Development and validation of the satisfaction with treatment for pain questionnaire (STPQ) among patients with sickle cell disease

A brief measure of patient satisfaction with treatment for pain is needed to help improve the treatment of painful episodes caused by sickle cell disease (SCD), especially during and after the transition from paediatric to adult care. Focus groups of 28 adolescent and adult patients were consulted about the content, clarity and relevance of 30 potential items, resulting in an 18-item version. This was validated by analysing questionnaire responses from 120 patients aged 12-53 years. Confirmatory factor analysis and item analysis indicated five subscales with high internal reliability: ‘Communication and Involvement’ (6 items, α=0.87); ‘Respect and Dignity’ (3 items, α=0.82); ‘Pain Control’ (3 items, α=0.91); ‘Staff Attitudes and Behaviour’ (4 items, α=0.88); and ‘Overall Satisfaction’ (2 items, α=0.85); plus a Total Satisfaction score (18 items, α=0.96). High negative correlations with the Picker Patient Experience Questionnaire, a measure of problem experiences, indicated good convergent validity. Lower satisfaction scores among patients aged over 18 years, those admitted via the emergency department, those treated by non-specialist hospital staff, and those reporting more breakthrough pain indicated good concurrent validity. The questionnaire provides a convenient brief measure that can be used to inform and evaluate improvements in healthcare for adolescent and adult patients with SCD, and could potentially be adapted for other painful conditions.Bart’s Charity Strategic Research Grant (Reference Number 1704); non-restricted financial grants from Kyowa Kirin and Mundipharma; University of Derby Undergraduate Research Scholarship awards; University of Derby REF reinvestment programme

Cytotoxicity and DNA damage in the neutrophils of patients with sickle cell anaemia treated with hydroxyurea

Hydroxyurea (HU) is the most important advance in the treatment of sickle cell anaemia (SCA) for preventing complications and improving quality of life for patients. However, some aspects of treatment with HU remain unclear, including their effect on and potential toxicity to other blood cells such as neutrophils. This study used the measurement of Lactate Dehydrogenase (LDH) and Methyl ThiazolTetrazolium (MTT) and the comet assay to investigate the cytotoxicity and damage index (DI) of the DNA in the neutrophils of patients with SCA using HU.In the LDH and MTT assays, a cytoprotective effect was observed in the group of patients treated, as well as an absence of toxicity. When compared to patients without the treatment, the SS group (n=20, 13 women and 07 men, aged 18-69 years), and the group of healthy individuals (AA) used as a control group (n=52, 28 women and 24 men, aged 19-60 years), The SSHU group (n=21, 11 women and 10 men, aged 19-63 years) showed a significant reduction (p20 months), demonstrating that despite the cytoprotective effects in terms of cell viability, the use of HU can induce DNA damage in neutrophils

Patient perceptions of crisis pain management in sickle cell disease: a cross-cultural study

Sickle cell disease has a variety of signs and symptoms, the most common being painful vaso-occlusive crises. Due to the severity of the pain, narcotic analgesia is described in the literature as the drug of choice for pain relief. The UK, in line with many other countries, uses narcotic analgesia in crisis management. In Jamaica, however, mild analgesia is the usual drug of choice for the patient in crisis. This difference in management approaches between the two countries was seen as an area for exploration to determine the factors which may reflect the nursing strategies used. This paper describes a cross-cultural survey of patients' perceptions of the painful crises and their management within the home and healthcare settings in Jamaica (West Indies) and Birmingham (UK). The results of the study show many areas of similarities, particularly in relation to the causes of the crises, home management and in-patient admissions. However, there were significant differences in crisis length and the in-patient management of crises. The study highlighted areas of crisis management which must be improved in the UK if patients are to receive optimum care from primary care and hospital nurses, as well as from general practitioners