Comparison of traditional anesthesia method and jet injector anesthesia method (MadaJet XL®) for Nexplanon® insertion and removal.

BACKGROUND: This study compared a needle-free anesthesia method with traditional local anesthesia for insertion and removal of Nexplanon® long-acting removable contraceptive device. In our clinic, patients often avoid this highly effective form of contraception due to fear of needles. We sought to determine if patients perceived a difference in pain with the injection, anxiety level or pain with the procedure when local anesthesia was given with a needle v/s a needle-free jet injector device. METHODS: Patients were randomly assigned to one of two groups: jet injector or needle lidocaine delivery. Outcomes were ease of use, patient anxiety level, painfulness, and efficacy of anesthesia method. RESULTS: Patient pain perception with administration of jet injector lidocaine was statistically lower than traditional needle with no difference in anxiety or ease of use, or efficacy of the anesthesia. CONCLUSION: The jet injector device is a reasonable alternative to needle injection delivery of anesthesia prior to insertion/removal of Nexplanon® device. Further studies may determine whether this needle-free alternative for administration of local anesthetic would result in more women choosing Nexplanon® as a contraceptive method.

Clinical utility of the chronic obstructive pulmonary disease knowledge questionnaire.

BACKGROUND AND OBJECTIVES: Although typically symptomatic, chronic obstructive pulmonary disease (COPD) is undertreated as compared to many asymptomatic conditions such as hypertension. Unfortunately, many patients lack basic information about their major disease states, including COPD. The purpose of this study was to assess the clinical utility of the valid and reliable COPD Questionnaire (COPD-Q) in a sample of underserved patients carrying a diagnosis of COPD. METHODS: This prospective, descriptive study enrolled COPD patients at a family medicine residency teaching clinic. Patients were administered a telephone survey assessing COPD knowledge, demographic data, and health literacy. Data regarding COPD clinical outcomes were gathered through the electronic medical record. RESULTS: Average total COPD-Q score was 7.6 plus or minus 2.1 (total possible score=13). Total COPD-Q scores were significantly related to health literacy and educational attainment. CONCLUSIONS: The COPD-Q is a valid, reliable tool used to assess COPD knowledge in a setting that includes patients with limited health literacy. It is useful in identifying key knowledge deficits that will allow the clinician to offer focused, individualized patient education and counseling.

Development and validation of a low-literacy Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q).

OBJECTIVE: The objective of this study was to develop a content valid, understandable, readable, and reliable Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q). METHODS: Twenty-one questions were generated as potential items to include in the COPD-Q. Twenty-two content experts provided both qualitative and quantitative assessments of two COPD-Q drafts. Ten patient volunteers completed a field test to assess clarity of individual COPD-Q items. An additional 24 patient volunteers completed a pilot test to determine internal consistency and test-retest reliability of the COPD-Q. The Flesch Reading Ease (FRE) was used to assess reading grade level of the COPD-Q. RESULTS: Thirteen items were rated as "essential" (content validity ratio= p <0.05) by content experts and composed the final COPD-Q. Internal consistency, using Cronbach's alpha, was 0.72. Test-retest reliability, using intraclass correlation coefficient, was 0.90. The FRE score of the COPD-Q was 74.7 (equivalent to a 5th grade reading level). CONCLUSION: The COPD-Q is a valid, readable and reliable knowledge assessment instrument for assessing COPD knowledge in patients who may have low health literacy skills. PRACTICE IMPLICATIONS: Health care providers can use the COPD-Q to tailor counseling efforts according to individual patient needs, and to assess the effectiveness of their educational interventions.