The patient care evaluation system: patients' perception of anesthetic care.

Our department's Patient Care Evaluation Survey was developed to measure the patients' perception of the care they received by our anesthesia caregivers (attending physicians, residents, and certified registered nurse anesthetists [CRNAs]), and identify those areas of patient contact which might require improvement in the delivery of anesthesia. The survey instrument (a personal letter sent by the chairman), is mailed to randomly selected patients two weeks following discharge from the hospital or ambulatory surgery center. Patients rated the anesthesia care they received from one (poor) to 10 (excellent) in three areas: the preoperative visit, the postoperative visit, and overall satisfaction. From October 1986 to October 1991, a total of 2,374 (n = 2,374) questionnaires representing a random sample of 99,964 anesthetics, were sent to patients. Fifty-four percent or 1,291/2,374 patients returned the survey. A high degree of patient satisfaction is seen for all categories: the preoperative visit, (mean score of 9.17 +/- 1.6); the postoperative visit (8.33 +/- 2.7); and overall satisfaction (9.15 +/- 1.7). Of the responses returned, 0.9% of the patients surveyed rated their interaction with the department as unsatisfactory in all three areas; 2.6% in two areas; 10.8% in at least one area. The Patient Care Evaluation system has served as an important means of feedback for medical, educational, and administrative goals of the department.

Influence of promethazine on symptom-therapy scores for nausea during patient-controlled analgesia with morphine.

We assessed whether adding promethazine to the syringe containing morphine for patient-controlled analgesia (PCA) decreases nausea after gynecologic surgery. Patients were assigned randomly to receive PCA (morphine 1.5 mg, 6-min lockout interval) with or without promethazine (0.625 mg/PCA dose, providing an average of 17.6 mg/24 h). Assessments included a visual analogue scale (VAS) for nausea (0 = none, 10 = worst possible) at scheduled times, rescue therapy requirements, and a maximum symptom-therapy score that provided an aggregate assessment of nausea intensity, duration, and response to rescue therapy (0 = no nausea; 1 = mild; 2 = moderate, requiring droperidol; 3 = severe or persistent, requiring droperidol; 4 = requiring droperidol+transdermal scopolamine; 5 = unrelieved). Nausea scores on the visual analogue scale at 2, 6, 8, and 24 h and use of rescue droperidol identified no significant differences between the groups. However, symptom-therapy scores differed significantly, with median values of 0 and 2, respectively, for the promethazine-treated and control groups. We conclude that simultaneous titration of morphine and promethazine decreases nausea associated with PCA therapy; the difference may best be appreciated with use of the combined symptom-therapy score.

Nausea prophylaxis using transdermal scopolamine in the setting of patient-controlled analgesia.

We evaluated the effectiveness of transdermal scopolamine in patients receiving morphine via patient-controlled intravenous analgesia following intra-abdominal gynecologic surgery. Soon after arrival in the post-anesthesia recovery unit (time 0), patients were randomized either to receive or not receive a postauricular transdermal scopolamine patch. Nausea and vomiting were scored on a 0-3 scale at this time and at 2, 4, 6, and 24 hours. Patients were treated with droperidol as deemed necessary by the primary care nurse. Within 2-4 hours, transdermal scopolamine patients evidenced less nausea and vomiting and required less droperidol than their counterparts who did not receive transdermal scopolamine. A significant decline in the severity of nausea was noted in the transdermal scopolamine group between 2-24 hours; significant inter-group differences were noted for changes in nausea severity during the 0-6-hour and 0-24-hour intervals. Transdermal scopolamine patients evidenced a significant (P less than .05) decrease in the severity of vomiting during the first 2 hours, significantly different from the increase in the non-transdermal scopolamine patients. After the 4-hour assessment, no transdermal scopolamine patients required droperidol; nine doses were administered to the patients who were not given transdermal scopolamine (P less than .05). Thus, transdermal scopolamine therapy appears to be an effective means of treating the nausea and vomiting that are encountered after gynecologic surgery.

Electrical wiring configurations and childhood leukemia in Rhode Island.

The study of the relationship between childhood leukemia and electric power line configurations in the greater Denver, Colorado, area by Wertheimer and Leeper (Am J Epidemiol 109:273-284, 1979) was repeated in Rhode Island, focusing on leukemia (age at onset, 0-20 years; year of onset, 1964-1978). The addresses of 119 leukemia patients and 240 controls were studied by mapping power lines within 50 yards (45.72 m) of each residence. The shortest distance between each power line and the point of the residence closest to it was found; the number and types of wires in each power line were noted. Exposure weights were assigned each type of wire using Wertheimer and Leeper's median field strength reading for each. Assuming that the strength of the field decreases with the square of the distance from its source, and that fields generated by different wires grouped in the same power line are simply additive, a summary value of relative exposure was calculated for each address. Quartile exposure values for controls were used to group patient exposures. Contrary to Wertheimer and Leeper's results, no relationship was found between leukemia and electric power line configurations.