Patient expectations, outcomes and satisfaction : related, relevant or redundant?

Abstract Study design: A prospective investigation of patients undergoing lumbar spine surgery. Objective: Is there a correlation between patient’s expectations before lumbar surgery, postoperative outcomes and satisfaction levels? Methods: A prospective study of 145 patients undergoing primary, single-level surgery for degenerative lumbar conditions was conducted. Oswestry Disability Index (ODI), back visual analogue scale (VAS) and leg VAS were assessed pre-operatively and at 6 weeks and 6 months post-surgery. Patients’ expectations were measured pre-operatively by asking them to score the level of pain and disability that would be least acceptable for them to undergo surgery and be satisfied. Satisfaction was assessed six weeks post-operatively with a Likert scale. Differences in patient expectations between actual and expected improvements were quantified. Results: Most patients had a clinically relevant improvement, but only about half achieved their expectation. Satisfaction did not correlate with pre-operative pain or disability, or with patient expectation of improvement. Instead, satisfaction correlated with positive outcomes. Conclusions Patient expectations have little bearing on final outcome and satisfaction.

Affecting interference

This collaborative project by Daniel Mafe and Andrew Brown, one of a number in they have been involved in together, conjoins painting and digital sound into a single, large scale, immersive exhibition/installation. The work as a whole acts as an interstitial point between contrasting approaches to abstraction: the visual and aural, the digital and analogue are pushed into an alliance and each works to alter perceptions of the other. For example, the paintings no longer mutely sit on the wall to be stared into. The sound seemingly emanating from each work shifts the viewer’s typical visual perception and engages their aural sensibilities. This seems to make one more aware of the objects as objects – the surface of each piece is brought into scrutiny – and immerses the viewer more viscerally within the exhibition. Similarly, the sonic experience is focused and concentrated spatially by each painted piece even as the exhibition is dispersed throughout the space. The sounds and images are similar in each local but not identical, even though they may seem to be the same from casual interaction, closer attention will quickly show this is not the case. In preparing this exhibition each artist has had to shift their mode of making to accommodate the other’s contribution. This was mainly done by a process of emptying whereby each was called upon to do less to the works they were making and to iterate the works toward a shared conception, blurring notions of individual imagination while maintaining material authorship. Empting was necessary to enable sufficient porosity where each medium allowed the other entry to its previously gated domain. The paintings are simple and subtle to allow the odd sonic textures a chance to work on the viewer’s engagement with them. The sound remains both abstract, using noise-like textures, and at a low volume to allow the audience’s attention to wander back and forth between aspects of the works.

Guerrilla research tactics: alternative research methods

This case-study explores alternative and experimental methods of research data acquisition, through an emerging research methodology, ‘Guerrilla Research Tactics’ [GRT]. The premise is that the researcher develops covert tactics for attracting and engaging with research participants. These methods range between simple analogue interventions to physical bespoke artefacts which contain an embedded digital link to a live, interactive data collecting resource, such as an online poll, survey or similar. These artefacts are purposefully placed in environments where the researcher anticipates an encounter and response from the potential research participant. The choice of design and placement of artefacts is specific and intentional. DESCRIPTION: Additional information may include: the outcomes; key factors or principles that contribute to its effectiveness; anticipated impact/evidence of impact. This case-study assesses the application of ‘Guerrilla Research Tactics’ [GRT] Methodology as an alternative, engaging and interactive method of data acquisition for higher degree research. Extending Gauntlett’s definition of ‘new creative methods… an alternative to language driven qualitative research methods' (2007), this case-study contributes to the existing body of literature addressing creative and interactive approaches to HDR data collection. The case-study was undertaken with Masters of Architecture and Urban Design research students at QUT, in 2012. Typically students within these creative disciplines view research as a taxing and boring process, distracting them from their studio design focus. An obstacle that many students face, is acquiring data from their intended participant groups. In response to these challenges the authors worked with students to develop creative, fun, and engaging research methods for both the students and their research participants. GRT are influenced by and developed from a combination of participatory action research (Kindon, 2008) and unobtrusive research methods (Kellehear, 1993), to enhance social research. GRT takes un-obtrusive research in a new direction, beyond the typical social research methods. The Masters research students developed alternative methods for acquiring data, which relied on a combination of analogue design interventions and online platforms commonly distributed through social networks. They identified critical issues that required action by the community, and the processes they developed focused on engaging with communities, to propose solutions. Key characteristics shared between both GRT and Guerrilla Activism, are notions of political issues, the unexpected, the unconventional, and being interactive, unique and thought provoking. The trend of Guerrilla Activism has been adapted to: marketing, communication, gardening, craftivism, theatre, poetry, and art. Focusing on the action element and examining elements of current trends within Guerrilla marketing, we believe that GRT can be applied to a range of research areas within various academic disciplines.

