Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil.

The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants' mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach's alpha was .75, and .84 in the general communication subscale and .51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach's alpha was .83, and .88 in the general communication subscale, and .71 in the end-of-life communication subscale. The root mean square error of approximation was .07 (90% CI: .04 - .08); Tucker-Lewis index was .97 (95% CI: .95 - .98); comparative fit index was .98 (95% CI: .97 - .99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p = .05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC.

[Sugammadex by ideal body weight versus 20% and 40% corrected weight in bariatric surgery - double-blind randomized clinical trial]. / Uso de sugamadex pelo peso corporal ideal versus corrigido em 20% e 40% em cirurgia bariátrica ­ ensaio clínico randômico e duplo­cego.

BACKGROUND AND OBJECTIVES: The weight parameters for use of sugammadex in morbidly obese patients still need to be defined. METHODS: A prospective clinical trial was conducted with sixty participants with body mass index≥40kg.m-2 during bariatric surgery, randomized into three groups: ideal weight (IW), 20% corrected body weight (CW20) and 40% corrected body weight (CW40). All patients received total intravenous anesthesia. Rocuronium was administered at dose of 0.6mg.kg-1 of Ideal weight for tracheal intubation, followed by infusion of 0.3-0.6mg.kg-1.h-1. Train of four (TOF) was used to monitor depth of blockade. After spontaneous recovery TOF-count 2 at the end of surgery, 2mg.kg-1 of sugammadex was administered. Primary outcome was neuromuscular blockade reversal time to TOF≥0.9. Secondary outcome was the occurrence of postoperative residual curarization in post-anesthesia recovery room, searching the patient's ability to pass from the surgical bed to the transport, adequacy of oxygenation, respiratory pattern, ability to swallow saliva and clarity of vision. RESULTS: Groups were homogenous in gender, age, total body weight, ideal body weight, body mass index, type and time of surgery. The reversal times (s) were (mean±standard deviation) 225.2±81.2, 173.9±86.8 and 174.1±74.9 respectively, in the IW, CW20 and CW40 groups (p=0.087). CONCLUSIONS: No differences were observed between groups with neuromuscular blockade reversal time and frequency of postoperative residual curarization. We concluded that ideal body weight can be used to calculate sugammadex dose to reverse moderate neuromuscular blockade in morbidly obese patients.

Attitudes of residents and anesthesiologists toward basic sciences.

The perceived relevance of the subject matter is an essential condition for adult learning. Attitudes refer to internal states that influence learner's choices of personal action, which determine the probability of learning behaviors. Our objectives in this study were to describe and compare attitudes of residents and anesthesiologists towards the relevance of basic sciences to clinical practice. An 8-item questionnaire was given to 105 residents and 142 anesthesiologists. Data were electronically collected. Responses were graded on 5-level Likert scales. Comparisons were made between responses of residents and anesthesiologists. Although a general pattern of acknowledged relevance of basic sciences to clinical practice was observed in both groups, anesthesiologists' ratings were significantly higher than residents' ratings. Both groups emphasized in-depth formal learning of basic sciences before their clinical application, but attending anesthesiologists' scores were significantly higher than residents' scores. Residents were more favorable to a more superficial approach represented by learning general concepts than anesthesiologists, although median scores were below the center of the scale (neutral). In both groups median ratings of the role of instructors in exciting residents' curiosity through the teaching of basic sciences were located in the center of the respective scales. Both groups rated their in-training educational experiences high.

Influência do tiopental e do propofol nas condiçöes de intubaçäo traqueal com rocurônio / Influence of propofol and thiopental on the intubating conditions after rocuronium

Justificativa e objetivos: o rocurônio é um bloqueador neuromuscular adespolarizante que apresenta rápido início de açäo. Experimentalmente foi observado que o agente de induçäo pode interfirir na instalaçäo do relaxamento muscular. O objetivo deste estudo foi comparar a qualidade das condiçöes de intubaçäo traqueal com o rocurônio, após a administraçäo de propofol ou tiopental. Método: participaram do estudo trinta pacientes de ambos os sexos, estado físico (ASA) I e II, submetidos a cirurgias eletivas. Todos os pacientes receberam midazolam 5 a 15mg por via oral como medicaçäo pré-anestésica, noventa minutos antes da induçäo da anestesia. Após a monitorizaçäo, que constou de eletrocardiografia em DII, aferiçäo automática da pressäo arterial e oximetria de pulso, todos os pacientes receberam oxigênio a 100 por cento sob máscara e fentanil 2-5µg.kg(elevado a menos um) por via venosa. Os pacientes foram entäo distribuídos aleatoriamente em dois grupos, que receberam propofol (n=15) ou tiopental (n=15) em doses suficientes para abolir o reflexo palpebral. O bloqueio neuromuscular foi obtido com a administraçäo de rocurônio na dose de 0,6mg.kg(elevado a menos um). As condiçöes de intubaçäo traqueal foram analisadas aos 60 segundos após a administraçäo do rocurônio e pontuadas por escala de avaliaçäo clínica. Os dados estatísticos foram avaliados pelos testes t de Student, x² e teste de Mann Whitney. Resultados: o grupos foram homogêneos quanto ao sexo, idade, peso e altura. As condiçöes de intubaçäo traqueal foram similares nos dois grupos e foram classificadas como excelentes ou boas em quase todos os casos. Conclusöes: conclui-se que ambos agentes, propofol e tiopental, promoveram condiçöes similares de intubaçäo traqueal aos 60 segundos após a injeçäo de rocurônio na dose de 0,6mg.kg(elevado a menos um)