was used to formulate a research steering group consisting of 5 public representatives and 4 researchers with equal decision-making input. Surgical patients were recruited from the community using multiple approaches, including Web based (eg, social media, recruitment websites, and charitable or voluntary organizations) and face to face (via community centers). Participants referred to MySurgery before, during, and after their surgery and provided feedback via an embedded questionnaire and using reflective notes.ResultsA diverse mix of 42 patients took part with good representation from 2 “seldom heard” groups: those with a disability and those from a black, Asian, or minority ethnic group. Most were very supportive of MySurgery, particularly those with previous experience of surgery and those who felt comfortable to be involved in conversations and decisions around their care. The app showed particular potential to empower patients to become involved in their care conversations and safety-related behaviors. Perceptions did not differ according to age, ethnicity, or length of hospital stay. Suggestions for improving the app included how to make it more accessible to certain groups, for example, those with a disability.ConclusionsMySurgery is a novel technology-driven approach for empowering patients to play a role in improving surgical safety that seems feasible for use within the United Kingdom’s National Health Service. Adopting a PAR approach and the use of a diversity strategy considerably enhanced the research process in terms of gaining diverse participant recruitment and patient and public involvement. Further testing with stakeholder groups will follow.

AWARENESS OF PATIENTS REGARDING ANESTHESIA;

… Awareness of patients regarding anesthesia &amp; their attitude towards basic types ofanesthesia techniques. Objective: The purpose of this study was to assess the knowledge ofpatients regarding anesthesia, their attitudes towards basic types of anesthesia techniques andeffect of previous experience of anesthesia on the awareness. Study design: Descriptiveobservational study. Place and duration of study: This descriptive, prospective study wasconducted in the isra university hospital Hyderabad, Sindh, Pakistan from 2nd August 2013 upto8th March 2014. Patients and Methods: Two hundred thirty one patients were included in thestudy after taking verbal informed consent. All patients who were scheduled for elective surgerywere interviewed while patients who had refused from participation, have language barrier,psychiatric disease, had lack of sufficient mental capacity due to poor health status and patientsundergoing emergency surgeries were excluded from the study. Patients were interviewed intheir local language upon arrival in the preoperative area of operation theatre. Self madequestionnaire was filled. All the data was entered on SPSS version 16. Frequency andpercentages were calculated to show the results. Mean with SD of patients age was computed.Chi-square test was applied to assess the affect of previous experience of surgery on patient’sknowledge regarding anesthesia. P value less than 0.05 was taken as significant. Results: Total231 patients were included in the study. Mean age of the patients was 36 ± SD 1.01. Fifty one(22.1%) patients were illiterate; while 54 (23.4%) patients were graduate. 103(44.6%) patients hadprevious experience of surgery/ anesthesia while 128(55.4%) patients had no experience. Out of231 patients, 111 (48.1%) patients were aware of different type of anesthesia techniques while120(51.9%) patients were not aware. Out of 103 patients, who had previous exposure ofanesthesia, 64 patients answered correctly about different types of anesthesia techniques while81 patients who had no previous exposure of anesthesia, answered incorrectly (P value = 0.000).Fifty three patients who had previous exposure of anesthesia answered correctly that anesthetistis a qualified doctor, while 62 patients answered incorrectly who had no previous exposure (Pvalue=0.546). Out of 231 patients, 91 (39.39%) patients were in favor of having generalanesthesia while 52(22.51%) patients were in favor of regional anesthesia, while 88(38.0%) hadleft the choice on surgeon. Conclusions: Results of the study show poor knowledge of patientsregarding anesthesia and anesthesiologists. Majority of the patients were in favor of havinggeneral anesthesia rather regional anesthesia. There is need to correct the misconceptions ofpatients and to educate the public.

