Correlates of U.S. Adults Aged 50-75 Years Having Had a Colorectal Cancer Screening Test

Introduction

Colorectal cancer is a leading cause of cancer death in the U.S. Until 2021, the U.S. Preventive Services Task Force recommended colorectal cancer screening for all adults aged 50-75 years. Using a nationally representative sample, we explored the associations between having colorectal cancer screening and key sociodemographic and health-related factors among U.S. adults aged 50-75 years.

Methods

We analyzed self-reported data from the National Cancer Institute's Health Information National Trends Survey 5 (Cycle 4) collected from February to June 2020. A multivariable weighted logistic regression model was conducted using all of the factors that were univariably significant with p<0.10. Using backward elimination, factors that were not significant with p>0.05 were removed one at a time until the remaining factors were all significant collectively with p<0.05.

Results

Complete data were available for 1,649 respondents: 1,384 (81.2% weighted) had a colorectal cancer screening test, and 265 (18.8% weighted) did not. Multivariably, the odds of having had a colorectal cancer screening test increased with age (OR=1.07) and were higher for participants who identified as Black/African American than for White participants (OR=2.4), participants who had a family member who ever had cancer (OR=1.7), participants who believed that being overweight and obese influences development of cancer a lot than those who believed not at all (OR=2.0), and participants who had friends or family to talk with about health (OR=2.3).

Conclusions

Age, race, family history, weight-related beliefs about the causes of cancer, and having someone to talk with about health were associated with having colorectal cancer screening test.

Role of digital health communication, sociodemographic factors, and medical conditions on perceived quality of patient-centered communication

OBJECTIVE

To simultaneously explore associations between digital health, sociodemographic factors, and medical conditions on patient-centered communication (PCC). These are under-explored, yet important knowledge gaps to fill because perceived quality PCC may influence health information seeking behaviors and health outcomes.

METHODS

Data from the 2019 Health Information National Trends Survey were analyzed. The primary outcome was PCC, which was the summed score of 7 PCC-related questions. Factors of interest included whether participants used electronic methods to communicate with health professionals, age, gender, race/ethnicity, education, feelings about household income, and history of medical conditions. Descriptive statistics and linear regressions were conducted.

RESULTS

In the multivariate linear regression model, people aged 65-74 years compared with 18-34 year-olds, those with some college compared with college graduates, and those who felt they were living comfortably on their household income compared with all others reported higher PCC scores. People with a history of hypertension compared with those without reported higher PCC scores.

CONCLUSION

Similar to past studies, sociodemographic factors were associated with PCC. A novel finding was that a history hypertension was associated with perceived quality of PCC.

PRACTICE IMPLICATIONS

This research may inform methods to enhance communication between patients and clinicians.

Does the Location of Endotracheal Intubation Affect the Success of Airway Management in a Helicopter Air Ambulance Service? A Simulation Study

OBJECTIVE

Airway management is a cornerstone of helicopter air ambulance patient management. The purpose of this study was to evaluate the overall quality of airway management of critical care crews in 3 common locations for intubation.

METHODS

This was a prospective observational simulation study assessing the overall airway management of critical care providers managing simulated patients in an emergency department, helicopter, and ambulance. Composite scores were obtained and compared with respect to physical environment and provider certification level.

RESULTS

Fifty-four participants completed the simulations. The median score for the emergency department was 100; for ambulance, it was 80; and for helicopter, it was 80. Ambulance scores were significantly lower than emergency department scores (median difference = -5 points, P = .002) as were helicopter scores (median difference = -10 points, P < .001). The small sample size limited the statistical power to detect differences in provider type, and no statistically significant differences were found in these groups.

CONCLUSION

In this study, the physical location of airway management negatively impacted the overall airway management success as determined by a standardized composite score. This suggests that airway management may have the highest rate of success in an emergency department as opposed to ground ambulance or helicopter air ambulance settings.

