Validation of simplified postoperative nausea and vomiting intensity scale in Taiwan.

This study determined whether the Simplified Postoperative Nausea and Vomiting Impact Scale (SPONVIS), could be used to predict clinically important PONV in Taiwanese. In this prospective, observational study, SPONVIS, simplified Apfel PONV Risk Scores, post-operative anti-emetic drug use, total PONV score, and 3-month recall score for PONV were recorded from Taiwanese patients who had undergone general anesthesia and surgery. With antiemetic use and 3-month recall score as validations of clinical significance, we determined whether the elements and cut-off points used in the original SPONVIS study could be used in Taiwanese patients. A total of 378 patients were included in the analysis. One hundred forty (37.1%) patients had PONV. Forty-eight patients (12.7%) had clinically important PONV (SPONVIS score ≥ 5). The odds ratios were 14.26 (CI 6.91-29.43; P < 0.001) and 4.95 (CI 2.42 to 10.11; P < 0.001), respectively, for prediction of anti-emetic drug use and 3-month recall. The SPONVIS and its construct elements were significantly related to anti-emetic drug use, 3-month recall score for PONV, total PONV score, and Apfel risk score (all P ≤ 0.005), results similar to those reported in the original Australian PONV impact score study. The SPONVIS cut-off points 3 and 5 were statistically significant predictors of anti-emetic drug use. However, a cut-off point of 3 had a higher OR (24.08) than a cut-off of 5 (14.26) for prediction of anti-emetic drug use. SPONVIS and both construct elements (the nausea and vomiting impact scores) are useful predictors of clinically important PONV in Taiwanese.

Sequence variants of the HTR3A gene contribute to the genetic prediction of postoperative nausea in Taiwan.

Postoperative nausea (PON) is a common complication, and therefore, it is important to identify the associated genetic factors and the candidate predictive markers. Current clinical and basic research suggests that the 5-hydroxytryptamine type 3A receptor (HTR3A) may be important in the occurrence of PON. The association between three single nucleotide polymorphisms (SNPs) of the HTR3A gene and PON was examined to determine whether this can be used to predict the incidence of PON in a unique Taiwanese population without any reported postoperative nausea and vomiting (PONV) risk factors associated with PON occurrence. One thousand adult surgical patients who received general anesthesia were included in this analysis. A total of 369 patients were finally selected for a two-stage association study. Significant single-locus associations for all three HTR3A SNPs and PON were identified in both stages. In addition, two of the most common haplotypes, CTT and TAG, showed both a significant risk for and a protective effect against PON, respectively. Our findings support the notion that different haplotypes of HTR3A have reciprocal effects in the etiology of PON. Therefore specific haplotypes of HTR3A may be useful as predictors of PON for 24 h immediately after surgery in our population.

A survey of how patient-perceived empathy affects the relationship between health literacy and the understanding of information by orthopedic patients?

BACKGROUND: There is a lack of research examining patient-perceived empathy and its effect on low-literacy patients' understanding of health information. This study investigated the moderating effect of patient-perceived empathy on the relationship between health literacy and understanding of preoperative information. METHODS: During a 2-month period, a total of 144 patients took a survey that included the Chinese-edition Rapid Estimate of Adult Literacy in Medicine, the Barrett-Lennard Relationship Inventory and the Preoperative Information Understanding Scale. Hierarchical multiple regression analysis provided a test of moderator effects. RESULTS: All Cronbach's alphas exceeded 0.6, with REALM at 0.91, BLRI at 0.67, and PIUS at 0.77.The finding that the interaction term was significant suggests perceived empathy is a relevant factor when considering the relationship between health literacy and the understanding of information by patients. The relationship between the health literacy and understanding of information was stronger and positive among patients who perceived greater empathy from their physicians. CONCLUSION: Our study demonstrates that a focus on improving physician-patient empathy skills could be beneficial in helping to overcome the negative consequences associated with limited health-literacy capabilities. Healthcare providers who wish to improve the understanding of information by low health-literacy patients should first identify components of their empathic communication mechanisms, and then try to refine these skills to better serve their patients.

Intubation difficulty scale contributors and time delay in clinical practice.

ABSTRACT: The intubation difficulty scale (IDS) includes 7 contributors that provide a comprehensive assessment of difficult intubation. However, the effect of each contributor is unclear, and the scale has not been revalidated recently and has not been validated in orient. This study determined the duration of successful intubation (DSI) for each of these 7 contributors.The patients were intubated by attending anesthesiologists. The duration and other data were recorded by 2 research assistants. Anaesthesiologists reported the IDS and their perceptions. A linear mixed-effects model with a DSI was constructed using IDS factors.In total, 1095 patients were enrolled. The average DSI was 23.9 ±â€Š21.8 seconds (37.1% IDS = 0). All 7 factors were independently associated with duration, with the exception of vocal cord adduction. The best model was as follows: DSI (in seconds) = 15.2 + 31.1 (number of additional attempts) + 26.2 (number of additional operators) + 11.4 (number of alternative techniques) + 7.9 (increased lift force) + 4.9 (external laryngeal pressure) + 3.5 (Cormack grade 1). The mixed models were similar except for the regression coefficient for the number of alternative techniques that decreased from 11.4 to 6.9 seconds.We confirmed that each IDS contributor affects the DSI and validated a prediction model with 6 IDS contributors. This prediction model may facilitate the development of strategic plans for critical airway management. Furthermore, it could improve simulations and monitor learning progress and help provide valuable feedback.