Assessment of Preoperative Anxiety among Patients Undergoing Elective Surgery

Introduction: Although patients undergoing elective surgery are assumed to have a lower level of preoperative anxiety, studies reported a high level of anxiety among those patients. . This study aimed at assessing the level of preoperative anxiety and its predictors in adult patients undergoing elective surgery. Methods: This study is a cross-sectional design conducted among patients admitted for elective surgery. A total of 278 patients with non-life-threatening surgeries were included and those who had mental or psychological problems were excluded from this study. Sample type and sample size. The data collected through a questionnaire about demographics, preoperative knowledge and anxiety in the preoperative room 24 hours before the operation. The frequencies, percentages, mean and SD were calculated, and t-test was used to detect significant associations. Results: The overall preoperative anxiety score had a mean ±SD of 18.2±5.8 and the questions regarding knowledge component reported higher scores than those about anxiety component. The components of anxiety about surgery reported higher scores than those of anxiety about anesthesia. Age, gender, availability of family support and type of surgery were found as significant predictors for preoperative anxiety prior to elective surgery. However, the association between preoperative anxiety and marital status and previous experience of surgery were found statistically non-significant. Conclusion: This study concluded that patients underwent elective surgery had high preoperative anxiety. The patients with younger age, female gender, patients under general anesthesia, or those who had no family support showed a higher level of preoperative anxiety.

Clinical manifestation of pediatric acute pancreatitis - a prospective multicenter nationwide cohort

The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain.Ninety-two children (5–15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE). Measures: Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac.These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated.SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.

A Survey of Patients' Preoperative Need for Information About Postoperative Pain—Effect of Previous Surgery Experience

The aim of this study was to determine the kind of information patients need preoperatively about postoperative pain (POP) and whether this is affected by previous surgery experience. A descriptive study design using preoperative questionnaires. Questionnaires with fixed questions related to POP and its management were distributed preoperatively to consenting, consecutive surgical patients. Patients were divided into two groups: patients with previous surgery experience (group A) and patients without previous surgery experience (group B). Of the patients who participated in the study, 94.2% wanted information about POP and 77.8% of them believe that they will feel calmer if they get the information they need. The patients' biggest concern relates to pain management issues after discharge. Next, in order of preference is information about the analgesics that they need to take. The patients want to be informed primarily with a personal interview (59.4%). Previous surgery experience has no effect on patients' needs for information. Most of the patients want to be informed about the management of the POP after being discharged. It is remarkable that patients who had previous surgery experience need the same information with those who had no previous surgery.

A Study to Assess the Effectiveness of Structured Teaching Programme (STP) on the Knowledge of Postoperative Patients Regarding Deep Breathing Exercises at J.K. Hospital & Research Centre, Bhopal (MP)

Postoperative chest physiotherapy was implemented in the beginning of the 20th century; deep breathing exercise was one of the first methods. Consequently, several manual treatments including percussion, clapping, and vibration or shaking was developed to improvise bronchial drainage. Recently, mechanical breathing devices like incentive spirometry (IS), blow bottles, intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP) were introduced into clinical practice (McMahon, 1915). Aim of the study: The aim of the study was to assess the effectiveness of structured teaching programme on deep breathing exercises on the knowledge of postoperative patients. Material and Method: A quasi experimental-nonrandomized control group research design was used; the research approach was pre- and post-test design in nature. The sample size was 80 postoperative patients in selected hospital of Bhopal out of which 40 patients were kept under experimental group and 40 under control group. The instruments used for the data collection were demographic questionnaire, 30 multiple choice questionnaire. The nonprobability purposive sampling technique was adopted to select the subjects. Results: The result showed that pre-test knowledge score of postoperative patients in experimental and control group of postoperative patients regarding deep breathing exercises was 2.7, (SD ± 2.81) and in control group were 2.9, (SD ± 2.56) t value of (0. 0.3328). Post-test scores of patients in experimental and control group were 22.2(SD ± 2.25)in experimental and 5.6(SD ± 4.041) with t value of 22.97 which is significant at the level of p ≤ 0.05. It had been found that the computed Chi-squares values between the post-test knowledge scores and the demographic variables like education, duration of hospital stay, previous experience of surgery and source of information were associated and age, sex, type of family were not associated at the significance level of (p ≥ 0.05). Conclusion: These finding support the hypothesis that STP resultant in significant improvement in the knowledge level of postoperative patients regarding deep breathing exercises.

Patients' decision making in total knee arthroplasty: a systematic review of qualitative research.