The prevalence and perception of pain amongst hospital in-patients

The aim of this paper is to describe the prevalence and perceptions of pain and pain management amongst hospital in-patients. A cross-sectional descriptive survey of 205 patients was conducted. Presence and severity of pain was assessed using verbal descriptor and visual analogue scales, and perceptions of pain were assessed using multi-item scales. Although the severity of pain reported was consistent across age groups and clinical areas, women in the study sample were significantly more likely to report high levels of pain than men. Differences in how men and women communicate their pain were observed, with women indicating that they were less willing to ask for help with their pain. Results suggest that pain continues to be an important problem for a large number of men and women in hospital, and that the experience of pain impacts negatively upon their well-being. Gender differences in the experience of and response to pain remain important considerations for clinical nurses who have major responsibilities for the management of pain in hospitalized patients.

Teaching creatively, teaching for creativity : QUT’s Creative Industries Faculty Showcase Panel

In this panel, we showcase approaches to teaching for creativity in disciplines of the Media, Entertainment and Creative Arts School and the School of Design within the Creative Industries Faculty (CIF) at QUT. The Faculty is enormously diverse, with 4,000 students enrolled across a total of 20 disciplines. Creativity is a unifying concept in CIF, both as a graduate attribute, and as a key pedagogic principle. We take as our point of departure the assertion that it is not sufficient to assume that students of tertiary courses in creative disciplines are ‘naturally’ creative. Rather, teachers in higher education must embrace their roles as facilitators of development and learning for the creative workforce, including working to build creative capacity (Howkins, 2009). In so doing, we move away from Renaissance notions of creativity as an individual genius, a disposition or attribute which cannot be learned, towards a 21st century conceptualisation of creativity as highly collaborative, rhizomatic, and able to be developed through educational experiences (see, for instance, Robinson, 2006; Craft; 2001; McWilliam & Dawson, 2008). It has always been important for practitioners of the arts and design to be creative. Under the national innovation agenda (Bradley et al, 2008) and creative industries policy (e.g., Department for Culture, Media and Sport, 2008; Office for the Arts, 2011), creativity has been identified as a key determinant of economic growth, and thus developing students’ creativity has now become core higher education business across all fields. Even within the arts and design, professionals are challenged to be creative in new ways, for new purposes, in different contexts, and using new digital tools and platforms. Teachers in creative disciplines may have much to offer to the rest of the higher education sector, in terms of designing and modelling innovative and best practice pedagogies for the development of student creative capability. Information and Communication Technologies such as mobile learning, game-based learning, collaborative online learning tools and immersive learning environments offer new avenues for creative learning, although analogue approaches may also have much to offer, and should not be discarded out of hand. Each panelist will present a case study of their own approach to teaching for creativity, and will address the following questions with respect to their case: 1. What conceptual view of creativity does the case reflect? 2. What pedagogical approaches are used, and why were these chosen? What are the roles of innovative learning approaches, including ICTs, if any? 3. How is creativity measured or assessed? How do students demonstrate creativity? We seek to identify commonalities and contrasts between and among the pedagogic case studies, and to answer the question: what can we learn about teaching creatively and teaching for creativity from CIF best practice?

Abstraction as noise : enhancing the poetic

Abstraction in its resistance to evident meaning has the capacity to interrupt or at least provide tools with which to question an overly compliant reception of the information to which we are subject. It does so by highlighting a latency or potentiality inherent in materiality that points to the possibility of a critical resistance to this ceaseless flow of sound/image/data. This resistance has been remarked on in differing ways by a number of commentators such as Lyotard, in his exploration of the avant-garde and the sublime for example. This joint paper will initially map the collaborative project by Daniel Mafe and Andrew Brown, Affecting Interference which conjoins painting with digital sound and animations into a single, large scale, immersive exhibition/installation. The work acts as an interstitial point between contrasting approaches to abstraction: the visual and aural, the digital and analogue. The paper will then explore the ramifications of this through the examination of abstraction as ‘noise’, that is as that raw inassimilable materiality, within which lays the creative possibility to forge and embrace the as-yet-unthought and almost-forgotten. It does so by establishing a space for a more poetic and slower paced critical engagement for the viewing and receiving information or data. This slowing of perception through the suspension of easy recognition runs counter to our current ‘high performance’ culture, and it’s requisite demand for speedy assimilation of content, representing instead the poetic encounter with a potentiality or latency inherent in the nameless particularity of that which is.

