Serum hepatitis G virus (HGV) RNA in multitransfused thalassemics from eastern Sicily

To evaluate the efficacy of continuous administration of 50% nitrous oxide in oxygen for reducing pain during flexible fiberoptic bronchoscopy 32 children aged 3-60 months were randomly assigned to an experimental or a control group. Indications for endoscopy included persistent atelectasis (6), wheezing (10) cystic fibrosis (2) pneumonia (11) persistent cough (3). All patients received Midazolam (0.3 mg/kg) atropine (20 mcg/kg) intra rectaly 20 minutes before the procedure. The flexible fiberoptic bronchoscope (Olympus BF3C4) was inserted transnasally through a face mask. Topical anesthesia with 1% lidocaine hydrochloride (3 mg/kg) was applied to the nose, larynx, trachea and bronchial tree over 15 minutes through the suction chanel of the bronchoscope. All patients were monitored with a pulse oximeter and a cardiac monitor. The experimental group (n = 16) received 50% nitrous oxide in oxygen prior (3 minutes) and during flexible fiberoptic bronchoscopy, the control group (n = 16) received only oxygen. We measured pain of the children by a behavioral observation scale (Children's Hospital of Eastern Ontario Pain Scale: CHEOPS) at each phase of topical anesthesia during bronchoscopy in the two groups. At the end of bronchoscopy physician's satisfaction was scored by a visual analogue scale (VAS 0-100) in which 0 corresponded to absence of satisfaction. Nitrous oxide was associated with lesser pain scores than those with oxygen. Physician significantly preferred these procedure compared with oxygen. No complication occurred during procedure. Combined with local anesthesia midazolam and atropin the administration of 50% nitrous oxide in oxygen seems a better choice for flexible fiberoptic bronchoscopy in children and should be used routinely.     

Long-term marriage: Age, gender, and satisfaction.

Long-term marriages (N?=?156) varying in spouses' age (40–50 yrs or 60–70 yrs) and relative marital satisfaction (satisfied and dissatisfied) were studied. Spouses independently completed demographic, marital, and health questionnaires and then participated in a laboratory-based procedure focused on areas of conflict and sources of pleasure. Findings supported a positive view of older marriages. Compared with middle-aged marriages, older couples evidenced (1) reduced potential for conflict and greater potential for pleasure in several areas (including children), (2) equivalent levels of overall mental and physical health, and (3) lesser gender differences in sources of pleasure. The relation between marital satisfaction and health was stronger for women than for men. In satisfied marriages, wives' and husbands' health was equivalent; in dissatisfied marriages, wives reported more mental and physical health problems than did their husbands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determination of the minimal clinically significant difference on a patient visual analog satisfaction scale

OBJECTIVE: To determine the minimal clinically significant difference (MCSD) on a visual analog patient satisfaction scale. METHODS: The authors prospectively collected patient satisfaction evaluations during a clinical trial assessing the effect of introducing personal television sets on overall patient satisfaction from their ED encounters. Patient satisfaction was assessed with 2 scales: a 100-mm visual analog scale (VAS) (0 = least satisfied, 100 = most satisfied) and a 7-point categorical scale ("terrible," "mostly dissatisfied," "mixed," "partially satisfied," "mostly satisfied," "pleased," and "delighted"). The differences between the mean VAS scores of "delighted" and "pleased" patients, and between "pleased" and "mostly satisfied" patients were used to determine the MCSD on the VAS. Reliability of each of the scales was determined. RESULTS: 181 patients were evaluated. Mean age was 41 years; 59% were female. On a subset of 19 patients, the VAS yielded an interobserver correlation of 0.93. The kappa measurement of agreement on the categorical scale was 0.77. The mean difference between "delighted" and "pleased" patient VAS satisfaction scores was 6.8 mm (95% CI, 1.3-12.3 mm). The mean difference between "pleased" and "mostly satisfied" patient VAS satisfaction scores was 10.7 mm (95% CI, 5.5-15.8 mm). CONCLUSION: The MCSD in patient satisfaction scores measured with a 100-mm VAS was approximately 7-11 mm. Future studies evaluating differences in patient satisfaction should be designed to detect this difference.     

