Patient Experiences with the Preoperative Assessment Clinic (PEPAC): validation of an instrument to measure patient experiences.

BACKGROUND: Presently, no comprehensive and validated questionnaire to measure patient experiences of the preoperative assessment clinic (PAC) is available. We developed and validated the Patient Experiences with the Preoperative Assessment Clinic (PEPAC) questionnaire, which can be used for quantitative measurements of patient experiences of the PAC. METHODS: We adapted the National Health Service outpatient questionnaire, incorporating questions specific for anaesthesiology. To make the PEPAC appropriate for quantitative measurements, dimensions and single items suitable for statistical analysis were constructed. Each dimension consists of multiple items measuring the same aspect of care. Reliability was established by computing Cronbach's alpha coefficients. Construct validity was assessed by correlating the dimensions with the patient's overall appraisal (Pearson's r). These dimensions should explain a substantial level of variance of the patients' overall appraisal; therefore, regression analysis was performed. RESULTS: After a pilot phase, the questionnaire was sent to 700 consecutive patients (response 74%). Five scales measuring five dimensions of patient experiences were constructed. Cronbach's alpha ranged from 0.56 to 0.84, supporting reliability of the PEPAC. Correlations between the dimensions and patients' overall appraisal ranged from 0.22 to 0.56. Collectively, the five scales explained 51% of patients' overall appraisal. CONCLUSIONS: The PEPAC is a comprehensive, reliable, and validated questionnaire to measure patient experiences with the PAC. It might be a useful tool to identify the service areas of the PAC that require improvement and to determine which actions can bring about improvement.

[An instrument for the assessment of the training qualities of clinician-educators]. / Een instrument voor de evaluatie van opleiderskwaliteiten van stafleden.

OBJECTIVE: The development and testing of a questionnaire to enable anesthesiology residents to assess the training qualities oftheir clinician-educators. DESIGN: Questionnaire. METHODS: The taskforce drafted a questionnaire based on the 26 item Stanford Faculty Development Program questionnaire (SFDP26) and adapted to the Dutch situation. Following its discussion in separate meetings ofanesthesiology residents and clinical staff, the questionnaire was further edited. The resulting instrument contained 6 teaching domains and 26 items. The questionnaire was made available electronically to anesthesiology residents only. Participation was voluntary, confidential and anonymous. Group results were presented at a plenary session. Anesthesiology staff received their individual scores by e-mail; results were confidential. RESULTS: 21 residents assessed 39 anesthesiologists. A total of 423 questionnaires were completed. Factor analysis resulted in the reduction and re-grouping of the teaching domains. The internal consistency ofthe teaching domains was high (Cronbach-alpha > or = 0.86). The assessment results of the teaching qualities of the anesthesiology faculty were positive. 'Communication of goals' was the lowest scoring (mean = 3.41) and 'Professional attitude towards residents' the highest scoring teaching domain (mean = 4.07). Gender did not correlate with the assessment scores of faculty. 'Year of training' was negatively correlated with most of the teaching domains. CONCLUSION: A feasible and reliable instrument for the evaluation of Dutch clinician-educators is now available.

[Are nail polish, artificial nails and piercings allowed outside the surgical area?Recommendations for the perioperative policy]. / Mogen nagellak, kunstnagels en piercings buiten het operatiegebied blijven zitten?

- An increasing number of patients wear nail polish, artificial nails or have piercings.- There is uncertainty about the perioperative management of these items, especially when located outside the surgical area.- In the majority of hospitals, patients are urged to remove these items preoperatively, under the assumption that they might cause problems.- Frequently, however, these items cannot be removed straightforwardly.- Nail polish and artificial nails only very rarely cause perioperative problems and therefore do not need to be removed pre-operatively.- The same applies to most piercings, except when located in or near the respiratory tract, if they have sharp endings or if they might cause problems as a result of the perioperative positioning of the patient.- Providing adequate information to the patient, knowledge about removal of these items and documentation of agreed arrangements are all important.- A national guideline concerning perioperative policy is urgently required.

The effect of mechanical cleaning and thermal disinfection on light intensity provided by fibrelight Macintosh laryngoscopes.

The increased use of thermal decontamination procedures for fibrelight laryngoscope blades, to comply with international guidelines, will have considerable economical effects. We evaluated the effect of mechanical cleaning plus thermal disinfection at 90 degrees C, with or without subsequent steam sterilisation at 134 degrees C, on light intensity provided by fibrelight laryngoscopes. After mounting the blades in a special frame with a built-in light source, light intensity was measured using radiometer/photometer. In total, 14 blades provided by 11 companies were tested. The majority of fibrelight laryngoscope blades were fairly resistant to the damaging effects of machine washing plus disinfection at 90 degrees C (mean [range] reduction in light intensity 34.6%[2.1-78.3%]). However, when exposed to an additional sterilisation procedure at 134 degrees C, the majority of blades were unable to withstand the combined treatment for 300 cycles (mean [range] reduction in light intensity 86.5%[32.0-98.7%]). This study stresses the need for fibrelight laryngoscope blades which are more resistant to thermal decontamination procedures than those available at present.