Vibrational spectroscopic study of the mineral pitticite Fe, AsO4, SO4, H2O

Some minerals are colloidal and show no X-ray diffraction patterns. Vibrational spectroscopy offers one of the few methods for the determination of the structure of these minerals. Among this group of minerals is pitticite, simply described as (Fe, AsO4, SO4, H2O). In this work, the analogue of the mineral pitticite has been synthesised. The objective of this research is to determine the molecular structure of the mineral pitticite using vibrational spectroscopy. Raman and infrared bands are attributed to the AsO43−, SO42− and water stretching and bending vibrations. The Raman spectrum of the pitticite analogue shows intense peaks at 845 and 837 cm−1 assigned to the AsO43− stretching vibrations. Raman bands at 1096 and 1182 cm−1 are attributed to the SO42− antisymmetric stretching bands. Raman spectroscopy offers a useful method for the analysis of such colloidal minerals.

Assessment of real-time networks and timing for process bus applications

Widespread adoption by electricity utilities of Non-Conventional Instrument Transformers, such as optical or capacitive transducers, has been limited due to the lack of a standardised interface and multi-vendor interoperability. Low power analogue interfaces are being replaced by IEC 61850 9 2 and IEC 61869 9 digital interfaces that use Ethernet networks for communication. These ‘process bus’ connections achieve significant cost savings by simplifying connections between switchyard and control rooms; however the in-service performance when these standards are employed is largely unknown. The performance of real-time Ethernet networks and time synchronisation was assessed using a scale model of a substation automation system. The test bed was constructed from commercially available timing and protection equipment supplied by a range of vendors. Test protocols have been developed to thoroughly evaluate the performance of Ethernet networks and network based time synchronisation. The suitability of IEEE Std 1588 Precision Time Protocol (PTP) as a synchronising system for sampled values was tested in the steady state and under transient conditions. Similarly, the performance of hardened Ethernet switches designed for substation use was assessed under a range of network operating conditions. This paper presents test methods that use a precision Ethernet capture card to accurately measure PTP and network performance. These methods can be used for product selection and to assess ongoing system performance as substations age. Key findings on the behaviour of multi-function process bus networks are presented. System level tests were performed using a Real Time Digital Simulator and transformer protection relay with sampled value and Generic Object Oriented Substation Events (GOOSE) capability. These include the interactions between sampled values, PTP and GOOSE messages. Our research has demonstrated that several protocols can be used on a shared process bus, even with very high network loads. This should provide confidence that this technology is suitable for transmission substations.

Factors associated with suboptimal adherence to antiretroviral therapy in Viet Nam: A cross-sectional study using audio computer-assisted self-interview (ACASI)

Background: Optimal adherence to antiretroviral therapy (ART) is necessary for people living with HIV/AIDS (PLHIV). There have been relatively few systematic analyses of factors that promote or inhibit adherence to antiretroviral therapy among PLHIV in Asia. This study assessed ART adherence and examined factors associated with suboptimal adherence in northern Viet Nam. Methods: Data from 615 PLHIV on ART in two urban and three rural outpatient clinics were collected by medical record extraction and from patient interviews using audio computer-assisted self-interview (ACASI). Results: The prevalence of suboptimal adherence was estimated to be 24.9% via a visual analogue scale (VAS) of past-month dose-missing and 29.1% using a modified Adult AIDS Clinical Trial Group scale for on-time dose-taking in the past 4 days. Factors significantly associated with the more conservative VAS score were: depression (p < 0.001), side-effect experiences (p < 0.001), heavy alcohol use (p = 0.001), chance health locus of control (p = 0.003), low perceived quality of information from care providers (p = 0.04) and low social connectedness (p = 0.03). Illicit drug use alone was not significantly associated with suboptimal adherence, but interacted with heavy alcohol use to reduce adherence (p < 0.001). Conclusions: This is the largest survey of ART adherence yet reported from Asia and the first in a developing country to use the ACASI method in this context. The evidence strongly indicates that ART services in Viet Nam should include screening and treatment for depression, linkage with alcohol and/or drug dependence treatment, and counselling to address the belief that chance or luck determines health outcomes.