Ataxia induced by small amounts of alcohol

OBJECTIVE: To compare short- and long-term complications after tenectomy of the deep digital flexor tendons or onychectomy and owner satisfaction with these surgical procedures. DESIGN: Prospective cohort study. ANIMALS: 20 cats undergoing tenectomy and 18 cats undergoing onychectomy. PROCEDURE: Cats undergoing tenectomy or onychectomy were monitored for a minimum of 5 months to enable comparison of type and frequency of complications. Owner satisfaction was also assessed. RESULTS: Cats undergoing tenectomy had significantly lower pain scores 24 hours after surgery, compared with those undergoing onychectomy. Type and frequency of other complications did not differ between procedures. Owners appeared to be less satisfied with the tenectomy procedure than with the onychectomy procedure, although scores for satisfaction with each procedure were not significantly different. CLINICAL IMPLICATIONS: Owners should be aware of the high complication rate for both procedures and of the need for constant trimming of claws of cats that have undergone tenectomy.     

Parents and procedures: a randomized controlled trial

INTRODUCTION: Previous work has shown that parents prefer to be present when their children undergo common invasive procedures, although physicians are ambivalent about parental presence. PURPOSE: To determine the effect of a parent-focused intervention on the pain and performance of the procedure, anxiety of parents and clinicians, and parental satisfaction with care. POPULATION: Children younger than 3 years old undergoing venipuncture, intravenous cannulation, or uretheral catheterization. SETTING: Pediatric emergency department of Boston City Hospital. DESIGN: Randomized controlled trial with three groups; parents present and given instructions on how to help their children; parents present, but no instructions given; and parents not present. INTERVENTION: The parents were instructed to touch, talk to, and maintain eye contact during the procedure. RESULTS: A total of 431 parents was randomized to the intervention (N = 153), present (N = 147), and not present (N = 131) groups. The groups were equivalent with respect to measured sociodemographic variables and parents' previous experience in the pediatric emergency department. No differences emerged with respect to pain (3-point scale measured by parent and clinician, and analysis of cry); performance of the procedure (number of attempts, completion of procedure by first clinician, time); clinician anxiety; or parental satisfaction with care. Parents who were present were more likely to rate the pain of the children as extreme/severe (52%) in comparison to clinicians (15%, kappa .07, poor agreement) and were significantly less anxious than parents who were not present. CONCLUSION: Overall, the intervention was not effective in reducing the pain of routine procedures. Parental presence did not negatively affect performance of the procedure or increase clinician anxiety. Parents who were present were less anxious than those who were not present. CLINICAL IMPLICATION: In general, parents have indicated that they want to be present when their children undergo procedures. The results of this study challenge the traditional belief that parental presence negatively affects our ability to successfully complete procedures. We should encourage parents who want to be present to stay during procedures.     

Is psychological stress a risk factor for cerebrovascular disease?

OBJECTIVE: This prospective study was conducted to assess functional results obtained after pseudo-continent perineal colostomy using the Schmidt procedure. METHODS: Functional outcome was assessed in 40 patients who had undergone amputation of the rectum for cancer and pseudo-continent perineal colostomy reconstruction between 1989 and 1995 in our institution. The cancer pathology, operative procedure and post-operative care were noted. Morbidity, functional outcome and degree of patient satisfaction were recorded. Mean follow-up was 45 months (18-87) in 100% of the patients. RESULTS: There were no operative deaths. Twenty patients had post-operative complications and 2 patients required early conversion to definitive abdominal colostomy due to severe perineal complications. Function outcome showed normal continence in 4 patients, air incontinence in 23, occasional minimal leakage in 9 and incontinence requiring iliac colostomy in 2. Eighty-six percent of the patients were highly satisfied or satisfied with their continence capacity. DISCUSSION: Pseudo-continent perineal colostomy is a reliable technique which can be proposed as an alternative to left iliac colostomy after amputation of the rectum for cancer if a rigorous procedure is applied: careful patient selection, informed consent, rigorous surgical procedure, daily life-long irrigation of the colon.     

Tonsillectomy and adenoidectomy pathway plan of care for the pediatric patient in day surgery

The care of children undergoing tonsillectomy and adenoidectomy (T&A) in the day surgery setting can be costly, due in a large part to the length of stay after surgery. A clinical pathway standardizes the length of stay and, therefore, directly controls costs associated with outpatient T&A. A T&A pathway plan of care was developed at one institution to (1) decrease the cost of the procedure, (2) improve parent/patient satisfaction, and (3) maintain or improve the quality of care.     

Reciprocity of social exchange and social satisfaction among older women.

