Delayed Surgery, Low Presurgery Activity, and Poor Preoperative IKDC Scores Are Correlated with Lower Rates of Return to Sports after ACL Reconstruction in an Asian Population.

There is limited literature regarding the early postsurgical outcomes of anterior cruciate ligament (ACL) reconstruction in Asian populations, particularly in the rates of return to sports. We aimed to quantify early clinical outcomes for ACL reconstruction, determine the predictive value of surgeon- and patient-reported outcomes on the rate of return to sports in the early postoperative period, and identify factors predictive of return to sports. We analyzed the data of 55 patients who underwent ACL reconstruction at our tertiary medical center from 2015 to 2016. All patients underwent transportal ACL reconstruction and a standardized post-ACL reconstruction rehabilitation protocol. Patients with concurrent meniscal injury and repair were included. Patients were evaluated at the 3-month, 6-month, 1-year, and 2-year postoperative periods. Surgeon- and patient-reported outcome scores were collected at each follow-up through a systematic questionnaire designed to determine the patient's level of return to sport and reasons for not returning. Surgeon- and patient-reported outcome measures improved significantly over the 2-year postoperative period (p < 0.001). Overall rate of return to sports was 58.2%. The International Knee Documentation Committee (IKDC) subjective (p = 0.02), symptomatic (p = 0.001), composite (p = 0.005), Tegner (p < 0.001) and Lysholm (p = 0.049) scores at 2-year follow-up were significantly worse in patients who failed to return to sports. Earliest difference in scores manifested at 3-month postsurgery (p = 0.011). IKDC grade-D patients were 18.1 times less likely to return to sports (p = 0.035). Delayed surgery (p = 0.01) and presurgery inactivity (p = 0.023) were negatively predictive of return to sports. The rate of return to sport is consistent with the literature analyzing other ethnic populations. Both surgeon- and patient-reported outcome scores at 2-year postsurgery exhibited significant differences between those who did and did not return to sports. Patients should be advised to seek surgical treatment as soon as possible and stay active preoperatively to maximize return to sports.

Post-Disaster Mental Health Among Parent-Child Dyads After a Major Earthquake in Indonesia.

The interdependent adjustment of children and their parents following disasters has been well documented. We used the Actor-Partner Interdependence Model (APIM) to provide an appropriate analytical framework for examining how family members may contribute to each other's post-disaster mental health. Independent self-reports were collected from parent-child dyads (n = 397) residing in a rural community in Indonesia that was devastated by a major earthquake. Elementary school children (M = 10 years; 51 % female) and one of their parents (M = 41 years; 73 % female) each reported on their disaster exposure, posttraumatic stress (PTS) symptoms, and general distress. The APIM was used to examine mental health within dyads and moderation by gender across dyads. Children reported lower disaster exposure and fewer PTS symptoms, but similar general distress levels, as their parents. Children's and parents' disaster-specific PTS symptoms were the strongest predictor of their own general distress. Parents' PTS symptoms were associated with children's general distress (b = 0.14, p < 0.001), but children's PTS symptoms were not associated with parents' general distress (b = -0.02, p > 0.05). Findings were not moderated by parents' or children's gender. Although children and parents may respond differently to natural disasters, they may be best understood as a dyad. APIM analyses provide new evidence suggesting a unidirectional path of influence from parents' disaster-related symptomatology to children's general mental health. Dyadic approaches to understanding mental health and treating symptoms of distress among disaster survivors and their families following trauma are encouraged.

Attitudes toward and use of complementary and alternative medicine among Hispanic and white mothers.

CONTEXT: Complementary and alternative medicine (CAM) use has become more prevalent in the United States. Little is known, however, regarding the ethnic and language differences of mothers as related to their beliefs about and use of CAM. OBJECTIVE: This study intended to examine the differences in CAM beliefs and use in English- and Spanish-speaking Hispanic and white mothers of children undergoing surgery. DESIGN: The research team employed a cross-sectional survey design. SETTING: Mothers were recruited from the Children's Hospital of Orange County (CHOC) in Southern California, and they completed the study's surveys on the day of their children's outpatient surgery. PARTICIPANTS: A total of 206 mothers participated: (1) 42 English-speaking, non-Hispanic white (ESW) women; (2) 92 English-speaking Hispanic (ESH) women; and (3) 72 Spanish-speaking Hispanic (SSH) women. OUTCOME MEASURES: Participants completed (1) the Holistic and Complementary and Alternative Medicine Questionnaire (HCAMQ), which captured beliefs about holistic health measures and about the validity of CAM; and (2) a checklist identifying past and present use of 27 different CAM therapies. RESULTS: The research team analyzed and controlled for demographic differences using linear regression, and the analysis revealed significant group differences in CAM use (P < .0001). ESW mothers and ESH mothers used more CAM than SSH mothers (P = .02). No significant differences were observed between groups for CAM related beliefs. CONCLUSIONS: After controlling for socioeconomic status, the research team found that SSH mothers used less CAM compared to ESH and ESW mothers. Employment of culturally specific measures of CAM use may be necessary to understand fully the differences in CAM use between Spanish- and English-speaking mothers as well as to understand the medical conditions that prompt CAM use.