Self-efficacy to Get Cancer-Related Information or Advice

Self-efficacy, or confidence, for being able to get cancer information may affect a person's understanding of cancer risk and subsequent cancer-related decisions such as screening, treatment, and genetic testing. In this study, we explored key correlates associated with self-efficacy for getting cancer information. We analyzed cross-sectional data from the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2). There were 3504 responses in the full dataset; 2513 remained after eliminating respondents with incomplete data for all variables of interest. Self-efficacy for getting cancer information was assessed with the item, "Overall, how confident are you that you could get advice or information about cancer if you needed it?" First, we explored correlates associated with self-efficacy in getting cancer information including sociodemographic factors, patient-provider communication, and health-related self-efficacy in the full sample. Secondarily, we examined associations between self-efficacy to get cancer information and cancer information-seeking burden (e.g., difficulty understanding cancer information) in the subset of participants who reported ever looking for cancer-specific information. Descriptive statistics and logistic regressions were conducted. Asian race/ethnicity, higher perceived quality of patient-provider communication, and higher health-related self-efficacy were associated with higher odds of confidence about getting cancer information. In the subset of people who ever sought cancer-specific information, higher patient-provider communication scores, higher health-related self-efficacy, greater difficulty understanding information, greater concern about the quality of information, and greater frustration during the search were associated with higher self-efficacy for getting cancer information. Future research should evaluate strategies to improve cancer information seeking skills.

Correlates of knowledge of clinical trials among U.S. adults: Findings from the 2020 Health Information National Trends Survey

BACKGROUND

Knowledge about clinical trials affects efficient and equitable clinical trial recruitment and retention. This study explored correlates of clinical trial knowledge in a nationally representative sample of US adults.

METHODS

Cross-sectional data from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4) were evaluated. There were 3,865 responses in the full dataset; 2,648 remained after eliminating respondents without complete data for all covariates of interest. Participants were asked, "How would you describe your level of knowledge about clinical trials?" The response options "know a little bit" and "know a lot" were combined and compared to the response option "don't know anything." Covariates of interest included patient-provider communication, history of medical conditions, eHealth use, knowledge of clinicaltrials.gov, prior invitation to join a clinical trial, and socio-demographic factors.

RESULTS

Participants with a history of cancer were 1.6 times more likely [CI 1.2, 2.2] to have knowledge of clinical trials. Participants who used electronic means to look for health information were 1.7 times more likely [CI 1.2, 2.4] to have knowledge of clinical trials. Participants who had heard of the website clinicaltrials.gov had 5.1 times greater odds of knowing about clinical trials [CI 2.6, 10.3] and 4.5 greater odds if they had been invited to participate in a clinical trial [CI 2.0, 9.8]. College graduates had higher odds than others.

CONCLUSION

Several factors affect clinical trial knowledge in US adults. Findings from this study may inform interventions to raise awareness about clinical trials and thereby, potentially improve enrollment.

Use of YouTube to watch health-related videos and participation in online support groups among US adults with heart disease, diabetes, and hypertension

Objective

Social media use has grown over time. However, it is unclear how people with a self-reported history of cardiovascular disease or cardiovascular disease-related risk factors such as diabetes and hypertension use social media.

Methods

Data from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4) were analyzed (N = 3865). Only respondents with complete data for all variables of interest were included in the analyses, resulting in 306 respondents with a heart condition, 1291 with hypertension, and 608 with diabetes. We explored associations between two dependent variables: (1) participated in an online forum or support group and (2) watched a health-related video on YouTube, and sociodemographic factors and patient-provider communication. Analyses were conducted separately by medical condition. Odds ratios, 95% confidence intervals, and p-values were calculated.

Results

In respondents with a heart condition, hypertension, or diabetes, 5.4%, 8.4%, and 10.3% had participated in an online support group and 29.6%, 40.4%, and 36.6% had watched health-related videos on YouTube, respectively. Univariately, the odds of using online support groups was associated with younger age (vs. > = 65) in people with a heart condition and hypertension, but not diabetes. Regarding YouTube, younger age was associated with watching health-related videos across all three medical conditions, with additional gender and education associations observed in those with hypertension. There were no associations between social media use and patient-provider communication.

Conclusions

These findings may inform the selection of social media platforms for behavioral interventions depending on the intended patient population and goals (e.g. social support vs. video-based health education).

Use of Online Medical Records to Support Medical Decision Making: A Cross-Sectional Study of US Adults

The use of online medical records has increased over time and may enhance patient involvement in medical decisions. We explored sociodemographic, medical condition, and digital health correlates of using online medical records to support medical decision making. Cross-sectional data from the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3, N = 5438) were analyzed. Final analyses included participants who accessed their online medical records within 12 months and had complete data for all variables (n = 1807). The outcome was, "In the past 12 months have you used your online medical record to help you make a decision about how to treat an illness or condition (yes/no)?" Univariate and multivariate odds ratios and 95% confidence intervals were calculated. Multivariately, the odds of using online medical records to support medical decision making were significantly higher for individuals who (a) used online medical records to securely send messages to health care providers, (b) used a smartphone health app to access their online medical records, (c) had online medical records that contained clinical notes, (d) reported that online medical records were useful for monitoring health, and (e) self-identified as African American, Asian, or "Other." Online medical records may support medical decision making depending on the context.

