The effect of virtual reality on pain and anxiety management during outpatient hysteroscopy: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Our study aimed to evaluate the effectiveness of virtual reality (VR) intervention for pain and anxiety relief during outpatient hysteroscopy. METHODS: Various databases were searched for available clinical trials from inception until June 2023. We selected randomized controlled trials (RCTs) that compared virtual reality intervention versus standard care among women undergoing outpatient hysteroscopy. We used Revman software to perform our meta-analysis. The primary outcome was the pain score during the procedure. The secondary outcomes were anxiety during the procedure and pain post-procedure. The Visual Analog Scale (VAS) was used to assess pain and anxiety. RESULTS: Six RCTs were retrieved, involving a total of 457 patients. Virtual reality was associated with a significant reduction in pain score during the procedure in comparison with the control group (MD = - 1.43, 95% CI [- 1.69, - 1.16], p < 0.001). In addition, there was a significant decrease in anxiety during the procedure among the virtual reality group compared to the control group (p = 0.01). The pain score post-procedure significantly decreased within the virtual reality group (MD = - 1.52, 95% CI [- 1.78, - 1.26], p < 0.001). CONCLUSIONS: Virtual reality technology is a simple, feasible, and effective intervention for reducing pain and anxiety during outpatient hysteroscopy. More trials are required to confirm our findings.

The impact of digital storytelling for children during paediatric day surgery on anxiety and negative emotional behaviors: Randomized controlled trial.

PURPOSE: The aim of the study was to examine the effectiveness of digital storytelling as a therapeutic care intervention in paediatric day surgery. DESIGN AND METHODS: his study was conducted in a randomized controlled experimental design. Seventy-two voluntary children who were scheduled for day surgery and met the inclusion criteria for the study were included. Research data were collected using the Child's Descriptive Information Form, the Children's Emotional Manifestation Scale, and the State Anxiety Inventory for Children. The study group used digital storytelling to prepare for day surgery. RESULTS: State anxiety scores decreased over time in the study group. The digital storytelling intervention was found to be effective in reducing anxiety scores. In the control group, state anxiety scores were highest on the day of the surgery. Children in the control group experienced higher levels of anxiety on the day of the surgery compared to those in the study group. The high anxiety levels in the control group continued at a higher level even two weeks after surgery. Children in the control group exhibited more negative emotional behaviors on the day of the surgery. CONCLUSION: The digital storytelling intervention implemented in this research was found to be effective in reducing children's anxiety and negative emotional behaviors. PRACTICE IMPLICATIONS: Digital storytelling should be applied and adapted to various other areas of paediatric surgery. Its utilization is significant for nurses working in the field of day surgery.

Incorporating the Distress Thermometer into preoperative vital signs in patients undergoing ambulatory oncology surgery: a pilot feasibility study.

BACKGROUND: Despite the extensive literature supporting distress screening at relevant transitions of care, the implementation of distress screening remains limited in ambulatory surgery settings. Our multidisciplinary team completed a pilot study to assess the feasibility and acceptability of including a standardized psychosocial assessment, the Distress Thermometer (DT), with the collection of admission vital signs by Patient Care Technicians (PCTs) in patients undergoing oncology surgery. METHODS: We assessed feasibility by the response rate and acceptability through discussions with the PCTs. RESULTS: Of the 189 men who underwent radical prostatectomy at our center, 71 were approached with the DT scale, and all patients who were approached completed the DT with no missing data. The staff reported no issues with data collection. A total of 21/71 (30%; 95% CI 19%, 42%) reported a clinically relevant distress DT ≥ 4. CONCLUSION: Our results demonstrated that incorporating the DT into vital sign collection was feasible, acceptable, and provided a valuable assessment.

Turkish Cross-cultural Adaptation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS).

PURPOSE: The purpose of this study is to cross-culturally adapt the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) to Turkish and test its validity and reliability. DESIGN: This is a methodological study. METHODS: This study was conducted with 121 children aged 1 to 12 years who underwent ambulatory surgery. The data of the study were collected using a Descriptive Information Form, PHBQ-AS, and the Parents' Postoperative Pain Measure. Data analysis and evaluation were performed using factor analysis, Cronbach's α analysis, item-total score correlation analysis, content validity, construct validity, and concurrent validity. FINDINGS: PHBQ-AS showed a high level of internal consistency (Cronbach's α = 0.801). The item-total correlation values of PHBQ-AS were found to be 0.458 to 0.753. PHBQ-AS was determined to be a single-factor scale explaining 66% of the variance in the examined variable. PHBQ-AS and Parents' Postoperative Pain Measure scores were moderately correlated. CONCLUSIONS: The Turkish version of PHBQ-AS was highly valid and reliable for the Turkish population. A recommendation for health care professionals in Turkey is to use the PHBQ-AS scale to evaluate posthospitalization behavioral changes in children who are admitted for ambulatory surgery.

