Managing Postoperative Nausea With an Application of Ice Pack to the Posterior Upper Neck.

PURPOSE: Measure effectiveness of a non-pharmacological approach to manage postoperative nausea (PON) by applying an ice pack to the posterior upper neck. DESIGN: This was an observational quality improvement project. The sample included adults 18 years old and older who received general anesthesia (inhalation and/or intravenous), recovering in Phase I or Phase II postoperative care unit (PACU) experiencing very mild to moderate nausea. Exclusion criteria were patients who experienced severe nausea or were actively vomiting; were admitted for head or neck plastic surgery; were hypothermic (< 36.0°C); patients who refused the ice pack, or the provider stated that placing an ice pack to the patient's posterior upper neck was contraindicated. METHODS: Patients who experienced mild to moderate PON had an ice pack applied to the posterior upper neck as first line management. If the patient's nausea continued to progress or did not improve within five minutes of ice pack application the patient was offered a different non-pharmacological approach or pharmacological approach to prevent vomiting as per standards of care. Demographics were collected and patient's level of nausea was documented at the time of ice pack application and after five minutes. FINDINGS: Of the 70 patients included in this study, 61% reported ice pack application as effective in mitigating their nausea, 14% were unsure, and 24% reported not effective. There was a significant decrease in nausea between baseline (2.3 ± 0.6; range 1-3) and five minutes post application (1.5 ± 1.1; range 0-4). The within subject baseline-post change (↓0.9 ± 1.1; P < .001) reflected a decrease in nausea. CONCLUSIONS: Application of an ice pack to the posterior upper neck, may effectively decrease very mild to moderate PON.

Randomized trial of supplementary interviewing techniques to enhance recall of sexual partners in contact interviews.

BACKGROUND: People with multiple sex partners tend to forget a significant proportion when recalling them. METHODS: Randomized trial of supplementary interviewing techniques during routine partner notification contact interviews for chlamydia, gonorrhea, and syphilis in Colorado Springs, CO. Cases with multiple sex partners in the last 3 months (n = 123) participated. Interviewers prompted nonspecifically and read back the list of elicited partners after cases recalled partners on their own. We then randomly assigned cases to receive 1 of 3 sets of recall cues: (1) an experimental set of cues consisting of locations where people meet partners, role relationships, network ties, and first letters of names; (2) another experimental set including common first names; and (3) control cues referring to individual characteristics (e.g., physical appearance). RESULTS: Nonspecific prompting and reading back the list each increased the number of additional partners elicited and located by 3% to 5% on average. On average, the combined location/role/letter/network cues elicited more additional partners (0.57) than did the first-name (0.29) and individual characteristics (0.28) cues. The location and first-name cues were the most effective in eliciting located partners. The supplementary techniques increased the number of new cases found by 12% and, importantly, identified branches of the sexual network that would not otherwise have been discovered. CONCLUSION: Elicitation of sex partners can be enhanced in contact interviews with simple interviewing techniques, resulting in improved network ascertainment and sexually transmitted disease case finding.

Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence.

OBJECTIVE: The purpose of this study was to compare intra-anal electromyographic biofeedback alone with intra-anal biofeedback that was augmented with electrical stimulation of the anal sphincter in the treatment of postpartum fecal incontinence. A secondary aim was to examine the impact of the treatment on continence-related quality of life. STUDY DESIGN: Sixty symptomatic women were assigned randomly to receive intra-anal electromyographic biofeedback or electrical stimulation of the anal sphincter once weekly for 12 weeks and to perform daily pelvic floor exercises between treatments. Therapeutic response was evaluated with a symptom questionnaire to determine continence score, anal manometry, and endoanal ultrasound scanning. Quality of life was assessed before and after treatment with a validated questionnaire. RESULTS: Fifty-four women completed the treatment; 52 women (96%) had ultrasonic evidence of an external anal sphincter defect. After the treatment, both groups demonstrated significant improvement in continence score (P < .001) and in squeeze anal pressures (P < .04). Resting anal pressures did not alter significantly. Quality of life improved after the completion of physiotherapy, but there were no differences in outcome between intra-anal electromyographic biofeedback and electrical stimulation of the anal sphincter. CONCLUSION: Intra-anal electromyographic biofeedback therapy was associated with improved continence and quality of life in women with altered fecal continence after delivery. The addition of electrical stimulation of the anal sphincter did not enhance symptomatic outcome.