The impact of major life events on the use of complementary and alternative medicine among individuals with chronic pain: a cross-sectional study.

CONTEXT: Chronic pain affects millions of Americans. Treating chronic pain can be difficult because it is a complex condition influenced by genetic makeup and physiological and psychological factors. The experience of major life events has also been found to affect the psychosocial functioning, health, and health behaviors of patients. Whereas the impact of major life events on the use of traditional medical practices has been explored, only one study to date has examined the relationship between major life events and use of complementary and alternative medicine (CAM). OBJECTIVE: This study examined the impact of major life events on the use of CAM among patients with chronic pain syndromes. DESIGN: Participants were consecutive patients seeking treatment at a pain clinic. SETTING: The study occurred at a tertiary center for pain management in Southern California. PARTICIPANTS: Participants were adult patients experiencing chronic pain for at least 6 mo, seeking treatment at a pain center. OUTCOME MEASURES: Participants completed a measure assessing their use of CAM modalities as well as their receptiveness to using previously unused CAM modalities, and they provided demographic information, including the occurrence of major life events, such as a job loss. RESULTS: A total of 199 adults with chronic pain participated in the study. The majority (91.6%) of chronic pain patients in the study reported using at least one form of CAM, with an average of at least five different forms of CAM. Individuals reported receptiveness to CAM modalities that they had not previously used (P < .05). Rates of CAM use were greater among those that had experienced a major life event in the prior 6 mo (P < .05). The most common major life events for this group included a compromised medical status, death of a loved one, financial hardship, a major geographical move, and altered family relationships. CONCLUSIONS: The study found that individuals with chronic pain frequently use CAM therapies, especially those who had recently experienced a major life event. Major life events may motivate patients with chronic pain to seek out different forms of CAM as a way to manage their pain.

Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery.

OBJECTIVES: To determine the efficacy of the locally infused anesthetic, ON-Q(®) pain relief system (Kimberly-Clarke, GA-USA), in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after major pediatric urological surgery. MATERIAL AND METHODS: A case-control analysis comparing 20 patients undergoing major urological procedures who were treated postoperatively with the ON-Q system was compared to 20 patients treated with current hospital standard of care intravenous and oral analgesics. Pain was assessed in both groups by staff nurses using the different validated scales depending on the child's age. Information regarding analgesic consumption along with recovery parameters such as temperature, start of oral nutrition, and length of hospitalization (LOH) were collected. RESULTS: The ON-Q group experienced significantly lower ratings of maximal pain on the first postoperative day as compared to the control group (3 vs. 5.2, p = 0.03) and a trend toward lower mean of maximal pain score on postoperative day two (1.8 vs. 3.5, p = 0.055). Systemic intravenous and oral analgesics were significantly lower on the day of surgery and the first postoperative day for the ON-Q group (p = 0.014; and p = 0.046 respectively). No differences in frequency of fever, start of oral nutrition and LOH were found between the study groups. CONCLUSION: Continuous incisional infusion of local anesthetic with the ON-Q system is a viable option for postoperative pain management in children undergoing major urological surgeries. This technology significantly decreases the need for systemic analgesic consumption.

Ethnicity and parental report of postoperative behavioral changes in children.