Safety of Oral Midazolam as a Perioperative Anxiolytic for Outpatient Dermatologic Procedures.

BACKGROUND: Perioperative anxiety can negatively impact patient satisfaction and can complicate outpatient dermatologic procedures. OBJECTIVE: Evaluate adverse events associated with oral midazolam as a perioperative anxiolytic during dermatologic surgery and assess whether an enhanced monitoring approach is associated with an increased detection rate. MATERIALS AND METHODS: Five hundred cases (250 before and after change in monitoring) where patients were administered oral midazolam between July 2015 and May 2017 were retrospectively reviewed. The number of procedures, type of procedures, dose in milligrams, number of doses, major and minor adverse events, and vital signs were recorded. RESULTS: The difference in number of treatment sites, types of procedures, and total dose administered was not significant. There were minor but significant differences in the mean change in blood pressure, heart rate, respiratory rate, and Richmond Agitation and Sedation Scale score before and after the procedure but not oxygen saturation. These vital sign changes were not clinically significant. There were zero major adverse events in both groups. There were 2 patients who became transiently hypoxic. CONCLUSION: Oral midazolam administration was not associated with major adverse events including in the more intensively monitored group. This supports its use as an anxiolytic for outpatient dermatologic procedures.

Ambulatory neurosurgery in the COVID-19 era: patient and provider satisfaction with telemedicine.

OBJECTIVE: Telemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors' institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits. METHODS: This quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively. RESULTS: During the study period, 607 surveys were sent out to patients seen by telehealth at the authors' academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors' center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice. CONCLUSIONS: Although the authors' transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.

Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study.

BACKGROUND: Day surgical procedures are increasing both in Sweden and internationally. Day surgery patients prepare for and handle their recovery on their own at home. The aim of this study was to investigate patients' preoperative mental and physical health and its association with the quality of their recovery after day surgery. METHOD: This was a secondary analysis of a randomized controlled trial. Data were collected at four-day surgery units in Sweden. Health-related quality of life was measured using the Short Form 36 (SF-36) Health Survey, and postoperative recovery was assessed using the Swedish web version of the Quality of Recovery (SwQoR) scale. RESULT: This study included 756-day surgery patients. A low, compared with a high, preoperative mental component score was associated with poorer recovery as shown by responses to 21/24 and 22/24 SwQoR items, respectively, on postoperative days (PODs) 7 and 14. A low compared with a high preoperative physical component score was associated with poorer recovery in 18/24 SwQoR items on POD 7 and 13/24 on POD 14. CONCLUSION: A clear message from this study is for surgeons, anaesthetists and nurses to consider the fact that postoperative recovery largely depends on patients' preoperative mental and psychical status. A serious attempt must be made, as a part of the routine preoperative assessment, to assess and document not only the physical but also the mental status of patients undergoing anaesthesia and surgery. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT0249219.

Randomized-controlled trial of parent-led exposure to anesthetic mask to prevent child preoperative anxiety.

PURPOSE: To examine the efficacy of parent-directed anesthetic mask exposure and shaping practice to prevent child preoperative anxiety, with a specific focus on timing of exposure. METHODS: This randomized-controlled trial included 110 children ages four to seven years undergoing day surgery dental procedures and their parents. Families were randomly assigned to one of three groups: 1) parent-directed mask exposure/shaping practice at least three times in the week prior to surgery (Group 1); 2) parent-directed mask exposure/shaping practice at least once on the day of surgery (Group 2); 3) no exposure prior to induction (Group 3). Child anxiety was observer-rated using the modified Yale Preoperative Anxiety Scale during the day surgery experience, and induction compliance was observer-rated using the Induction Compliance Checklist. RESULTS: Results demonstrated significant differences in observer-rated child anxiety at anesthetic induction across groups. Group 2 demonstrated significantly lower observer-rated anxiety than Group 3 with a medium effect, F(1, 71) = 4.524, P = 0.04, η p 2 = 0.06. A significant interaction was observed between these two groups over time (i.e., admission to anesthesia induction), F(1, 71) = 4.365, P = 0.04, η p 2 = 0.06 (i.e., small to medium effect). Group 2 demonstrated the best anesthesia induction compliance (i.e., significantly lower scores than Group 3, P = 0.04). CONCLUSION: Timing of the delivery of mask exposure (i.e., on the day of surgery) to address child preoperative anxiety and induction compliance in the day surgery setting may be an important consideration. The current results inform the integration of this simple, effective strategy into practice.