ObjectivesA patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review’s objective is to systematically examine the qualitative literature surrounding patients’ decision making in knee arthroplasty.MethodsA systematic literature review using Medline and Embase was conducted to identify qualitative studies that examined patients’ decision making around knee arthroplasty. An aggregated account of what is known about patients’ decision making in knee arthroplasties is provided.ResultsSeven studies with 234 participants in interviews or focus groups are included. Ten themes are replicated across studies, namely: expectations of surgery; coping mechanisms; relationship with clinician; fear; pain; function; psychological implications; social network; previous experience of surgery; and conflict in opinions.ConclusionsThis review is helpful in not only directing future research to areas that are not understood, or require confirmation, but also in highlighting areas that future interventions could address. These include those aimed at delivering information, which are likely to affect the satisfaction rate, demand, and use of knee arthroplasties.Cite this article: Bone Joint Res 2015;4;163–169.

Measuring preoperative anxiety in patients undergoing elective surgery in Czech Republic

Aim: The main aim of the study was to measure preoperative anxiety in patients in the Czech Republic before elective surgery, using the Visual Analogue Scale for Anxiety (VAS-A). Design: A cross-sectional descriptive study. Methods: The sample consisted of 344 patients undergoing elective surgery. The day before surgery patients completed a questionnaire consisting of demographic data, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the VAS-A. Spearman correlation was used to test correlation between the VAS-A and the subscales of the APAIS. Analysis of Variance (ANOVA) and the Kruskal-Walis test were used for group comparison. A p-value < 0.05 was considered to be significant. Results: Female patients and patients without previous experience of surgery had a significantly higher VAS-A score. The anxiety score measured by the VAS-A positively correlated with APAIS-Anxiety (r = 0.71) and its subscales. The results also showed that the most common anxieties resulted from postoperative pain, anaesthesiological complications, postoperative nausea and vomiting, concerns about regaining consciousness after anaesthesia, surgical errors, and postponement of surgery. Conclusion: The findings of this study support the utility of the VAS-A as a measure of preoperative anxiety. The VAS-A quickly and simply assesses anxiety and may be useful for research as well as clinical purposes when researchers or clinicians have very limited time.

Effect Of Age And Previous Surgery Experience On Preoperative Anxiety

Background: It has been recognized for more than 40 years that patients experience different levels of anxiety when faced with impending surgery. The degree to which each patient manifests anxiety is related to many factors. Objective: This study aims to identify the effect of age and previous surgery experience on preoperative anxiety. Methodology: For the purpose of this study a sample of 200 patients who were admitted in 5th April 2009 to the 10th November 2009; in general surgery units of teaching hospitals ( Rezgari &amp; Hawler ) in Erbil city were interviewed to assess their level of anxiety before surgery and identify effect of age and previous surgery on anxiety. The instrument used for this purpose was a questionnaire that included socio-demographic information and the State-Trait Anxiety Inventory (STAI) of Spilberger. STAI is a validated scale which includes 20 items related to measurement of state anxiety. High scores indicate high levels of anxiety. Results: Most of the patients showed moderate to severe anxiety level; (moderate=50% and severe=38.3%) others showed mild anxiety level (11.7%). A statistically significant relationship was seen between age and previous surgery experience before surgery. Young patients with first surgery experience showed higher level of anxiety. Conclusions: According to the results of the study patients undergoing major surgery need to be assessed regarding level of anxiety before surgery. This anxiety should be reduced through appropriate interventions, especially in young patients with no previous surgery experience that have been found to experience high levels of anxiety.

Stress materno e hospitalização infantil pré-cirúrgica

O objetivo deste estudo foi a valiar o nível de stress de mães acompanhantes de crianças hospitalizadas para realização de procedimentos cirúrgicos eletivos, relacionando-o com variáveis demográficas da criança e experiência prévia no contexto. Participaram 54 mães acompanhantes de crianças hospitalizadas para realização de cirurgia eletiva. Utilizaram-se como instrumentos o Inventário de Sintomas de Stress para Adultos de Lipp e, para levantamento das variáveis da criança, um questionário elaborado para o estudo. Os resultados apontaram que 82% da amostra apresentavam stress, prevalencendo a fase de resistência e sintomas psicológicos. Observou-se relação estatisticamente significativa entre a presença de stress materno e o fato de o filho não ter experiência anterior com cirurgia (p=0,052). Por outro lado, não foram observadas diferenças estatisticamente significativas entre a presença de stress materno e a idade e gênero da criança. Conclui-se que o impacto dos procedimentos cirúrgicos acomete a criança e a família, o que deve ser levado em consideração a fim de que sejam propostas intervenções para a preparação pré-operatória.