OBJECTIVES: To examine the role of ethnicity and language in parent report of children's postoperative behavioral recovery. AIM: To compare incidence of new onset negative behavior change in English- and Spanish-speaking White and Hispanic children following outpatient surgery. BACKGROUND: Postoperative behavioral change in children is common; however, it is unknown whether cultural variables including ethnicity and language may influence parent report of children's behavioral recovery. METHODS/MATERIALS: Participants included 288 parents (English-speaking White, English-speaking Hispanic, Spanish-speaking Hispanic parents) of children undergoing outpatient elective surgery. Parents completed the post-hospitalization behavior questionnaire (PHBQ) and parents' postoperative pain measure (PPPM) on postoperative days one, three, and seven at home. RESULTS: Most parents (83%) reported onset of new negative behavioral change in children postoperatively. Generalized estimating equations revealed significant group differences in overall behavior change [Wald χ(2)(12) = 375.69, P < 0.0001] after controlling for demographic and socioeconomic differences. At all three postoperative days, Spanish-speaking Hispanic (SSH) parents reported lower negative behavioral changes in their children compared to English-speaking White (ESW) parents (day 1: P < 0.01; day 3: P < 0.001; day 7: P < 0.10). On postoperative days one and three, SSH parents also reported lower total PHBQ scores than English-speaking Hispanic (ESH) parents [day 1: χ(2)(1) = 6.72, P = 0.01; day 3: χ(2)(1) = 7.98, P = 0.005]. CONCLUSION: The present study provides evidence that parent report of children's postoperative behavioral recovery may be influenced by cultural variables, such as ethnicity and language. The present results contribute to a growing body of evidence that highlights the need for culturally sensitive assessment and care of families in the medical setting. The findings may reflect differences in cultural values such as stoicism; however, future studies would benefit from examination of the factors that may account for the differences in reported behavior change after surgery (i.e., report bias, cultural values).

Adult-child interactions in the postanesthesia care unit: behavior matters.

BACKGROUND: Many children experience significant distress before and after surgery. Previous studies indicate that healthcare providers' and parents' behaviors may influence children's outcomes. This study examines the influence of adults' behaviors on children's distress and coping in the postanesthesia care unit. METHODS: Children aged 2-10 yr were videotaped during their postanesthesia care unit stay (n = 146). Adult and child behaviors were coded from video, including the onset, duration, and order of behaviors. Correlations were used to examine relations between behaviors, and time-window sequential statistical analyses were used to examine whether adult behaviors cued or followed children's distress and coping. RESULTS: Sequential analysis demonstrated that children were significantly less likely to become distressed after an adult used empathy, distraction, or coping/assurance talk than they were at any other time. Conversely, if a child was already distressed, children were significantly more likely to remain distressed if an adult used reassurance or empathy than they were at any other time. Children were more likely to display coping behavior (e.g., distraction, nonprocedural talk) after an adult used this behavior. CONCLUSIONS: Adults can influence children's distress and coping in the postanesthesia care unit. Empathy, distraction, and assurance talk may be helpful in keeping a child from becoming distressed, and nonprocedural talk and distraction may cue children to cope. Reassurance should be avoided when a child is already distressed.

Attitudes regarding analgesic use and pain expression in parents of children with cancer.

BACKGROUND: Children with cancer often experience significant levels of pain and their pain is generally undermanaged. Management of care to patients with cancer has shifted from the hospital to the home, and as such parents are charged with managing children's pain. However, parents may have misconceptions of analgesic use, which can lead to undertreatment of pain in children. The purpose of this study is to examine attitudes toward pain medication and perceptions of pain expression among parents of children undergoing cancer treatment. PROCEDURE: Parents of children who were undergoing cancer treatment at a hospital were recruited to take part in a survey study. A total of 187 parents completed a survey examining their attitudes toward medication and perceptions of pain expression in children. RESULTS: Many parents reported concerns regarding analgesic use to treat their children's pain and misconceptions about how children can express pain. Regression analyses noted that parental perceptions of pain expression were related to children's experience of chronic or recurring pain and the 2 dimensions of child temperament: emotionality and sociability. CONCLUSIONS: Many parents of children with cancer have misconceptions regarding issues of pain management; these misconceptions can potentially lead to undertreatment of pain in children. These misconceptions are associated with aspects of children's temperament.

Children's behavior in the postanesthesia care unit: the development of the Child Behavior Coding System-PACU (CBCS-P).

OBJECTIVE: To develop and validate a behavioral coding measure, the Children's Behavior Coding System-PACU (CBCS-P), for children's distress and nondistress behaviors while in the postanesthesia recovery unit. METHODS: A multidisciplinary team examined videotapes of children in the PACU and developed a coding scheme that subsequently underwent a refinement process (CBCS-P). To examine the reliability and validity of the coding system, 121 children and their parents were videotaped during their stay in the PACU. Participants were healthy children undergoing elective, outpatient surgery and general anesthesia. The CBCS-P was utilized and objective data from medical charts (analgesic consumption and pain scores) were extracted to establish validity. RESULTS: Kappa values indicated good-to-excellent (κ's > .65) interrater reliability of the individual codes. The CBCS-P had good criterion validity when compared to children's analgesic consumption and pain scores. CONCLUSIONS: The CBCS-P is a reliable, observational coding method that captures children's distress and nondistress postoperative behaviors. These findings highlight the importance of considering context in both the development and application of observational coding schemes.