RéSUMé: OBJECTIF: Examiner l'efficacité d'une exposition au masque anesthésique menée par un parent et détermination d'une pratique visant à prévenir l'anxiété préopératoire de l'enfant en se concentrant spécifiquement sur le moment de l'exposition. MéTHODES: Cette étude randomisée contrôlée a inclus 110 enfants âges de quatre à sept ans subissant une procédure dentaire en chirurgie d'un jour et leurs parents. Après randomisation, les familles ont été assignées à l'un des trois groupes suivants : 1) exposition au masque/pratique de modelage comportemental dirigée par le parent au moins trois fois dans la semaine précédant l'intervention (Groupe 1); 2) exposition au masque/pratique de modelage comportemental dirigée par le parent au moins une fois le jour de la chirurgie (Groupe 2); 3) aucune exposition avant l'induction (Groupe 3). L'anxiété de l'enfant a été évaluée par un observateur utilisant l'échelle mYPAS (échelle modifiée d'anxiété préopératoire de Yale) au cours de l'expérience le jour de la chirurgie et la conformité de l'induction a été évaluée par un observateur utilisant l'ICC (liste de vérification de la conformité de l'induction). RéSULTATS: Les résultats ont mis en évidence des différences significatives entre les groupes sur l'anxiété de l'enfant évaluée par un observateur au moment de l'induction anesthésique. Le Groupe 2 a présenté une anxiété évaluée par l'observateur significativement inférieure à celle du Groupe 3 avec un effet médian F (1, 71) = 4,524, P = 0,04, η P 2 = 0,06. Une interaction significative a été observée entre ces deux groupes au fil du temps (c'est-à-dire entre l'admission et l'induction de l'anesthésie), F (1, 71) = 4,365, P = 0,04, η P 2 = 0,06 (soit un effet petit à moyen). Le Groupe 2 a manifesté la meilleure conformité de l'induction de l'anesthésie (c'est-à-dire, des scores significativement inférieurs au Groupe 3, P = 0,04). CONCLUSION: Il peut être important de tenir compte du moment de l'exposition au masque (c'est-à-dire le jour de l'intervention) pour répondre à l'anxiété préopératoire de l'enfant et à la conformité de l'induction dans le cadre de la chirurgie d'un jour. Les résultats actuels renseignent sur l'intégration de cette stratégie simple et efficace dans la pratique.

Attitudes towards child life specialists and their utilization within pediatric urology.

INTRODUCTION: The American Academy of Pediatrics views Certified Child Life Specialists (CCLS) as "an important component of pediatric hospital based care to address the psychosocial concerns that accompany hospitalization." CCLSs help patients and parents navigate the complex medical system in order to minimize psychosocial and emotional stress by implementing age appropriate coping skills. This survey explores the perceptions towards CCLS and their utilization with pediatric urology. MATERIALS AND METHODS: A Survey Monkey questionnaire was developed and distributed to Society for Pediatric Urology members (SPU) (n = 314). Providers were queried about CCLS implementation and their perception regarding CCLS's role in improving health related quality of life (HRQOL). RESULTS: There was a 34.1% response rate (n = 107). Ninety-four providers (87.9%) reported CCLS interaction with their patients and greater than 95% of providers felt CCLS imparted some degree of benefit to their patients' HRQOL. Only 4.7% felt CCLS offered no benefit to the patients. CCLS were consistently used in a minority of inpatient and outpatient settings and never in the radiological setting. They were used at least 50% of the time by the most responders in inpatient and radiological setting and nearly the same in the ambulatory surgery setting. CONCLUSIONS: This survey illuminates that the majority of providers interact with CCLS in clinical settings and believe their involvement is beneficial. However, CCLSs are under-utilized during invasive urological procedures where patient anxiety is high. By understanding perceptions of providers and their practice patterns we can overcome barriers to CCLS use and improve their quality of life.

