The post-operative tonsillectomy (POPT) study: A multi-centre prospective paediatric cohort study.

OBJECTIVES: Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary. DESIGN: Prospective observational cohort study. SETTING: Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed. PARTICIPANTS: Children (≥4 years, ≤16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology. MAIN OUTCOME MEASURES: Frequency and severity of post-operative bleeding. Intensity and pattern of post-operative pain. RESULTS: In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008). CONCLUSION: A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.

Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings.

Personally owned handheld referencing technology such as smartphones or tablets, and the adjunct applications (apps) that can be used on them, are becoming a part of everyday life for the New Zealand population. In common with the population at large, student nurses have embraced this technology since the advent of the Apple iPhone in 2010. Little is known internationally or in New Zealand about the way student nurses may apply personally owned handheld referencing technology to their education process. The perceptions of New Zealand nurse managers, toward personally owned handheld referencing technology, could not be located. Using a qualitative descriptive methodology, semi structured interviews were conducted with New Zealand student nurses (n = 13), and nurse managers (n = 5) about their perceptions of use of personally owned handheld referencing technology as an educational tool in clinical settings. A thematic analysis was conducted on the resulting text. Student nurses said they wanted to use their own handheld referencing technology to support clinical decisions. Nurse managers perceived the use of personally owned handheld referencing technology as unprofessional, and do not trust younger cohorts of student nurses to act ethically when using this technology. This research supports historical research findings from the student perspective about the usefulness of older hand held referencing devices to augment clinical decisions. However, due to perceptions held by nurse mangers regarding professional behaviour, safety and the perceived institutional costs of managing personally owned handheld referencing technology, the practice may remain problematic in the studied setting.

Exploring the Validity of the Short Version of the Problem Behaviours Assessment (PBA-s) for Huntington's disease: A Rasch Analysis.

BACKGROUND: The short version of the Problem Behaviours Assessment (PBA-s) is the recommended outcome measure for behavioural symptoms in Huntington's disease. Rasch analysis was used to further investigate the measurement limitations of the PBA-s. OBJECTIVES: 1) To assess the psychometric properties of the 11 severity and frequency items within the PBA-s and 2) to determine the construct validity of using a total PBA-s score as a clinical outcome measure. METHODS: PBA-s data for 517 participants from Enroll-HD were included in the Rasch analysis. Separate analyses were conducted for the severity and frequency items of the PBA-s, using RUMM2030 software. Achieving fit to the model provides supporting evidence that all items contribute to a single underlying latent trait. This property is defined as internal construct validity. RESULTS: The total PBA-s severity score demonstrated several important limitations, including disordered response categories for all 11 severity items, local dependency and poor targeting. However, modifying the original five-point scoring system to a four-point system resulted in ordered response categories for seven of the severity items and achieved a good overall fit to the Rasch model. For the total PBA-s frequency score, fit to the model was not achieved even after amendments to the scoring system. CONCLUSIONS: This study suggests that with reduction to a four-point scoring system, the total PBA-s severity score may be considered a valid clinical outcome measure. This study also suggests limitations in the use of a total PBA-s frequency score.