Validation of the clinical frailty score (CFS) in French language.

BACKGROUND: Very old critical ill patients are a rapid expanding group. To better understand the magnitude of the challenges involved in intensive care practice for an ageing population and discuss a rational allocation of resources, healthcare practitioners need a reliable evaluation of frailty. In order to promote the adequate use of the Clinical Frailty Scale (CFS) in a wider panel of countries, we aimed to develop, validate and characterise a French (FR) version from the original English (EN) CFS. METHODS: We included participants recruited prospectively for the observational "The very old intensive care patient: A multinational prospective observation study" (VIP Study) at Geneva University Hospitals (FR speaking hospital). A FR version of the CFS was obtained by translation (EN- > FR) and back translation (FR- > EN). The final CFS-FR was then evaluated twice on the same participants with at least a 2-week interval by FR-speaking doctors and nurses. RESULTS: Inter-rater reliability was 0.87 (95%CI: 0.76-0.93) between doctors for the original CFS version and 0.76 (95%CI: 0.57-0.87) between nurses for the FR version. Inter-rater variability between doctor and nurse was 0.75 (95%CI: 0.56-0.87) for the original version, and 0.73 (95%CI: 0.52-0.85) for the FR version. Test-retest (stability) with the original vs the FR version was 0.86 (95%CI: 0.72-0.93) for doctors and 0.87 (95%CI: 0.76-0.93) for nurses. Differences between the evaluations of the CFS-EN and CSF-FR were not different from 0, with a mean difference of 0.06 (95%CI -0.24, 0.36) for the EN version and - 0.03 (95%CI -0.47, 0.41) for the FR version. Average original version ratings were slightly lower than FR version ratings, though this difference did not reach significance: -0.29 (95%CI -0.54, 0.04). CONCLUSION: In this prospective cohort of very old intensive care participants we developed and tested the basic psychometric properties (internal consistency, reproducibility) of a French version of the CFS. This manuscript provides clinically meaningful psychometric properties that have not been previously reported in any other language, including in the original EN version. The French cultural adaptation of this CFS has adequate psychometric properties for doctors or nurses to evaluate frailty in very old intensive care patients.

Ergonomics, surgeon comfort, and theater checklists in pediatric laparoscopy.

UNLABELLED: Laparoscopy is often carried out with personnel unfamiliar with the equipment and layout, thereby forcing the surgical team to adapt by twisting and stretching awkwardly. This can make laparoscopy more difficult and frustrating for the surgeon, potentially increasing patient risk. We carried out a short survey of laparoscopic procedures to determine when surgeons experience discomfort, and whether or not operative checklists could reduce these. MATERIALS AND METHODS: All patients undergoing laparoscopic operations by one surgeon between November 2006 and May 2007 were studied. Patients and surgeons had various physical measurements recorded, including the placement and orientation of equipment, staff and patients, any problems arising, and the discomfort of the surgical team. Scaled diagrams were drawn, outlining positions and orientation, allowing the measurement of the degree to which the surgeons twisted and stretched. Peroperative surgeon comfort levels were recorded. The ideal table height for surgery was calculated, suggestions to improve the surgeon's comfort were identified, recommendations on theater layout were produced, and sample checklists of common problems with ways of avoiding them were established. RESULTS: Of 31 procedures, 10 had full data recorded for analysis. Physically demanding positions were common. There was no correlation between surgeon position and comfort for short operations (<60 minutes). Data for operative time >60 minutes was incomplete, but a definite trend to increasing discomfort with time was evident. In 10 operations, 85 problems occurred, 57 relating to theater layout. A third were avoidable repeat problems. CONCLUSIONS: Simple measurements of surgeons, patients, and equipment improves staff and equipment positioning. A log of problems and discomforts in the theater ensures that preventable factors are not repeated, reducing the frustrations of laparoscopy. By planning equipment positioning and testing it, a preferred theater set-up layout can be retained for future use. Checklists would help in the smooth execution of a laparoscopic procedure.