Soap bubbles as a distraction technique in the management of pain, anxiety, and fear in children at the paediatric emergency room: A pilot study.

BACKGROUND: Hospitals can cause anxiety, pain, and fear in children perceiving medical procedures as intrusive and painful. Among the nonpharmacological strategies, distraction techniques have proved to be effective in the management of pain and distress. METHODS: The aim of the present study is to assess the effectiveness of soap bubbles as a distraction technique for the management of anxiety, fear, and pain in children waiting for a medical examination at the paediatric emergency room. We employed a parallel trial design with a sample consisting of 74 children (M = 9.30; SD = 1.10; 50% female) randomly assigned to either a control or experimental group. The children in the experimental group underwent the soap bubble protocol while waiting for a medical examination at the paediatric emergency room. Anxiety, fear, and pain were assessed by self-report administered to the children before the triage and the application of the soap bubbles (baseline), after the application of the soap bubbles (T1), and after the medical examination (T2). RESULTS: The children in the experimental group showed a significant reduction of perceived pain while waiting for the medical examination (T1), whereas no difference was found after the medical examination (T2). Furthermore, the children in the experimental group showed a significant reduction in fear (T1 and T2), whereas no difference was found in the anxiety scores measured by the Child Anxiety. CONCLUSION: The use of soap bubbles is a good distraction technique in the reduction of fear and the perception of pain in children awaiting a medical examination at the paediatric emergency room.

Patient Perceptions of the Safety of Outpatient Total Knee Arthroplasty.

BACKGROUND: Outpatient total joint arthroplasty is considered safe in a selected group of patients, based primarily on complications. However, patient perception of the safety of outpatient total joint arthroplasty is unknown. This study assesses patient perceptions of the potential benefits of and barriers to outpatient total knee arthroplasty among a cohort of patients who have recently undergone the procedure. METHODS: Patients who underwent unilateral primary total knee arthroplasty between March 1, 2017, and September 30, 2017 at our institution were given a questionnaire, in which they were asked about prior knowledge regarding outpatient total knee arthroplasty, their perceived ability to undergo the procedure as an outpatient, and their perceived risks and benefits to outpatient surgery. RESULTS: Three hundred forty-six patients completed the survey. Over 70% of patients did not think that they would be able to undergo total knee arthroplasty as an outpatient. Their primary concerns were pain, being able to go to the bathroom, and falls. CONCLUSIONS: Patients in this study largely would not feel safe undergoing total knee arthroplasty on an outpatient basis. Payers should not only take into account existing literature but also the concerns and perceived needs of patients, before encouraging widespread implementation of outpatient total knee arthroplasty.

Nonpharmacological Relaxation Technology for Office-Based Rhinologic Procedures.

BACKGROUND: Office-based rhinologic procedures are increasingly performed to control costs and enhance patient convenience. Adequate management of pain and anxiety is essential for the technical performance of these procedures, in addition to ensuring patient comfort. Pharmacologic agents are often used to manage anxiety and pain. Nonpharmacological adjuncts may be useful for achieving these effects without oral opioids and benzodiazepines. METHODS: Charts of patients who underwent office-based rhinologic procedures with the NuCalm system (Solace Lifesciences, Inc., Wilmonton, DE, USA) in combination with local anesthesia were reviewed. NuCalm is a proprietary system that combines cranial electrotherapy stimulation, neuroacoustic software, light-blocking lenses, and topical γ--aminobutyric acid. Patients rated their pain and anxiety before, during, and after the procedure. RESULTS: Twenty-five patients underwent office procedures using the NuCalm system. Preoperative anxiety (2.00) was significantly higher than postoperative anxiety (1.25) according to patient reporting on a 5-point scale (p = 0.005). Preoperative pain (1.83) was not significantly different from intraoperative (2.54) and postoperative pain (2.04, p = 0.054). CONCLUSIONS: A variety of office-based rhinologic procedures are technically feasible and can be performed with adequate patient comfort without the use of oral drugs. Adjuncts to pharmacologic agents may enhance pain control and anxiety management and improve patient tolerance of these procedures.