Investigated the association between reciprocity and older women's satisfaction with their social relationships. The sample consisted of 120 elderly widowed women. Analyses indicated that social exchange patterns that either overbenefited or underbenefited respondents were associated with greater loneliness. Reciprocity was greater in interactions with friends than with adult children and was more strongly related to satisfaction with friends than with children. Reciprocity was also found to vary as a function of the type of social exchange involved (companionship, instrumental support, or emotional support). The results suggest that the meaning of reciprocity is contingent on the actors' role relations and the content of their exchanges. The implications of studying reciprocity within a network perspective versus a dyadic-relationship perspective are also considered. (57 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aesthetics and lateral thoracotomy in the neonate

BACKGROUND: Lateral thoracotomy is a relatively common procedure in the neonate. Early reports on the incidence of shoulder deformity, scoliosis, and winged scapula rapidly led to a muscle-sparing approach. Scar cosmesis, however, received less attention. Better education and increasing sophistication have led to a higher aesthetic expectation by the public. METHODS: Since 1988 the authors have combined both principles in the high axillary skin crease approach to lateral thoracotomy in 27 children with esophageal atresia and tracheoesophageal fistula and two children with a patent ductus arteriosus. RESULTS: Access was not restricted, and early healing was uncomplicated by wound breakdown or infection. Scar aesthetics is excellent and is enhanced by the natural tendency of the scar to migrate into the axilla. Long-term morbidity has been singularly absent. CONCLUSION: Parent appreciation and operator satisfaction have been noteworthy.     

Determinations of participant and observer satisfaction with adversary and inquisitorial modes of adjudication.

To determine the reasons for previously reported greater satisfaction of defendants and observers with adversary vs single investigator inquisitorial procedures, 93 undergraduate males, who thought they were innocent, were tried under 1 of 4 procedures. 124 additional males and females served as observers. The procedures incorporated the 3 essential differences between the adversary and inquisitorial models: 2 attorneys rather than 1, attorney alignment with the defendant, and choice of attorney. All 3 factors were required to produce a significant increment in defendants' procedural satisfaction compared to the single investigator model. All 3 factors were also necessary to produce a significant increment in satisfaction with guilty verdicts. (Procedure did not affect evaluations of innocent verdicts.) Only number of attorneys produced a significant increase in observers' satisfaction with the procedure. Innocent verdicts produced more favorable procedure and verdict evaluations. Opportunity for evidence presentation is proposed as the mediator of adjudication evaluations. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty

BACKGROUND: Studies have found that female faculty publish less, have slower career progress, and generally have a more difficult time in academic careers than male faculty. The relation of family (dependent) responsibilities to gender and academic productivity is unclear. OBJECTIVE: To describe dependent responsibilities by gender and to identify their relation to the aspirations, goals, rate of progress, academic productivity, and career satisfaction of male and female medical school faculty. DESIGN: 177-item survey questionnaire. SETTING: 24 randomly selected medical schools in the contiguous United States. PARTICIPANTS: 1979 respondents from a probability sample of full-time academic medical school faculty. MEASUREMENTS: The main end point for measuring academic productivity was the total number of publications in refereed journals. Perceived career progress and career satisfaction were assessed by using Likert scales. RESULTS: For both male and female faculty, more than 90% of time devoted to family responsibilities was spent on child care. Among faculty with children, women had greater obstacles to academic careers and less institutional support, including research funding from their institutions (46% compared with 57%; P < 0.001) and secretarial support (0.68 full-time equivalents compared with 0.83 full-time equivalents; P = 0.003), than men. Compared with men with children, women with children had fewer publications (18.3 compared with 29.3; P < 0.001), slower self-perceived career progress (2.6 compared with 3.1; P < 0.001), and lower career satisfaction (5.9 compared with 6.6; P < 0.001). However, no significant differences between the sexes were seen for faculty without children. CONCLUSIONS: Compared with female faculty without children and compared with men, female faculty with children face major obstacles in academic careers. Some of these obstacles can be easily modified (for example, by eliminating after-hours meetings and creating part-time career tracks). Medical schools should address these obstacles and provide support for faculty with children.     

Interrelations and moderators of longitudinal links between marital satisfaction and depressive symptoms among couples in established relationships.

Extending research based on newlywed couples, this study investigated longitudinal associations between marital satisfaction and depressive symptoms in a community sample of 296 couples in established relationships (M = 13.25 years, SD = 5.98) with children (M age = 11.05 years, SD = 2.31). Support was found for reciprocal relations between marital satisfaction and depressive symptoms in couples with established relationships. Further extending previous work, the study showed that relationship length and hostile marital conflict were significant moderators of these linkages. Husbands in longer term relationships were more vulnerable to depressive symptoms in the context of marital problems compared with husbands in shorter term relationships. At higher levels of marital conflict, the negative relationship between marital satisfaction and depressive symptoms was strengthened. Reflecting an unexpected finding, increased conflict buffered spouses from marital dissatisfaction in the context of depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.     

