The incidence of intraoperative awareness in children: childhood awareness and recall evaluation.

BACKGROUND: There is a considerable discrepancy between the reported incidences of awareness under anesthesia in children (0.2%-2.7%). In this prospective, observational, cohort study we evaluated 1) the incidence of awareness during general anesthesia in children across three settings, 2) factors contributing to awareness, and 3) short-term psychological effects of awareness. METHODS: Children (aged 5-15 yr) who underwent general anesthesia were included, and all perioperative data including anesthetic drugs were collected prospectively. Children were interviewed three times postoperatively using a semistructured questionnaire. All cases of possible or probable awareness were discussed with the child's care providers to confirm or refute the memories. Internal consensus among investigators across sites was reached, and these cases and a random selection of others were reviewed by three external reviewers. For the purpose of this study, possible/probable awareness was defined as cases with agreement between the internal consensus and at least two of the three external reviewers. RESULTS: One thousand seven hundred eighty-four children completed at least one interview. Thirty-two cases were coded as possible or probable awareness by at least one entity (i.e., either the internal consensus or one of the external reviewers). Fourteen of these cases met the definition for possible/probable awareness, making the incidence of awareness 0.8%. Six of the 14 children with awareness (43%) remembered feeling scared during their surgery and three (21%) reported hurting. Two children in this group (14%) said they would feel worse if they had to have surgery again, which was not significantly different from reports of children with no recall (15%). None of the children with awareness required psychological follow-up. Endoscopic procedures were associated with a higher risk for awareness (relative risk = 4.5 [confidence interval 1.5-13.6]). CONCLUSIONS: Although 0.8% of children experienced possible/probable awareness in this study, none experienced short-term psychological distress.

Development and Implementation of a Health Literacy Training Program for Medical Residents.

Nearly 50 percent of Americans lack the literacy skills needed to function effectively in today's health care environment. Experts recommend that health professionals be trained to better communicate with low-literacy patients, but few educational programs have been described. We developed a training program for medical residents that includes a videotaped standardized patient encounter, interactive small-group workshop, one-on-one feedback with a faculty member, and an individual behavioral prescription for improved communication. The program employs key principles of adult learning theory and evidence-based teaching approaches. Residents felt that the topic was relevant and that their communication skills benefited from the intervention. They enjoyed the teaching methods, particularly the individual feedback on their videotaped encounter. A qualitative process evaluation is provided to facilitate the teaching of similar programs elsewhere. Response to this curriculum indicates that residency appears to be a suitable time to raise awareness of health literacy and build appropriate communication skills.

Reducing HIV/AIDS transmission among African-American females: is the female condom a solution?

Rates of HIV/AIDS have increased at an alarming rate among minority women, especially African-American women. Suggestions that have been presented to decrease HIV/AIDS transmission among African-American women include promoting abstinence and the use of the male condom. Little recognition and support have been given for promoting the female condom as a viable solution to combating the HIV/AIDS epidemic.