The Effect of Text Messaging on Medication Adherence After Outpatient Knee Arthroscopy: A Randomized Controlled Trial.

PURPOSE: The purpose of this project was to examine if text message reminders can increase postoperative adherence to treatment with acetaminophen among outpatients undergoing arthroscopic knee surgery. DESIGN: A nonblinded randomized control trial. METHODS: In this study, 187 patients were randomized to either an intervention group (text message reminders) or a control group (no text message reminders). On the fourth postoperative day, all patients received an electronic questionnaire concerning (1) adherence to treatment with acetaminophen (main outcome), (2) pain intensity, and (3) unscheduled health care contacts. FINDINGS: Data were available from 134 patients (intervention group, n = 70; control group, n = 64). No significant differences between groups were found regarding the median number of missed acetaminophen doses (1 vs 2.5; P = .06), pain intensity at rest and during walking, or the number of unscheduled health care contacts (7 vs 4; P = .35). CONCLUSIONS: A nonsignificant trend toward an increased medication adherence of acetaminophen was found.

Preoperative Needs-Based Education to Reduce Anxiety, Increase Satisfaction, and Decrease Time Spent in Day Surgery: A Randomized Controlled Trial.

BACKGROUND: Too much or too little information during patient education can increase patient anxiety. Needs-based patient education helps to determine the appropriate amount of information required to provide education based on patient needs. This study aimed to compare needs-based patient education with traditional patient education in reducing preoperative anxiety. METHODS: This was a prospective, multicenter, single-blind, randomized controlled trial with a 1:1 allocation ratio. Patients undergoing day surgery were randomized into a study group (needs-based education) or a control group (traditional education). The primary outcome was patient anxiety. Secondary outcomes were patient satisfaction and time spent in patient education. Patients completed questionnaires to evaluate their anxiety and satisfaction before patient education, after patient education, and after surgery. RESULTS: In total, 450 patients were randomized and analyzed (study group n = 225, control group n = 225). Comparisons before education, after education, and after surgery showed that there was a significant decrease in patient anxiety and an increase in satisfaction in both groups (p < 0.001). The comparison between needs-based education and traditional education showed a greater decrease in anxiety (7.09 ± 7.02 vs. 5.33 ± 7.70, p = 0.001) and greater increase in satisfaction (21.1 ± 16.0 vs. 16.0 ± 21.6, p < 0.001) in the needs-based group. The needs-based group also had significantly less education time than the traditional group (171.8 ± 87.59 vs. 236.32 ± 101.27 s, p < 0.001). CONCLUSION: Needs-based patient education is more effective in decreasing anxiety, increasing patient satisfaction, and reducing time spent in education compared with traditional patient education. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT03003091.

Review of the Evaluation and Treatment of Vasovagal Reactions in Outpatient Procedures.

BACKGROUND: A vasovagal reaction is a commonly encountered event in outpatient procedures. There is a paucity of discussion on vasovagal reactions (VVRs) in the dermatologic surgery literature. However, recent investigations in the physiology, evaluation, and treatment of VVRs have been reported in other specialties. OBJECTIVE: A comprehensive review of the physiology, evaluation, treatment, and prevention of VVRs. MATERIALS AND METHODS: A search as performed using the PubMed/MEDLINE databases. Search terms included "vasovagal," "vasovagal reaction," "syncope," "reflex syncope," "neurocardiogenic syncope," and "fainting." RESULTS: Studies demonstrate greater understanding in the physiology of a vasovagal reaction. Although permanent sequelae are uncommon, it is important to respond in a prompt manner. A variety of treatment and prevention options are presented. CONCLUSION: Vasovagal reactions should be carefully evaluated. Additional studies may provide greater data in understanding and managing vasovagal reactions.

A prospective study comparing perioperative anxiety and posthospital behavior in children with autism spectrum disorder vs typically developing children undergoing outpatient surgery.