Compaction control of topography and fault network structure along strike-slip faults in sedimentary basins

Strike-slip faults commonly display structurally complex areas of positive or negative topography. Understanding the development of such areas has important implications for earthquake studies and hydrocarbon exploration. Previous workers identified the key factors controlling the occurrence of both topographic modes and the related structural styles. Kinematic and stress boundary conditions are of first-order relevance. Surface mass transport and material properties affect fault network structure. Experiments demonstrate that dilatancy can generate positive topography even under simple-shear boundary conditions. Here, we use physical models with sand to show that the degree of compaction of the deformed rocks alone can determine the type of topography and related surface fault network structure in simple-shear settings. In our experiments, volume changes of ∼5% are sufficient to generate localized uplift or subsidence. We discuss scalability of model volume changes and fault network structure and show that our model fault zones satisfy geometrical similarity with natural flower structures. Our results imply that compaction may be an important factor in the development of topography and fault network structure along strike-slip faults in sedimentary basins.

Meal induced thermogenesis and appetite : methodological issues and responses to energy restriction

Diet Induced Thermogenesis (DIT) is the energy expended consequent to meal consumption, and reflects the energy required for the processing and digestion of food consumed throughout each day. Although DIT is the total energy expended across a day in digestive processes to a number of meals, most studies measure thermogenesis in response to a single meal (Meal Induced Thermogenesis: MIT) as a representation of an individual’s thermogenic response to acute food ingestion. As a component of energy expenditure, DIT may have a contributing role in weight gain and weight loss. While the evidence is inconsistent, research has tended to reveal a suppressed MIT response in obese compared to lean individuals, which identifies individuals with an efficient storage of food energy, hence a greater tendency for weight gain. Appetite is another factor regulating body weight through its influence on energy intake. Preliminary research has shown a potential link between MIT and postprandial appetite as both are responses to food ingestion and have a similar response dependent upon the macronutrient content of food. There is a growing interest in understanding how both MIT and appetite are modified with changes in diet, activity levels and body size. However, the findings from MIT research have been highly inconsistent, potentially due to the vastly divergent protocols used for its measurement. Therefore, the main theme of this thesis was firstly, to address some of the methodological issues associated with measuring MIT. Additionally this thesis aimed to measure postprandial appetite simultaneously to MIT to test for any relationships between these meal-induced variables and to assess changes that occur in MIT and postprandial appetite during periods of energy restriction (ER) and following weight loss. Two separate studies were conducted to achieve these aims. Based on the increasing prevalence of obesity, it is important to develop accurate methodologies for measuring the components potentially contributing to its development and to understand the variability within these variables. Therefore, the aim of Study One was to establish a protocol for measuring the thermogenic response to a single test meal (MIT), as a representation of DIT across a day. This was done by determining the reproducibility of MIT with a continuous measurement protocol and determining the effect of measurement duration. The benefit of a fixed resting metabolic rate (RMR), which is a single measure of RMR used to calculate each subsequent measure of MIT, compared to separate baseline RMRs, which are separate measures of RMR measured immediately prior to each MIT test meal to calculate each measure of MIT, was also assessed to determine the method with greater reproducibility. Subsidiary aims were to measure postprandial appetite simultaneously to MIT, to determine its reproducibility between days and to assess potential relationships between these two variables. Ten healthy individuals (5 males, 5 females, age = 30.2 ± 7.6 years, BMI = 22.3 ± 1.9 kg/m2, %Fat Mass = 27.6 ± 5.9%) undertook three testing sessions within a 1-4 week time period. During the first visit, participants had their body composition measured using DXA for descriptive purposes, then had an initial 30-minute measure of RMR to familiarise them with the testing and to be used as a fixed baseline for calculating MIT. During the second and third testing sessions, MIT was measured. Measures of RMR and MIT were undertaken using a metabolic cart with a ventilated hood to measure energy expenditure via indirect calorimetry with participants in a semi-reclined position. The procedure on each MIT test day was: 1) a baseline RMR measured for 30 minutes, 2) a 15-minute break in the measure to consume a standard 576 kcal breakfast (54.3% CHO, 14.3% PRO, 31.4% FAT), comprising muesli, milk toast, butter, jam and juice, and 3) six hours of measuring MIT with two, ten-minute breaks at 3 and 4.5 hours for participants to visit the bathroom. On the MIT test days, pre and post breakfast then at 45-minute intervals, participants rated their subjective appetite, alertness and comfort on visual analogue scales (VAS). Prior to each test, participants were required to be fasted for 12 hours, and have undertaken no high intensity physical activity for the previous 48 hours. Despite no significant group changes in the MIT response between days, individual variability was high with an average between-day CV of 33%, which was not significantly improved by the use of a fixed RMR to 31%. The 95% limits of agreements which ranged from 9.9% of energy intake (%EI) to -10.7%EI with the baseline RMRs and between 9.6%EI to -12.4%EI with the fixed RMR, indicated