Detecting accurate tumor size across imaging modalities in breast cancer

BACKGROUND

Of the most common imaging modalities for breast cancer diagnosis - mammogram (MAM), ultrasound (US), magnetic resonance imaging (MRI) - it has not been well established which of these most accurately corresponds to the histological tumor size.

OBJECTIVE

To determine which imaging modality (MAM, US, MRI) is most accurate for determining the histological tumor size of breast lesions.

METHODS

A retrospective study of 76 breast cancers found in 73 female patients who received MAM, US, and/or MRI was performed. 239 charts were reviewed and 73 patients met inclusion criteria. Analysis was performed using signed rank tests comparing the reported tumor size on the imaging modality to the tumor size on pathology report.

RESULTS

Mammography and ultrasonography underestimated tumor size by 3.5 mm and 4 mm (p-values < 0.002), respectively. MRI tends to overestimate tumor size by 3 mm (p-value = 0.0570). Mammogram was equivalent to pathological size within 1 mm 24% of the time and within 2 mm 35% of the time.

CONCLUSIONS

No one single modality is the most accurate for detecting tumor size. When interpreting the size reported on breast imaging modalities, the amount of underestimation and overestimation in tumor size should be considered for both clinical staging and surgical decision-making.

Perceived involvement in health care decisions among US adults: Sociodemographic and medical condition correlates

OBJECTIVE

To explore factors associated with how often US adults perceived that they were "always" involved in decisions about health care to the degree that they desired.

METHODS

We examined cross-sectional, nationally representative data from the 2018 Health Information National Trends Survey. There were 3504 responses in the full HINTS dataset; 2499 remained after eliminating respondents with missing data for any factor of interest. Sociodemographic factors included age, gender, race/ethnicity, and education. Medical conditions included diabetes, hypertension, heart disease, lung disease, arthritis, cancer, and depression. Participants were asked to think about communication with health professionals during the last 12 months and how often health professionals involved them in decisions about health care.

RESULTS

In univariate analyses, Asian and Hispanic race were associated with lower odds of always being involved in decisions about health care; whereas higher education and a history of cancer were associated with higher odds of "always" being involved in decisions about health care, p < 0.05. In multivariate analyses, race and education both remained significant; however, history of cancer did not.

CONCLUSION

Differences by race/ethnicity and educational attainment exist regarding perceived involvement in decisions about health care.

PRACTICE IMPLICATIONS

Findings may inform future shared decision making interventions.

Radiographic findings of SARS-CoV-2 infection

STUDY OBJECTIVE

The 2019-20 coronavirus pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). This study was undertaken to identify and compare findings of chest radiography and computed tomography among patients with SARS-CoV-2 infection.

METHODS

This retrospective study was undertaken at a tertiary care center. Eligible subjects included consecutive patients age 18 and over with documented SARS-CoV-2 infection between March and July 2020. The primary outcome measures were results of chest radiography and computed tomography among patients with documented SARS-CoV-2 infection.

RESULTS

Among 724 subjects, most were admitted to a medical floor (46.4%; N = 324) or admitted to an ICU (10.9%; N = 76). A substantial number of subjects were intubated during the emergency department visit or inpatient hospitalization (15.3%; N = 109). The majority of patients received a chest radiograph (80%; N = 579). The most common findings were normal, bilateral infiltrates, ground-glass opacities, or unilateral infiltrate. Among 128 patients who had both chest radiography and computed tomography, there was considerable disagreement between the 2 studies (52.3%; N = 67; 95% confidence interval: 43.7% to 61.0%).). The presence of bilateral infiltrates (infiltrates or ground-glass opacities) was associated with clinical factors including older age, ambulance arrivals, more urgent triage levels, higher heart rate, and lower oxygen saturation. Bilateral infiltrates were associated with poorer outcomes, including higher rate of intubation, greater number of inpatient days, and higher rate of death.

