Epidural blood patch in leukemia patient: a case report.

OBJECTIVE: We present a case of a patient with acute lymphoblastic leukemia (ALL) undergoing an epidural blood patch (EBP) for post-puncture dural headaches despite the risks of spreading cancer cells to the epidural space. SETTING AND PATIENT: A 46-year-old male with a history of adult T-cell ALL presented with persistent positional headache and neutropenic fever 2 weeks after receiving multiple intrathecal methotrexate treatments. His symptoms were consistent with post-dural puncture headache. The patient underwent an EBP and experienced complete pain relief following the procedure. He had no evidence of central nervous system involvement of ALL on his last evaluation 3 months following the blood patch. CONCLUSION: Post-dural puncture headache due to intrathecal administration of chemotherapy agents becomes increasingly recognized, and there are an increasing number of requests to anesthesiologists for EBP. A major concern in the patient population with hematological malignancies is the possibility of neuroaxial seeding of malignancies. Therein, flow cytometry was implemented to screen for blast cells in the circulating blood. Careful analysis and minimization of this potential risk is required to ensure the safety of the EBP in this specific patient population.

Burnout among faculty physicians in an academic health science centre.

BACKGROUND: Burnout experienced by physicians is concerning because it may affect quality of care. OBJECTIVE: To determine the frequency of burnout among physicians at an academic health science centre and to test the hypothesis that work hours are related to burnout. METHODS: All 300 staff physicians, contacted through their personal e-mail, were provided an encrypted link to an anonymous questionnaire. The primary outcome measure, the Copenhagen Burnout Inventory, has three subscales: personal, work related and patient related. RESULTS: The response rate for the questionnaire was 70%. Quantitative demands, insecurity at work and job satisfaction affected all three components of burnout. Of 210 staff physicians, 22% (n=46) had scores indicating personal burnout, 14% (n=30) had scores indicating work-related burnout and 8% (n=16) had scores indicating patient-related burnout. The correlation between total hours worked and total burnout was only 0.10 (P=0.14) DISCUSSION: Up to 22% of academic paediatric physicians had scores consistent with mild to severe burnout. A simple reduction in work hours is unlikely to be successful in reducing burnout and, therefore, quantitative demands, job satisfaction and work insecurity may require attention to address burnout among academic physicians.

Sharing clinical trial results with adolescent idiopathic scoliosis patients.

BACKGROUND: Results from clinical trials are generally not shared with participants unless they are thought to affect their future medical care. Few institutional review boards require that participants receive results of the research. Research in this area has largely focused on life-threatening medical conditions, and little is known about sharing clinical trial results in other populations. The purpose of this study was to determine the experience of patients with adolescent idiopathic scoliosis who had participated in a clinical trial and the best method for sharing clinical trial results. METHODS: The participants were adolescents with idiopathic scoliosis from a randomized clinical trial comparing 2 spinal implants. Patients, and their parents, were surveyed by mail before (May 2005) and after (January 2008) receiving the results of the study. The first survey focused on clinical trial experience, satisfaction with surgery, and eliciting the preferred method for receiving clinical trial results. The second survey examined patient and parent reactions to the trial results letter. RESULTS: Of 126 families who were mailed the pretrial results survey, 68% (86/126) of patients and 59% (74/126) of parents responded. Ninety-eight percent (84/86) of respondent patients and 96% (71/74) of respondent parents wanted to receive the results of the trial. Eighty-seven percent (75/86) of respondent patients and 86% (63/74) of respondent parents said the trial was a positive experience. Thirty-seven percent (32/86) of patients and 31% (23/74) of parents responded to the posttrial results survey, 25% (32/126) and 18% (23/126) of total trial participants, respectively. Sixty-three percent (20/32) of respondent patients and 70% (16/23) of respondent parents also felt that receiving the trial results by letter, with a telephone number for any questions, was the best way to receive the information. Seventy-two percent (23/32) of respondent patients and 70% (16/23) of respondent parents said they would participate in a future clinical trial. CONCLUSIONS: Participating patients and parents want to know the results of research studies. Researchers should plan to inform patients by informing them of this option during the informed consent process.

What do patients and parents know about surgery for adolescent idiopathic scoliosis?: a knowledge questionnaire.

STUDY DESIGN: Questionnaire. OBJECTIVE: The purpose of this study was to develop a reliable and valid questionnaire to assess patient and parent knowledge concerning risks, benefits, and complications of surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Families of adolescents with moderate to severe AIS are required to make an important decision on whether to proceed with surgery. Prior research has found families have substantial need for information with regard to surgery, and these needs may not be met by the health care system. METHODS: The study sample consisted of AIS patients and their parents. The questionnaire was administered to patients (and their parents) who were either actively braced (Cobb angle 30 degrees-50 degrees) or were within 1 year of surgery. The questionnaires were completed 2 weeks apart to test reliability of responses. To test construct validity, we hypothesized that patients who were postoperative would know more about the risks and benefits of surgery for AIS than those who were currently braced. RESULTS: Postoperative patients' and parents' scores were significantly greater than bracing patients' and parents' scores (P < 0.0001). Parents and patients reliably completed the questionnaires 2 weeks apart (Intraclass coefficient 0.83 and 0.68; CI = 0.83-0.96 and 0.45-0.83, respectively). CONCLUSION: The questionnaire was valid and reliable in evaluating patients' and parents' knowledge of AIS surgery and may be used in evaluating educational interventions for patients and parents.