very large changes relative to the size of the average MIT response (MIT 1: 8.4%EI, 13.3%EI; MIT 2: 8.8%EI, 14.7%EI; baseline and fixed RMRs respectively). After just three hours, the between-day CV with the baseline RMR was 26%, which may indicate an enhanced MIT reproducibility with shorter measurement durations. On average, 76, 89, and 96% of the six-hour MIT response was completed within three, four and five hours, respectively. Strong correlations were found between MIT at each of these time points and the total six-hour MIT (range for correlations r = 0.990 to 0.998; P < 0.01). The reproducibility of the proportion of the six-hour MIT completed at 3, 4 and 5 hours was reproducible (between-day CVs ≤ 8.5%). This indicated the suitability to use shorter durations on repeated occasions and a similar percent of the total response to be completed. There was a lack of strong evidence of any relationship between the magnitude of the MIT response and subjective postprandial appetite. Given a six-hour protocol places a considerable burden on participants, these results suggests that a post-meal measurement period of only three hours is sufficient to produce valid information on the metabolic response to a meal. However while there was no mean change in MIT between test days, individual variability was large. Further research is required to better understand which factors best explain the between-day variability in this physiological measure. With such a high prevalence of obesity, dieting has become a necessity to reduce body weight. However, during periods of ER, metabolic and appetite adaptations can occur which may impede weight loss. Understanding how metabolic and appetite factors change during ER and weight loss is important for designing optimal weight loss protocols. The purpose of Study Two was to measure the changes in the MIT response and subjective postprandial appetite during either continuous (CONT) or intermittent (INT) ER and following post diet energy balance (post-diet EB). Thirty-six obese male participants were randomly assigned to either the CONT (Age = 38.6 ± 7.0 years, weight = 109.8 ± 9.2 kg, % fat mass = 38.2 ± 5.2%) or INT diet groups (Age = 39.1 ± 9.1 years, weight = 107.1 ± 12.5 kg, % fat mass = 39.6 ± 6.8%). The study was divided into three phases: a four-week baseline (BL) phase where participants were provided with a diet to maintain body weight, an ER phase lasting either 16 (CONT) or 30 (INT) weeks, where participants were provided with a diet which supplied 67% of their energy balance requirements to induce weight loss and an eight-week post-diet EB phase, providing a diet to maintain body weight post weight loss. The INT ER phase was delivered as eight, two-week blocks of ER interspersed with two-week blocks designed to achieve weight maintenance. Energy requirements for each phase were predicted based on measured RMR, and adjusted throughout the study to account for changes in RMR. All participants completed MIT and appetite tests during BL and the ER phase. Nine CONT and 15 INT participants completed the post-diet EB MIT and 14 INT and 15 CONT participants completed the post-diet EB appetite tests. The MIT test day protocol was as follows: 1) a baseline RMR measured for 30 minutes, 2) a 15-minute break in the measure to consume a standard breakfast meal (874 kcal, 53.3% CHO, 14.5% PRO, 32.2% FAT), and 3) three hours of measuring MIT. MIT was calculated as the energy expenditure above the pre-meal RMR. Appetite test days were undertaken on a separate day using the same 576 kcal breakfast used in Study One. VAS were used to assess appetite pre and post breakfast, at one hour post breakfast then a further three times at 45-minute intervals. Appetite ratings were calculated for hunger and fullness as both the intra-meal change in appetite and the AUC. The three-hour MIT response at BL, ER and post-diet EB respectively were 5.4 ± 1.4%EI, 5.1 ± 1.3%EI and 5.0 ± 0.8%EI for the CONT group and 4.4 ± 1.0%EI, 4.7 ± 1.0%EI and 4.8 ± 0.8%EI for the INT group. Compared to BL, neither group had significant changes in their MIT response during ER or post-diet EB. There were no significant time by group interactions (p = 0.17) indicating a similar response to ER and post-diet EB in both groups. Contrary to what was hypothesised, there was a significant increase in postprandial AUC fullness in response to ER in both groups (p < 0.05). However, there were no significant changes in any of the other postprandial hunger or fullness variables. Despite no changes in MIT in both the CONT or INT group in response to ER or post-diet EB and only a minor increase in postprandial AUC fullness, the individual changes in MIT and postprandial appetite in response to ER were large. However those with the greatest MIT changes did not have the greatest changes in postprandial appetite. This study shows that postprandial appetite and MIT are unlikely to be altered during ER and are unlikely to hinder weight loss. Additionally, there were no changes in MIT in response to weight loss, indicating that body weight did not influence the magnitude of the MIT response. There were large individual changes in both variables, however further research is required to determine whether these changes were real compensatory changes to ER or simply between-day variation. Overall, the results of this thesis add to the current literature by showing the large variability of continuous MIT measurements, which make it difficult to compare MIT between groups and in response to diet interventions. This thesis was able to provide evidence to suggest that shorter measures may provide equally valid information about the total MIT response and can therefore be utilised in future research in order to reduce the burden of long measurements durations. This thesis indicates that MIT and postprandial subjective appetite are most likely independent of each other. This thesis also shows that, on average, energy restriction was not associated with compensatory changes in MIT and postprandial appetite that would have impeded weight loss. However, the large inter-individual variability supports the need to examine individual responses in more detail.