An initial learning experience of tracheal intubation with video laryngoscope: Experiences from a novice PGY.

ABSTRACT: Tracheal intubation is an essential technique for many healthcare professionals and one of the mega code simulations in advanced cardiac life support. In recent years, video laryngoscopy (VL) has provided a rescue for difficult airways during intubation and has proven to have higher success rates. Moreover, VL facilitates a more rapid learning curve for inexperienced doctors.In this article, we report 16 cases intubated with VL by a novice doctor of postgraduate year 1, who shared the learning experience and the difficulties encountered in this case series. We also conducted a statistical analysis to evaluate the learning outcomes of the trainee after 1 month.Our results showed that the overall first-shot success rate was 81.3% for the 16 objectives. Over time, improvements in intubation performance measures, including shortened duration and lower Intubation Difficulty Scale score, have been observed. In this learning project, we found that limitation of mouth opening (<2.5 fingers wide) is an important risk factor for predicting the initial difficulty of tracheal intubation on the novice trainee.For inexperienced doctors, VL produces high first-shot success rates for tracheal intubation and may be useful for training their performance in a short period of time. In addition, mouth opening <3 fingers wide may result in difficult intubation by novice doctors.

Betel-Nut Chewing Increases Difficulty in Tracheal Intubation.

BACKGROUND: Betel-nut chewing (BC) causes oral submucous fibrosis (OSF), and this leads to difficult tracheal intubation (DI). Unanticipated DI was reported in chewers with apparently normal preoperative airway evaluations (PAEs). This analysis aims to investigate whether BC is an independent risk on DI besides the common DI risk prediction factors. METHODS: After the approval of Institutional Review Board and the written informed consent were obtained, 2,682 patients were enrolled in a cohort. PAEs, intubation difficulty scale (IDS), intubation time, and perceived DI were recorded prospectively. All 805 male patients received classical intubation, 307 with BC and 498 without BC were analyzed. Data were analyzed by Student's t-test and chi-square test. Stepwise logistic regression was performed to identify BC effects on IDS adjusting for related factors with WEKA (Waikato Environment for Knowledge Analysis; Machine Learning Group at the University of Waikato, Hamilton, New Zealand). RESULTS: Fewer BC patients were Cormack-Lehane (CL) grade I (38.9% vs. 47.6%) or IDS degree 〞Easy〞 (24.8% vs. 33.5%). Compared with IDS degree 〞Easy〞, patients in the BC group had a significantly higher odds ratio (OR) for 〞Slight + Moderate-Major〞 degree than in the non-BC group (adjusted OR, 1.75; 95% CI, 1.15-2.68). Compared with CL grade I, patients with BC was an independent risk for II (adjusted OR, 1.53; 95% CI, 1.02-2.32) and IV (adjusted OR, 3.25; 95% CI 1.01-10.49). Otherwise, patient's age ≥ 46 and the presence of teeth were also significant risk factors for IDS degree 〞Slight + Moderate-Major〞. CONCLUSION: BC increased not only the tracheal intubation difficulty in patients with apparent OSF but also in patients with PAEs. BC is an independent risk factor besides the commonly used DI prediction factors. We suggest physicians operating on BC patients to be better prepared for DI.

The Antinociceptive Effect of Light-Emitting Diode Irradiation on Incised Wounds Is Correlated with Changes in Cyclooxygenase 2 Activity, Prostaglandin E2, and Proinflammatory Cytokines.

Background. Light-emitting diode (LED) phototherapy has been reported to relieve pain and enhance tissue repair through several mechanisms. However, the analgesic effect of LED on incised wounds has never been examined. Objectives. We examined the analgesic effect of LED therapy on incision pain and the changes in cyclooxygenase 2 (COX-2), prostaglandin E2 (PGE2), and the proinflammatory cytokines interleukin 6 (IL-6), IL-1ß, and tumor necrosis factor α (TNF-α). Methods. Rats received LED therapy on incised skin 6 days before incision (L-I group) or 6 days after incision (I-L group) or from 3 days before incision to 3 days after incision (L-I-L group). Behavioral tests and analysis of skin tissue were performed after LED therapy. Results. LED therapy attenuated the decrease in thermal withdrawal latency in all the irradiated groups and the decrease in the mechanical withdrawal threshold in the L-I group only. The expression levels of COX-2, PGE2, and IL-6 were significantly decreased in the three LED-treated groups, whereas IL-1ß and TNF-α were significantly decreased only in the L-I group compared with their levels in the I groups (p < 0.05). Conclusions. LED therapy provides an analgesic effect and modifies the expression of COX-2, PGE2, and proinflammatory cytokines in incised skin.