Geluiden tijdens narcose en hun invloed op het postoperatief beloop : een klinisch onderzoek naar de invloed van verschillende geluidsprikkels tijdens algehele anesthesie op het postoperatief beloop van bepaalde patiënten (het STRIC-onderzoek)

Als inleiding op bet onderzoek, zoals in dit proefschrift beschreven, wil ik eerst enkele opmerkingen maken over de keuze van het onderzoeksondertoerv. Aan de afdeling medische psychologie van de Medische Faculteit van de Erasmus Universiteit te Rotterdam bestond bij het begin van mijn aanstelling de wens onderzoek te verrichten naar bepaalde basisbegrippen uit de psychotherapie. Basisbegrippen die als hoeksteen (kunnen) dienen in een dynamisch georiënteerde psychotherapie en waarvan het bestaan louter op theoretische gronden en klinische waarnemingen aannemelijk leek te zijn gemaakt. Hierbij kan bij voorbeeld worden gedacht aan begrippen als 'het Onbewuste' of 'verdringing'. De vraag was of een begrip als 'het Onbewuste' of 'verdringing' door middel van experimenteel onderzoek (b.v. in een laboratoriumsituatie) kon worden bestudeerd of reeds was bestudeerd. Deze vraagstelling leidde tot een literatuuronderzoek betreffende experimentele benadering van 'verdringing', waarin een onderscheid werd gemaakt tussen 'primal repression' en 'after repression'. Onder 'primal repression' wordt in dezen verstaan: de eerste fase van verdringing, waarbij gedachten naar het Onbewuste worden verwezen. zonder dat het individu zich bewust wordt van het bestaan van die gedachten. 'After repression' daarentegen houdt in: verwijzing van het materiaal (gedachten b.v.) naar het Onbewuste, nadat het materiaal door het individu bewust (h)erkend is als bedreiging. Uit de literatuurstudie kwam naar voren dat op het gebied van de 'primal repression' een aantal onderzoekingen is gedaan waarin het begrip verdringing experimenteel is benaderd, en dat op het gebied van de 'after repression' geen enkele onderzoeker erin is geslaagd het bestaan van die vorm van verdringing aannemelijk te maken in een experimentele situatie

Shortening the State-Trait Anxiety Inventory

Abstract Questionnaires that are used in studies with severely ill patients should be as short as possible. Abridged versions of existing inventories are very practical in these instances. The answers of 444 subjects in three samples (cancer patients, medical students, surgical patients) were used to investigate the possibility of constructing short and reliable versions of the scales of the State and Trait Anxiety Inventory. A stepwise regression procedure showed the possibility to reliably predict the total score of the unabridged versions by means of weighted sums of eight items for each scale. Omission of weights did not lead to substantial loss of information. Cronbach's α of the State-scale decreased from 0.93 to about 0.85 for different combinations of items and from 0.91 to about 0.82 for combinations of eight items of the Trait-scale. The relationship between both scales was only slightly modified by the shortening procedure

Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index

Memory for intraoperative events may arise from inadequate anesthesia when the hypnotic state is not continuously monitored. Electroencephalogram bispectral index (BIS) enables monitoring of the hypnotic state and titration of anesthesia to an adequate level (BIS 40 to 60). At this level, preserved memory function has been observed in trauma patients. We investigated memory formation in elective surgical outpatients during target-controlled propofol anesthesia supplemented with alfentanil. While BIS remained between 40 and 60, patients listened to a tape with either familiar instances (exemplars) from two categories (Experimental [E] group, n = 41) or bird sounds (Control [C] group, n = 41). After recovery, memory was tested directly and indirectly. BIS during audio presentation was on average (+/- SD) 44 +/- 5 and 46 +/- 5 for Groups E and C, respectively. No patient consciously recalled the intraoperative period, nor were presented words recognized reliably (Group E, 0.9 +/- 0.8 hits; Group C, 0.8 +/- 0.8 hits) (P = 0.7). When asked to generate category exemplars, Group E named 2.10 +/- 1.0 hits versus 1.98 +/- 1.0 in Group C (P = 0.9). We found no explicit or implicit memory effect of familiar words presented during adequate propofol anesthesia at BIS levels between 40 and 60 in elective surgical patients. IMPLICATIONS: This study suggests that stable levels of adequate hypnosis may prevent information processing and memory formation during general anesthesia and supports the feasibility of electroencephalogram bispectral index as a monitor of adequate anesthesia

Genetic risk estimation by healthcare professionals

OBJECTIVES: To assess whether healthcare professionals correctly incorporate the relevance of a favourable test outcome in a close relative when determining the level of risk for individuals at risk for Huntington's disease. DESIGN AND SETTING: Survey of clinical geneticists and genetic counsellors from 12 centres of clinical genetics (United Kingdom, 6; The Netherlands, 4; Italy, 1; Australia, 1) in May-June 2002. Participants were asked to assess risk of specific individuals in 10 pedigrees, three of which required use of Bayes' theorem. PARTICIPANTS: 71 clinical geneticists and 41 other healthcare professionals involved in genetic counselling. MAIN OUTCOME MEASURES: Proportion of respondents correctly assessing risk in the three target pedigrees; proportion of respondents who were confident of their estimate. RESULTS: 50%-64% of respondents (for the three targets separately) did not include the favourable test information and inc

Therapeutic suggestion has no effect on postoperative morphine requirements

This study was designed to confirm the effect of therapeutic intraoperative auditory suggestion on recovery from anesthesia, to establish the effect of preoperative suggestion, and to assess implicit memory for intraoperative information using an indirect memory task. Sixty consenting unpremedicated patients scheduled for elective gynecologic surgery were randomly divided into three equal groups: Group 1 received a tape of therapeutic suggestions preoperatively and the story of Robinson Crusoe intraoperatively; Group 2 heard the story of Peter Pan preoperatively and therapeutic suggestions intraoperatively; Group 3 heard the Crusoe story preoperatively and the Peter Pan story intraoperatively. A standardized anesthetic technique was used with fentanyl, propofol, isoflurane, and nitrous oxide. After surgery, all patients received patient-controlled analgesia (PCA) with a standardized regimen. In the 24 h postsurgery, morphine use was recorded every 6 h and at 24 h an indirect memory test(free association) was used to test for memory of the stories. Anxiety scores were measured before surgery and at 6 and 24 h postsurgery. There were no significant differences between groups for postoperative morphine rise, pain or nausea scores, anxiety scores, or days spent in hospital after surgery. Seven of 20 patients who heard the Pan story intraoperatively gave a positive association with the word 'Hook,' whereas 2 of 20 who did not hear the story gave such all association. Indirect memory for the Pan story was established using confidence interval (CI) analysis. (The 95% CI for difference in proportion did not include zero). No indirect memory for the Crusoe story could be demonstrated. This study did not confirm previous work which suggested that positive therapeutic auditory suggestions, played intraoperatively, reduced PCA morphine requirements. In contrast, a positive implicit memory effect was found for a story presented intraoperatively