Comment on "Local accumulation times for source, diffusion, and degradation models in two and three dimensions" [J. Chem. Phys. 138, 104121 (2013)]

In a recent paper, Gordon, Muratov, and Shvartsman studied a partial differential equation (PDE) model describing radially symmetric diffusion and degradation in two and three dimensions. They paid particular attention to the local accumulation time (LAT), also known in the literature as the mean action time, which is a spatially dependent timescale that can be used to provide an estimate of the time required for the transient solution to effectively reach steady state. They presented exact results for three-dimensional applications and gave approximate results for the two-dimensional analogue. Here we make two generalizations of Gordon, Muratov, and Shvartsman’s work: (i) we present an exact expression for the LAT in any dimension and (ii) we present an exact expression for the variance of the distribution. The variance provides useful information regarding the spread about the mean that is not captured by the LAT. We conclude by describing further extensions of the model that were not considered by Gordon,Muratov, and Shvartsman. We have found that exact expressions for the LAT can also be derived for these important extensions...

Postoperative pain relief using intermittent intrapleural analgesia following thoracoscopic anterior correction for progressive adolescent idiopathic scoliosis

Background Thoracoscopic anterior scoliosis instrumentation is a safe and viable surgical option for corrective fusion of progressive adolescent idiopathic scoliosis (AIS) and has been performed at our centre on 205 patients since 2000. However, there is a paucity of literature reporting on or examining optimum methods of analgesia following this type of surgery. A retrospective study was designed to present the authors’ technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime. Methods Records for 32 patients who underwent thoracoscopic anterior correction for AIS were reviewed. All patients received an intrapleural catheter inserted during surgery, in addition to patient-controlled opiate analgesia and oral analgesia. After surgery, patients received a bolus of 0.25% bupivacaine every four hours via the intrapleural catheter. Patient’s perceptions of their pain control was measured using the visual analogue pain scale scores which were recorded before and after local anaesthetic administration and the quantity and time of day that any other analgesia was taken, were also recorded. Results 28 female and four male patients (mean age 14.5 ± 1.5 years) had a total of 230 boluses of local anaesthetic administered in the 96 hour period following surgery. Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83. The quantity of opiates via patient-controlled analgesia after surgery decreased steadily between successive 24 hours intervals after an initial increase in the second 24 hour period when patients were mobilised. One intrapleural catheter required early removal due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method. Conclusions Local anaesthetic administration via an intrapleural catheter is a safe and effective method of analgesia following thoracoscopic anterior scoliosis correction. Post-operative pain following anterior thoracic scoliosis surgery can be reduced to ‘mild’ levels by combined analgesia regimes. Keywords: Adolescent idiopathic scoliosis; Thoracoscopic anterior spinal fusion; Anterior fusion; Intrapleural analgesia; Endoscopic anterior surgery; Pain relief; Scoliosis surgery

Is intermittent intrapleural analgesia safe and effective following thoracoscopic anterior scoliosis correction surgery?

