Primer on adult patient satisfaction in perioperative settings.

The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients

Applying Theoretical Models of Positive Emotion to Improve Pediatric Asthma: A Positive Psychology Approach

Positive emotion, encompassing feelings such as joy and happiness, has been shown to predict a multitude of health outcomes. However, the role of positive emotion in pediatric asthma is not understood. No work to date has examined how positive emotion may offer benefits to children and adolescents with asthma. Based on theory and models of positive emotion and health, we hypothesize that positive emotion may improve asthma outcomes through mediators such as health behaviors and health-relevant physiological functioning. Moreover, boosting positive emotion during times of stress may be particularly relevant in mitigating asthma symptoms. In the present commentary, we elaborate on the hypothesized mechanisms behind such associations grounded within positive emotion theoretical frameworks. Additionally, we summarize the methodologically rigorous work of positive emotion interventions in other clinical settings to propose that positive emotion could be a useful tool in the management of pediatric asthma

Sex as a Moderator in the Relationship between Post-operative Pain and Analgesics Administered in Children Undergoing Elective Surgery

About 85% of children who undergo elective surgery experience pain post-operatively and many do not receive proper pain management care after discharge. Most parents lack an understanding of proper pain care management using analgesics upon discharge. Research reveals that adults rate girls as more sensitive to pain and that they display a greater amount of pain in a pediatric post-operative environment. In adulthood, women report more sensations of pain and have a higher pain tolerance, which can be attributed to physiological characteristics. Nonetheless, the social differences by which boys and girls experience pain and express their pain cannot be denied. The purpose of this study is to understand the relationship between a child’s post-operative pain and the amount of analgesics given to the child, and how sex moderates this association. Parents of children ages 2-13 (59% male, 41% female) (N=112) were asked to evaluate the pain of their child and report the amount and type of analgesic use days 1, 3, and 7 post-operatively. The Parents Perceived Pain Management (PPPM) Scale was used to evaluate the child’s pain and analgesic use was self-reported. Using this scale in regression-based analysis, there was a significant association between pain and the amount of analgesic use given to the children on post-operative days 1 (ibuprofen: b = 0.24, t = 3.55, p \u3c 0.05, acetaminophen: b = 0.22, t = 5.38, p \u3c 0.05) and 3 (ibuprofen: b = 0.72, t = 4.81, p \u3c 0.05, acetaminophen: b = 0.34, t = 4.44, p \u3c 0.05); however; sex did not significantly moderate this association (ps \u3e .05). Evidence in this study does not suggest that boys receive different post-operative analgesic care from girls as a function of pain. Future analysis should analyze factors that interact with this association like the sex of the parent that is administering analgesics and the parent’s education of analgesic usage

Child Postoperative Pain: Impact of Child Temperament and Parent Mood on Pain After Surgery

Around 80% of children who undergo surgery experience moderate to severe postoperative pain. Various psychosocial factors contribute to exacerbations of this pain. A child’s inborn personality traits and style of interaction with the environment are known as temperament. Children who are less sociable and more distress-prone (e.g., those who cry, throw tantrums) are more likely to have an anxious temperament. This anxiety before and after surgery may lead to an increase in postoperative pain levels as well. Parent pain ratings do not always reflect true child pain. Overtime, a parent’s emotional state and mood may change how they perceive child pain. Parents who have more negative moods or are more distressed tend to report their child’s pain as worse and have a negative impact on a child’s pain. Therefore, parents play a crucial role in treatment after surgery. Given this, the purpose of this study was to see how child temperament factors are associated with postoperative pain and how parent mood moderates this relationship. These specific factors are analyzed in a sample of children ages 2-13 who underwent elective surgery at the Children’s Hospital of Orange County (N = 112). Prior to the surgery, parents completed online surveys assessing child temperament and parent mood. Postoperative pain measures were reported by both children and parents after surgery on days 1, 3, and 7. Child temperament factors did not interact with parent mood to predict postoperative pain. Emotionality and sociability were not significantly associated with parent pain measures or child pain after surgery (ps \u3e 0.05). However, other studies have shown that child temperament does affect pain in a hospital setting more than they do at home. Interestingly, pain in children was low at home after surgery (less than 3 on a scale of 0 to 10). It is possible that the impact of temperament and mood on pain were less potent once the child is at home following the surgery and pain is lower. Further investigation on the influence of temperament and mood on child pain is important to obtain more clarity and discover optimal methods of treating pain in children. Future work may benefit from investigating different surgical procedures that might lead to a greater diversity of pain once children are home

Obesity Heterogeneity by Neighborhood Context in a Largely Latinx Sample

Neighborhood socioeconomic context where Latinx children live may influence body weight status. Los Angeles County and Orange County of Southern California both are on the list of the top ten counties with the largest Latinx population in the USA. This heterogeneity allowed us to estimate differential impacts of neighborhood environment on children’s body mass index z-scores by race/ethnicity using novel methods and a rich data source. We geocoded pediatric electronic medical record data from a predominantly Latinx sample and characterized neighborhoods into unique residential contexts using latent profile modeling techniques. We estimated multilevel linear regression models that adjust for comorbid conditions and found that a child’s place of residence independently associates with higher body mass index z-scores. Interactions further reveal that Latinx children living in Middle-Class neighborhoods have higher BMI z-scores than Asian and Other Race children residing in the most disadvantaged communities. Our findings underscore the complex relationship between community racial/ethnic composition and neighborhood socioeconomic context on body weight status during childhood

Pediatric Postoperative Pain Medication: Child Sex and Ethnicity Interact to Predict Parent Medication Attitudes