Parental attitudes regarding analgesic use for children: differences in ethnicity and language.

PURPOSE: The aim of this study was to identify the impact of ethnicity and language on parental attitudes regarding analgesic use to treat children's pain. METHODS: A total of 206 parents of children undergoing outpatient surgery were recruited to complete the Medication Attitudes Questionnaire, a measure of parental beliefs about using analgesic medications to treat children's pain. Parents were grouped into one of 3 categories according to ethnicity and primary language spoken: English-speaking white, English-speaking Hispanic, and Spanish-speaking Hispanic. Group differences in pain medication attitudes were examined. RESULTS: After controlling for socioeconomic status, English-speaking Hispanic parents endorsed higher levels of misconceptions about pain medication use, including a tendency to avoid analgesic use for children, compared with English-speaking white and Spanish-speaking Hispanic parents. CONCLUSIONS: This study highlights parental characteristics, including ethnicity and language, which may place children at higher risk for undertreatment of acute pain based on misconceptions about analgesic use for children. Specifically, English-speaking Hispanic parents may be most likely to undertreat children's pain at home. Future studies are needed to identify the most appropriate means of providing education to counter parental misconceptions and support optimal pain management of children's pain in the home setting.

Changing healthcare providers' behavior during pediatric inductions with an empirically based intervention.

BACKGROUND: Each year more than 4 million children experience significant levels of preoperative anxiety, which has been linked to poor recovery outcomes. Healthcare providers (HCPs) and parents represent key resources for children to help them manage their preoperative anxiety. The current study reports on the development and preliminary feasibility testing of a new intervention designed to change HCP and parent perioperative behaviors that have been reported previously to be associated with children's coping and stress behaviors before surgery. METHODS: An empirically derived intervention, Provider-Tailored Intervention for Perioperative Stress, was developed to train HCPs to increase behaviors that promote children's coping and decrease behaviors that may exacerbate children's distress. Rates of HCP behaviors were coded and compared between preintervention and postintervention. In addition, rates of parents' behaviors were compared between those that interacted with HCPs before training to those interacting with HCPs after the intervention. RESULTS: Effect sizes indicated that HCPs who underwent training demonstrated increases in rates of desired behaviors (range: 0.22-1.49) and decreases in rates of undesired behaviors (range: 0.15-2.15). In addition, parents, who were indirectly trained, also demonstrated changes to their rates of desired (range: 0.30-0.60) and undesired behaviors (range: 0.16-0.61). CONCLUSIONS: The intervention successfully modified HCP and parent behaviors. It represents a potentially new clinical way to decrease anxiety in children. A multisite randomized control trial funded by the National Institute of Child Health and Development will examine the efficacy of this intervention in reducing children's preoperative anxiety and improving children's postoperative recovery.

Desire for perioperative information and parental ethnicity.

OBJECTIVES: To examine the role of ethnicity, language, and socioeconomic variables in parental desire for information regarding children's surgery. AIM: To compare anesthetic and surgical information desired between English- and Spanish-speaking White and Hispanic mothers of children undergoing outpatient surgery. BACKGROUND: Parents report wanting to receive detailed information regarding children's preoperative care; however, variables such as parent ethnicity and language spoken have not been accounted for in understanding desire for information. METHODS/MATERIALS: One hundred and eighty-one mothers of children undergoing outpatient surgery, elective surgery, and general anesthesia were recruited and categorized into one of three groups: English-speaking White (ESW, n=79), English-speaking Hispanic (ESH, n = 63), and Spanish-speaking Hispanic (SSH, n = 39). In addition to providing demographic questionnaire, mothers completed the Parental Desire for Information (PDI) questionnaire, a 14-item measure of surgery and anesthesia-related statements. RESULTS: Overall, mothers desired receiving information about the majority of the items on the PDI. As compared to ESW mothers, SSH mothers and ESH mothers were overrepresented in the 'have a right to know' response option, with significant differences existing in items concerning alternative methods of anesthesia, details of needles used, and location of PACU and OR. CONCLUSIONS: Anesthesiologists should tailor the provision of preoperative information based on ethnicity and language of mothers involved. Ethnic and language differences shown in this study may exist in other populations as well.