Introduction: Thoracoscopic anterior instrumented fusion (TASF) is a safe and viable surgical option for corrective stabilisation of progressive adolescent idiopathic scoliosis (AIS) [1-2]. However, there is a paucity of literature examining optimum methods of analgesia following this type of surgery. The aim of this study was to identify; if local anaesthetic bolus via an intrapleural catheter provides effective analgesia following thoracoscopic scoliosis correction; what pain levels may be expected; and any adverse effects associated with the use of intermittent intrapleural analgesia at our centre. Methods: A subset of the most recent 80 patients from a large single centre consecutive series of 201 patients (April 2000 to present) who had undergone TASF had their medical records reviewed. 32 patients met the inclusion criteria for the analysis (i.e. pain scores must have been recorded within the hour prior and within two hours following an intrapleural bolus being given). All patients received an intrapleural catheter inserted during surgery, in addition to patient-controlled opiate analgesia and oral analgesia as required. After surgery, patients received a bolus of 0.25% bupivacaine every four hours via the intrapleural catheter. Visual analogue pain scale scores were recorded before and after the bolus of local anaesthetic and the quantity and time of day that any other analgesia was taken, were also recorded. Results and Discussion: 28 female and four male patients (mean age 14.5 ± 1.5 years) had a total of 230 boluses of local anaesthetic administered intrapleurally, directly onto the spine, in the 96 hour period following surgery. Pain scores significantly decreased following the administration of a bolus (p<0.0001), with the mean pain score decreasing from 3.66 to 1.83. The quantity of opiates via patient-controlled analgesia after surgery decreased steadily between successive 24 hours intervals after an initial increase in the second 24 hour period when patients were mobilised. One intrapleural catheter required early removal at 26 hours postop due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method. Post-operative pain following anterior scoliosis correction was decreased significantly with the administration of regular local anaesthetic boluses and can be reduced to ‘mild’ levels by combined analgesia regimes. The intermittent intrapleural analgesia method was not associated with any adverse events or complications in the full cohort of 201 patients.

The confidence of speech-language pathology students regarding communicating with people with aphasia

Background Aphasia is an acquired language disorder that can present a significant barrier to patient involvement in healthcare decisions. Speech-language pathologists (SLPs) are viewed as experts in the field of communication. However, many SLP students do not receive practical training in techniques to communicate with people with aphasia (PWA) until they encounter PWA during clinical education placements. Methods This study investigated the confidence and knowledge of SLP students in communicating with PWA prior to clinical placements using a customised questionnaire. Confidence in communicating with people with aphasia was assessed using a 100-point visual analogue scale. Linear, and logistic, regressions were used to examine the association between confidence and age, as well as confidence and course type (graduate-entry masters or undergraduate), respectively. Knowledge of strategies to assist communication with PWA was examined by asking respondents to list specific strategies that could assist communication with PWA. Results SLP students were not confident with the prospect of communicating with PWA; reporting a median 29-points (inter-quartile range 17–47) on the visual analogue confidence scale. Only, four (8.2%) of respondents rated their confidence greater than 55 (out of 100). Regression analyses indicated no relationship existed between confidence and students‘ age (p = 0.31, r-squared = 0.02), or confidence and course type (p = 0.22, pseudo r-squared = 0.03). Students displayed limited knowledge about communication strategies. Thematic analysis of strategies revealed four overarching themes; Physical, Verbal Communication, Visual Information and Environmental Changes. While most students identified potential use of resources (such as images and written information), fewer students identified strategies to alter their verbal communication (such as reduced speech rate). Conclusions SLP students who had received aphasia related theoretical coursework, but not commenced clinical placements with PWA, were not confident in their ability to communicate with PWA. Students may benefit from an educational intervention or curriculum modification to incorporate practical training in effective strategies to communicate with PWA, before they encounter PWA in clinical settings. Ensuring students have confidence and knowledge of potential communication strategies to assist communication with PWA may allow them to focus their learning experiences in more specific clinical domains, such as clinical reasoning, rather than building foundation interpersonal communication skills.