Over 85% of children experience significant pain after surgery. Despite this presence of pain, research suggests that a quarter of these children receive very little or even no pain medication at home. Such poor pain management in children can have harmful long-term consequences, both physically and psychologically. Previous research indicates that the amount of pain medication administered to children in the home may be significantly impacted by beliefs and attitudes parents have regarding analgesics. Given this, the purpose of the present study is to identify which demographic factors are associated with certain parent analgesic attitudes or misconceptions among pediatric patients ages 2-13 who have undergone elective surgery at the Children’s Hospital of Orange County (N = 112). Prior to surgery, parents completed surveys to report demographics and medication attitudes—fear of side effects, avoidance, and appropriate use attitude. Ethnicity was found to interact with child sex to predict parents’ fear of side effects, b = -4.750, p = 0.043. Specifically, among Hispanic households, parents of daughters expressed a greater fear of side effects from analgesics compared to parents of sons. The opposite trend was seen in White households, such that parents of sons expressed a greater fear of side effects compared to parents of daughters. This sex difference in Hispanic families may be due to the phenomenon machismo, a term characterized by the hypermasculine idealization of men. Specifically, Hispanic parents may express a significantly lower fear of side effects for their male children because they are encouraging their sons to be more stoic and “tough.” The hypermasculinity principles behind machismo, however, may not significantly transcend across other ethnic groups, as showcased by the opposite trend observed in White parents. These findings can be utilized to develop interventions that specifically target and educate parents who are likely to have misconceptions concerning analgesic use while still respecting the family’s culture, values, and practices

Postoperative Pain: Factors and Tools to Improve Pain Management in Children

Outpatient surgery has made it increasingly common for parents to manage pain in the home setting. Studies have shown that parents often under treat pain, leaving children vulnerable to the negative side effects of suboptimal pain management. Multiple factors affect pain management like child’s age and developmental stage, language, cultural values like stoicism, parental beliefs about medication, biological differences among groups, etc. Understanding all the factors involved can help healthcare providers and parents better understand pain and contribute to optimal pain management. Multiple tools and technological interventions have been created to help create a better understanding of pain and a holistic approach to care

Development of a Short Version of the Modified Yale Preoperative Anxiety Scale

BACKGROUND: The modified Yale Preoperative Anxiety Scale (mYPAS) is the current “criterion standard” for assessing child anxiety during induction of anesthesia and has been used in \u3e100 studies. This observational instrument covers 5 items and is typically administered at 4 perioperative time points. Application of this complex instrument in busy operating room (OR) settings, however, presents a challenge. In this investigation, we examined whether the instrument could be modified and made easier to use in OR settings. METHODS: This study used qualitative methods, principal component analyses, Cronbach αs, and effect sizes to create the mYPAS-Short Form (mYPAS-SF) and reduce time points of assessment. Data were obtained from multiple patients (N = 3798; Mage = 5.63) who were recruited in previous investigations using the mYPAS over the past 15 years. RESULTS: After qualitative analysis, the “use of parent” item was eliminated due to content overlap with other items. The reduced item set accounted for 82% or more of the variance in child anxiety and produced the Cronbach α of at least 0.92. To reduce the number of time points of assessment, a minimum Cohen d effect size criterion of 0.48 change in mYPAS score across time points was used. This led to eliminating the walk to the OR and entrance to the OR time points. CONCLUSIONS: Reducing the mYPAS to 4 items, creating the mYPAS-SF that can be administered at 2 time points, retained the accuracy of the measure while allowing the instrument to be more easily used in clinical research settings

A Randomized Trial Examining Preoperative Sedative Medication and Post-operative Sleep in Children

Study Objective Midazolam has been found to have beneficial effects on anxiety in children in the preoperative setting. Prior studies have examined various postoperative behaviors of children, but little research has examined the effects of preoperative use of midazolam with postoperative sleep. The purpose of this investigation was to compare postoperative sleep in children as a function of preoperative sedative medication use. Design This study was a 2-group randomized controlled trial. Setting Participants were recruited from Yale-New Haven Children\u27s Hospital. Patients Participants included a convenience sample of 70 children between the ages of 3 to 12 years undergoing ambulatory tonsillectomy and adenoidectomy. Interventions Children were randomly assigned to 1 of 2 groups: a control group who received preoperative acetaminophen only (n = 32) and an experimental group who received both acetaminophen and midazolam preoperatively (n = 38). Measurements Parents completed measures of postoperative behavioral recovery and a subset of children wore actigraphs to examine objective sleep data. Main Results Children who received midazolam experienced similar sleep changes compared to children in the control group. The actigraph data revealed that children who received midazolam were awake significantly less during the night compared to the control group (P= .01). Conclusion Children who received midazolam before surgery had similar postoperative sleep changes compared to children who did not receive midazolam. Further understanding of the postoperative behavioral effects of midazolam on children will help guide healthcare providers in their practice

Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study

BACKGROUND: It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. METHODS: This study included 105 families of children aged 2 to 15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for 1 week were collected during home visits. RESULTS: Despite the high (70%; 99% confidence interval [CI], 57%–82%) incidence of significant pain in the first 24 hours home, 32% (95% CI, 20%–45%) of the children received 0 to 1 dose of analgesia. Overall, 21% children (99% CI, 11%–35%) received 4 or less total doses of pain medication over the entire week after surgery. Of the total analgesic doses administered to children in the week after surgery, only 44% (99% CI, 40%–47%) were in accepted ranges. CONCLUSIONS: Despite experiencing significant postoperative pain, Hispanic children assessed in this study received suboptimal analgesic therapy at home