BACKGROUND: Research describing the experience of youth with autism spectrum disorders in the perioperative setting is limited. This study compared youth with autism spectrum disorder to typically developing children in the perioperative setting and examined group differences in: child anxiety, parent anxiety, premedication patterns, induction compliance, and changes in behavior postprocedure. METHODS: Participants were 60 youth (32 with autism spectrum disorder, 28 typically developing) of ages 2-19 years undergoing outpatient surgery and their parents. Parents and research assistants rated children's anxiety at 3 time points (waiting room, preoperative holding, separation), and parents rated their own anxiety in the waiting room and at separation. The anesthesiologist rated induction compliance. Postprocedure behavior change was assessed via phone survey 1 and 7 days postprocedure. Analyses examined group differences in anxiety, medication patterns, and behavior. RESULTS: Children with autism spectrum disorder had higher research assistant reported anxiety than typically developing youth in the holding room only. There were no group differences in parent report of their own anxiety or their child's anxiety across time points. Compared to typically developing youth, children with autism spectrum disorder were more likely to receive a premedication (including nonstandard premedication), and had poorer induction compliance. Groups did not differ on posthospital behavior change 1 or 7 days postsurgery. CONCLUSION: Findings revealed ratings of anxiety in youth with and without autism spectrum disorder facing surgery varied by reporter and setting, highlighting the importance of using multiple reporters in research of youth with autism spectrum disorder in the perioperative period. Furthermore, while results showed group differences in premedication patterns and induction compliance, groups did not differ in level of negative behavior change after surgery. Future research can examine how individual differences in youth with autism impact anxiety in the perioperative setting and degree of behavior change postprocedure.

Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction?

BACKGROUND: More surgeons are offering patients the option of having adult reconstructive procedures performed as an outpatient at an ambulatory surgery center. However, it is unknown if these patients have higher or lower satisfaction with their care than patients having a traditional inpatient stay. The purpose of this study is to compare satisfaction between inpatients and outpatients undergoing hip or knee arthroplasty. METHODS: Portions of the Health Consumer Assessment of Healthcare Providers and Systems survey, the Friends and Family Test, and 8 additional questions were administered to 174 consecutive patients. There were 8 non-responders (95.4% response rate) leaving 102 who underwent inpatient and 64 who had outpatient surgery. Responses were stratified using the "boxes" scoring approach as recommended by Health Consumer Assessment of Healthcare Providers and Systems and analyzed with a chi-squared or Fischer's exact test where appropriate. Power analysis determined that 38 patients per group were needed to detect a 1-point difference in overall satisfaction between groups with 80% power and alpha of 0.05 considered significant. RESULTS: Outpatients responded with more top responses when asked about the staff's explanation of any medicines received (91.4% vs 77.5%, P = .026), the staff's assistance with their pain management (98.3% vs 88.0%, P = .022), the written health information they were given upon discharge (98.3% vs 90.1%, P = .05), and the courtesy and respect from the nurses (100.0% vs 92.2%, P = .022). Inpatients responded with more bottom responses when asked how prepared they felt for discharge home (8.9% vs 0.0%, P = .014). Top responses in overall satisfaction with the facility (87.1% vs 93.4%, P = .204) and overall experience (89.2% vs 95.2%, P = .177) were similar between inpatients and outpatients, respectively. Not surprisingly, inpatients were older (64.1 vs 59.2 years, P = .001), heavier (body mass index 32.7 vs 30.4, P = .035), and had higher Charlson comorbidity scores (2.6 vs 1.9, P = .002). CONCLUSION: Although satisfaction was high in both groups, when differences were present they favored outpatient surgery in the ambulatory surgery center.

Understanding the surgical care needs and use of outpatient surgical care services among homeless patients at the Ottawa Hospital

Background: The use of outpatient health care services by homeless people is low compared to their high level of need; however, it is unclear whether this applies to surgical care. We sought to describe surgical care access among homeless patients in a Canadian tertiary care setting. Methods: We reviewed the medical records of adult (age > 18 yr) patients with no fixed address or a shelter address who presented to The Ottawa Hospital Emergency Department from Jan. 1, 2013, to Dec. 31, 2014, and required surgical referral. We analyzed the data using descriptive statistics. Results: A surgical referral was initiated in 129 emergency department visits for 97 patients (77 men [79%], mean age 46.7 yr). Most patients lived in shelters (77 [79%]) and had provincial health insurance (82 [84%]), but only 35 (36%) had a primary care physician. The mean number visits for any reason was 7.9 (standard deviation 13.7) (range 1­106). The majority of surgical referrals (83 [64.3%]) were for traumatic injuries, and the most frequently consulted service (52 [40.3%]) was orthopedic surgery. Just under half (48 [49%]) of referred patients attended at least 1 outpatient appointment, and only a third (33 [34%]) completed full follow-up. Conclusion: Homeless patients presenting to an emergency department and requiring surgical care were predominantly men living in shelters, most frequently seeking care for traumatic injuries. Current outpatient services may not meet the surgical care needs of these patients, as many do not access them. Alternative approaches to outpatient care must be considered, particularly among high-need services such as orthopedics, to support surgical care access among this population.