Operative resection of 100 spinal lipomas in infants less than 1 year of age

A retrospective analysis of 100 children followed at Children's Memorial Hospital, Chicago, who underwent surgery for a spinal lipoma was performed. The mean follow-up was 5 years. We found that an operation performed during the 1st year of life with the goal of untethering the spinal cord and debulking the spinal lipoma was safe and effective, whereas a cosmetic (nonuntethering) procedure always led to delayed postoperative deterioration (symptomatic tethered cord). Of the infants that presented with motor, urologic or orthopedic symptoms, 39% improved, 58% stabilized, while 3% worsened as a result of surgery. No asymptomatic infant deteriorated postoperatively and 93% of these children remained symptom-free at follow-up (mean follow-up was 44 months). The overall outcome of infants after untethering procedures in this study was significantly better than the natural history of spinal lipomas. Several risk factors were identified that may predispose children to delayed postoperative deterioration: an initial cosmetic procedure; the presence of preoperative symptoms, and the presence of a lipomyelomeningocele.     

Malignant mesothelioma of the pleura. Morphometric study

Between April 1994 and October 1996 on account of complicated obstruction of the lacrimal pathways temporarily into the lacrimal efferent system 144 silicone cannulas were inserted in 127 children aged 4 months to 9 years. A standard procedure was used, with the children under general inhalation anaesthesia, in collaboration of an ophthalmologist and otorhinolaryngologist using endonasal optics. By October 1996 100 cannulas were extubated, on average after 4.1 months. The effectiveness of the procedure evaluated on the basis of clinical manifestations and the Dye Disappearance test is 81%.     

Union attitude and job satisfaction in Indian workers.

Relationship between attitude towards union and job satisfaction was studied on a sample of 100 workers in a light engineering factory in India by use of specially constructed interview schedules. There was a significant negative association between the 2 measures (r = -.47). Of the personal factors—age, marital staus, and length of union membership were significantly related to job satisfaction (p     

Parent Functioning in Families of Preadolescents With Spina Bifida: Longitudinal Implications for Child Adjustment.

The purpose of this study was to test a strength-of-association model regarding possible longitudinal and bidirectional associations between parent functioning and child adjustment in families of children with spina bifida (n = 68) and families of able-bodied children (n = 68). Parent functioning was assessed across 3 domains: parenting stress, individual psychosocial adjustment, and marital satisfaction. Child adjustment was indexed by teacher-reported internalizing and externalizing symptoms, self-reported depressive symptoms, and observed adaptive behavior. Findings revealed that all 3 parent functioning variables predicted child adjustment outcomes, and that such results were particularly strong for externalizing symptoms. Associations between parent functioning and child adjustment tended to be in the direction of parent to child and were similar across both groups. These findings have implications for potential interventions targeted at helping families manage the transition into early adolescence in families of children with spina bifida as well as families of healthy children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The life satisfaction of nonnormal persons.

Tested the proposition that membership in a fixed-status class would be unrelated to life satisfaction. In 2 experiments, questionnaire responses of handicapped persons (144 and 46) were compared with those of normals (151 and 44). No differences were found along the dimensions of life satisfaction, frustration with life, and mood, while some evidence indicated that the handicapped were less suicidal, more religious, more oriented toward the generalized other, and felt their lives were more difficult. Handicapped Ss who acquired their defect did not differ from those born with it. In Exp III, the observed moods of 40 mentally retarded children (mean age = 13) were compared with those of 40 normals (mean age = 13) via a time-sampling procedure while they were in class and at recess at school. Parents and teachers responded to a rating scale indexing intelligence, social adjustment, and happiness for each S. Differences uncovered favored the intelligence and social adjustment of the normals and the happiness of the male retardates. Results are construed as demonstrating essential equivalence in life satisfaction for handicapped, retarded, and normal persons. (16 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics and perceptions of beginning doctoral students in school psychology.

A national sample of 251 1st- and 2nd-yr doctoral students in school psychology responded to a questionnaire measuring demographic characteristics, preferences among applied specialties in professional psychology, graduate program applications, anticipated internship setting, preferred client population, personal interests, professional goals, and satisfaction with current training. Survey responses showed a clear preference for working directly with children and adolescents following graduation, a high degree of correspondence between training program emphases and student interests and goals, and a moderate degree of student satisfaction with training experiences. Results are interpreted with respect to training trends and standards in school psychology, the relationship between school and clinical psychology, satisfaction of students in clinical and counseling psychology programs, and methodology limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)