Training on synthetic ethylene-vinyl acetate bench model allows novice medical students to acquire suture skills

To assess the acquisition of suture skills by training on ethylene-vinyl acetate bench model in novice medical students. Sixteen medical students without previous surgery experience (novices) were randomly divided into two groups. During one hour group A trained sutures on ethylene-vinyl acetate (EVA) bench model with feedback of instructors, while group B (control) received a faculty-directed training based on books and instructional videos. All students underwent a both pre-and post-tests to perform two-and three-dimensional sutures on ox tongue. All recorded performances were evaluated by two blinded evaluators, using the Global Rating Scale. Although both groups have had a better performance (p<0.05) in the post-test when compared with the pre-test, the analysis of post-test showed that group A (EVA) had a better performance (p<0.05) when compared with group B (control). The ethylene vinyl acetate bench model allowed the novice students to acquire suture skills faster when compared to the traditional model of teaching.

Pre-surgical child behavior ratings and pain management after two different techniques of tonsil surgery

The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain. Ninety-two children (5-15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE). Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac. These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated. SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.

A influência da ansiedade nas estratégias de enfrentamento utilizadas no período pré-operatório

O presente estudo tem como objetivos: identificar o estado de ansiedade dos pacientes no período pré-operatório; identificar as estratégias de enfrentamento utilizadas pelos pacientes nesse período; verificar a relação entre o estado de ansiedade e as estratégias de enfrentamento utilizadas pelos pacientes, no período pré-operatório. A amostra foi composta por 40 pacientes cirúrgicos. Para a coleta dos dados foram utilizados dois instrumentos auto-aplicáveis: o questionário de estado de ansiedade de Spielberger e o inventário de estratégias de coping de Lazarus e Folkman. A amostra compôs-se, em sua maioria, por pacientes do sexo feminino com uma idade média de 46 anos, com baixo grau de escolaridade, com experiência cirúrgica anterior e sem intercorrências anteriores. As estratégias de enfrentamento mais comumente utilizadas foram as de suporte social e a de resolução de problemas. Em relação à ansiedade e às estratégias de enfrentamento, obteve-se uma correlação negativa entre o estado de ansiedade e o suporte social e a resolução de problemas.

The Validity of Amsterdam Preoperative Anxiety Information Scale in the Assessment of the Preoperative Anxiety - Compared with hospital anxiety depression scale and visual analogue scale -

Background: There are many objective and subjective methods for measuring the level of preoperative anxiety, but commonly used methods, such as HADS (hospital anxiety depression scale) and VAS (visual analogue scale), are not simple and easily used by patients. APAIS (Amsterdam preoperative anxiety and information scale) is a newly developed preoperative anxiety measuring instrument. The object of this study was to evaluate the ability of APAIS to overcome the limitations of other anxiety measuring instruments. Methods: 105 adult patients were asked to fill out the questionnaires in APAIS and HADS and also to mark on a 100 mm line in VAS in the range of 0 (calm) to 100 (terrified) how tense they felt at that moment in the evening before surgery. 95 patients responded to the questionnaire. We compared APAIS with the other subjective measurements of anxiety according to patients' sex, ASA class, past history of surgery and level of education, and evaluated the equivalence of the three methods. Results: APAIS has a significant relationship with the other two methods (P ＜ 0.05), but the other two methods have no significant relationship. The data of the APAIS showed a nearly symmetrical distribution as compared with that of HADS and VAS. Women and patients who had had no surgery were significantly anxious as opposed to men and to patients with previous experience of surgery, respectively (P ＜ 0.05). The HADS and APAIS were in good agreement in defining patients as having normal AFFECT or anxiety and there were significant correlations between the three instruments (P ＜ 0.05). Conclusions: We conclude that the three scales were equivalent in their assessment of anxiety before surgery. Therefore, APAIS will be useful alternative method of measuring subjective preoperative anxiety. (Korean J Anesthesiol 1999; 37: 179∼187)