Spanish version of the ICIQ-Bowel questionnaire among colorectal cancer patients: construct and criterion validity : Comprehensive assessment of bowel function.

PURPOSE: Bowel complaints are very common among patients with colorectal cancer. However, the most used questionnaires for colorectal cancer survivors do not comprehensively comprise bowel symptoms. This study aimed to examine construct and criterion validity, as well as internal consistency, of the Chilean Version of the International Consultation on Incontinence Questionnaire Bowel Module (ICIQ-B) among people with colorectal cancer. METHODS: Cross-sectional, validation study performed with 106 colorectal cancer patients from Hospital del Salvador, Chile. Bowel function was assessed with the ICIQ-B. Construct validity was assessed with confirmatory factor analysis and hypothesis testing. Specific items of a quality-of-life questionnaire (EORTC QLQ-CR29) were used to correlate with similar ICIQ-B items for criterion validity. For internal consistency, Cronbach's alpha was computed. RESULTS: For construct validity, the confirmatory factor analysis showed that the three factors model did not fit our data. Meanwhile, hypothesis testing favored the construct validity of the instrument, considering that rectal cancer patients showed worse bowel pattern (p = 0.001), bowel control (p = 0.001) and quality of life (p < 0.001) scores compared to colon cancer patients. In addition, those patients assessed before surgery also presented worse scores bowel control (p = 0.023) and quality of life (p = 0.009) compared to post-surgical patients. Regarding criterion validity, the ICIQ-B items showed a significant correlation with similar QLQ-CR29 items. The internal reliability of the instrument was good (Cronbach's α = 0.909). CONCLUSION: Considering that this questionnaire appraises bowel function in more depth, it is recommended for use in clinical practice and research with colorectal cancer patients.

Implementation of a teleprehabilitation program for oncosurgical patients during the COVID-19 pandemic: perspectives and user satisfaction.

INTRODUCTION: Many rehabilitation services in the face of the COVID-19 health emergency have had to adapt face-to-face interventions with remote care through teleprehabilitation. We aim to describe the implementation of a teleprehabilitation program during the COVID-19 pandemic for patients who are candidates for elective cancer surgery in a low-income Chilean public hospital. Secondarily, describe the perspectives and satisfaction of patients with the program. MATERIAL AND METHODS: Correspond to a descriptive and retrospective pre-habilitation telemedicine intervention study. Implementation was measured in terms of, recruitment rate, retention, dropouts, and occurrence of adverse events. User perspectives and satisfaction were evaluated through a survey composed of nine items on a Likert scale with five response options. Descriptive analyses were considered with mean, standard deviation, minimum, maximum, as well as absolute and relative frequency. For patients' perspectives on the program, a qualitative analysis was considered to describe them. The most relevant domains were identified in a text box to illustrate the results. RESULTS: One hundred fifty-five patients were referred to the teleprehabilitation program, with 99.3% recruitment, a retention rate of 46.7%, and no adverse events reported. In relation to user satisfaction, in general, patients showed good satisfaction with the teleprehabilitation program except items related to "access to the teleprehabilitation program connection" and "number of sessions." Thirty-three patients reported their perspectives on the intervention, represented in 12 domains. CONCLUSION: It is possible to implement a teleprehabilitation program for oncosurgical patients in the context of preoperative care during the COVID-19 pandemic, with good user satisfaction. Likewise, this study provides guidance for other health institutions that wish to implement a teleprehabilitation program.

A randomized clinical trial to assess the effectiveness of pre- and post-surgical pelvic floor physiotherapy for bowel symptoms, pelvic floor function, and quality of life of patients with rectal cancer: CARRET protocol.

BACKGROUND: There is scarcity of trials about preventative strategies for low anterior resection syndrome (LARS) in rectal cancer patients. The aim of this study is to evaluate the effectiveness of a pre- and post-surgical pelvic floor rehabilitation program on the bowel symptoms, pelvic floor function, and quality of life of rectal cancer patients. METHODS: A randomized controlled trial with parallel groups (pelvic floor rehabilitation versus control group), with a blinded evaluator. PARTICIPANTS AND SETTING: 56 stage I to III rectal cancer patients aged from 18 to 80 years old undergoing sphincter preservation surgery at Hospital del Salvador and who have a sufficient knowledge of Spanish. MAIN OUTCOME MEASURES: ICIQ-B questionnaire for intestinal symptoms, high-resolution anorectal manometry (Alacer Multiplex 24-channel manometry equipment) for anorectal function, pelvic floor muscle strength test with Oxford Modified Scale, and a quality of life test with the EORTC QLQ C30 questionnaire. The evaluations will be carried out at five stages: before surgery, before and after the pelvic floor rehabilitation, and during a 3-month and 1-year follow-up. INTERVENTIONS: one pre-rehabilitation session and 9 to 12 sessions of pelvic floor rehabilitation, including patient education, pelvic floor muscle exercises, pelvic floor electromyography biofeedback, and capacitive and sensory rectal training with a balloon probe. Rehabilitation will begin 3-5 weeks before the ileostomy is removed (four sessions) and around 3 weeks after stoma removal (5-8 sessions). DISCUSSION: We expect the program to improve the bowel symptoms, pelvic floor function, and quality of life of rectal cancer patients. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Register ACTRN12620000040965 . Registered on 21 January 2020.

Lightwand tracheal intubation with and without muscle relaxation.

BACKGROUND: Lightwand tracheal intubation is a suitable technique for patients who are difficult to intubate but who are receiving effective ventilation. The effect of muscle relaxants on the efficacy of lightwand intubation has not yet been evaluated. The authors conducted a prospective, double-blind, placebo-controlled study to assess the effectiveness and incidence of complications of lightwand tracheal intubation performed during general anesthesia with and without the use of a muscle relaxant in patients with apparently normal airway anatomy. METHODS: One hundred seventy-six patients who required orotracheal intubation were prospectively included. Anesthesia was administered using propofol (2 mg/kg, then 3 mg . kg (-1). h(-1)) and remifentanil (1 microg/kg, then 0.3 microg . kg(-1) . min(-1)). Patients were randomly assigned to one of two groups (n = 88 for each) to receive rocuronium 0.6 mg/kg or saline intravenously. Lightwand orotracheal intubation (Trachlight; Laerdal Medical Inc., Armonk, NY) was attempted after 3 min. The authors recorded the number of successful intubations, the number of attempts and their duration, and events during the procedure. RESULTS: The failure rate of lightwand intubation was 12% in the placebo group and 2% in the rocuronium group (P = 0.021). Patients in the placebo group received more multiple intubation attempts (P < 0.001), required a greater intubation time (77 +/- 65 vs. 52 +/- 31 s; P = 0.002) and experienced a greater incidence of events during intubation (61 vs. 0%; P < 0.001) than patients in the rocuronium group. CONCLUSIONS: The use of muscle relaxants in patients with apparently normal airways is associated with a lower failure rate, decreased intubation time, and fewer attempts when performing lightwand orotracheal intubation.