Contexte: L'utilisation des services de santé ambulatoires par les sans-abri est faible si on la compare à leurs besoins qui sont élevés; on ignore par contre s'il en va de même pour les soins chirurgicaux. Nous avons voulu décrire l'accès aux soins chirurgicaux chez les patients sans domicile fixe dans un hôpital de soins tertiaires au Canada. Méthodes: Nous avons passé en revue les dossiers médicaux de patients adultes (âge > 18 ans) sans domicile fixe ayant consulté aux urgences de l'Hôpital d'Ottawa entre le 1er janvier 2013 et le 31 décembre 2014, et pour qui une consultation en chirurgie avait été demandée. Nous avons analysé les données au moyen de statistiques descriptives. Résultats: Une consultation en chirurgie a été demandée lors de 129 visites aux urgences, pour 97 patients (77 hommes [79 %], âge moyen 46,7 ans). La plupart de ces patients vivaient dans des refuges (77 [79 %]) et bénéficiaient d'un régime d'assurance maladie provincial (82 [84 %]), mais seulement 35 (36 %) avaient un médecin de famille. Le nombre moyen de visites, toutes raisons confondues, a été de 7,9 (écart-type 13,7) (entre 1 et 106). La majorité des demandes de consultations en chirurgie (83 [64,3 %]) concernaient des lésions traumatiques et le service le plus souvent appelé en consultation (52 [40,3 %]) était la chirurgie orthopédique. Un peu moins de la moitié (48 [49 %]) des patients envoyés en consultation se sont présentés à au moins un rendez-vous en clinique externe, et seulement le tiers d'entre eux (33 [34 %]) se sont soumis au suivi complet. Conclusion: Les patients sans domicile fixe qui consultent aux urgences et ont besoin de soins chirurgicaux étaient principalement des hommes hébergés dans des refuges ayant le plus souvent consulté pour des blessures traumatiques. Les services ambulatoires actuels ne répondent peut-être pas aux besoins chirurgicaux de ces patients, car plusieurs n'y accèdent pas. Il faudrait envisager d'autres approches, particulièrement en ce qui concerne les services très en demande, comme l'orthopédie, pour faciliter l'accès aux soins chez cette population.

Effects of auditory and audiovisual presentations on anxiety and behavioral changes in children undergoing elective surgery.

BACKGROUND: : Preoperative anxiety is a critical issue in children, and associated with postoperative behavioral changes. AIMS: : The purpose of the current study is to evaluate how audiovisual and auditory presentations about the perioperative period impact preoperative anxiety and postoperative behavioral disturbances of children undergoing elective ambulatory surgery. MATERIALS AND METHODS: : A total of 99 patients between the ages of 5-12, scheduled to undergo outpatient surgery, participated in this study. Participants were randomly assigned to one of three groups; audiovisual group (Group V, n = 33), auditory group (Group A, n = 33), and control group (Group C, n = 33). During the evaluation, the Modified Yale Preoperative Anxiety Scale (M-YPAS) and the posthospitalization behavioral questionnaire (PHBQ) were used. RESULTS: : There were no significant differences in demographic characteristics between the groups. M-YPAS scores were significantly lower in Group V than in Groups C and A (P < 0.001 and P < 0.001, respectively). PHBQ scores in Group C were statistically higher than in Groups A and V, but, no statistical difference was found between Groups A and V. CONCLUSION: Compared to auditory presentations, audiovisual presentations, in terms of being memorable and interesting, may be more effective in reducing children's anxiety. In addition, we can suggest that both methods can be equally effective for postoperative behavioral changes.

[Patients taking an active role in their care in ambulatory knee replacement surgery]. / Le patient acteur de sa santé lors d'une arthroplastie de genou en ambulatoire.

National recommendations encourage the development of ambulatory surgery. This form of treatment, reserved mainly for short procedures, can also be used for more complex operations such as a total knee replacement. The teams at Vitré general hospital share their experience and emphasise the need to ensure the compliance of patients and their family.