CONCLUSIONS

Common radiographic findings of SARS-CoV-2 infection include infiltrates or ground-glass opacities. There was considerable disagreement between chest radiography and computed tomography. Computed tomography was more accurate in defining the extent of involved lung parenchyma. The presence of bilateral infiltrates was associated with morbidity and mortality.

Prehospital Ketamine Use for Rapid Sequence Intubation: Are Higher Doses Associated With Adverse Events?

OBJECTIVE

Ketamine for rapid sequence intubation (RSI) is typically dosed at 1 to 2 mg/kg intravenously. The need to ensure dissociation during RSI led some to administer ketamine at doses greater than 2 mg/kg. This study assessed associations between ketamine dose and adverse events.

METHODS

This multisite, retrospective study included adult subjects undergoing RSI with intravenous ketamine. Subjects were categorized into 2 groups: a standard ketamine dose (≤ 2 mg/kg intravenously) or a high dose (> 2 mg/kg intravenously). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for adverse events.

RESULTS

Eighty subjects received standard-dose ketamine, and 50 received high-dose ketamine. The high-dose group had a significantly (P < .05) higher proportion of trauma patients, were younger, and had higher predose blood pressure compared with the standard-dose group. High-dose ketamine was associated with greater odds of adverse events including hypotension (OR = 7.0; 95% CI, 3.0-16.6), laryngospasm (OR = 10.8; 95% CI, 1.3-93.4), bradycardia (OR = 7.5; 95% CI, 1.5-36.6), repeat medications (OR = 12.9; 95% CI, 1.5-107.9), oxygen desaturation (OR = 6.0; 95% CI, 1.8-19.9), multiple attempts (OR = 3.2; 95% CI, 1.5-6.8%), and failed airway (OR = 3.6; 95% CI, 1.0-12.7).

CONCLUSION

Ketamine at higher doses was associated with increased odds of adverse events. Studies assessing adverse events of ketamine at lower than standard doses in shock patients are needed.

Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study

BACKGROUND

Tablet and smartphone ownership have increased among US adults over the past decade. However, the degree to which people use mobile devices to help them make medical decisions remains unclear.

OBJECTIVE

The objective of this study is to explore factors associated with self-reported use of tablets or smartphones to support medical decision making in a nationally representative sample of US adults.

METHODS

Cross-sectional data from participants in the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2) were evaluated. There were 3504 responses in the full HINTS 5 Cycle 2 data set; 2321 remained after eliminating respondents who did not have complete data for all the variables of interest. The primary outcome was use of a tablet or smartphone to help make a decision about how to treat an illness or condition. Sociodemographic factors including gender, race/ethnicity, and education were evaluated. Additionally, mobile health (mHealth)- and electronic health (eHealth)-related factors were evaluated including (1) the presence of health and wellness apps on a tablet or smartphone, (2) use of electronic devices other than tablets and smartphones to monitor health (eg, Fitbit, blood glucose monitor, and blood pressure monitor), and (3) whether people shared health information from an electronic monitoring device or smartphone with a health professional within the last 12 months. Descriptive and inferential statistics were conducted using SAS version 9.4. Weighted population estimates and standard errors, univariate odds ratios, and 95% CIs were calculated, comparing respondents who used tablets or smartphones to help make medical decisions (n=944) with those who did not (n=1377), separately for each factor. Factors of interest with a P value of <.10 were included in a subsequent multivariable logistic regression model.

RESULTS

Compared with women, men had lower odds of reporting that a tablet or smartphone helped them make a medical decision. Respondents aged 75 and older also had lower odds of using a tablet or smartphone compared with younger respondents aged 18-34. By contrast, those who had health and wellness apps on tablets or smartphones, used other electronic devices to monitor health, and shared information from devices or smartphones with health care professionals had higher odds of reporting that tablets or smartphones helped them make a medical decision, compared with those who did not.

CONCLUSIONS

A limitation of this research is that information was not available regarding the specific health condition for which a tablet or smartphone helped people make a decision or the type of decision made (eg, surgery, medication changes). In US adults, mHealth and eHealth use, and also certain sociodemographic factors are associated with using tablets or smartphones to support medical decision making. Findings from this study may inform future mHealth and other digital health interventions designed to support medical decision making.

Measuring general surgery residents' communication skills from the patient's perspective using the Communication Assessment Tool (CAT)

OBJECTIVE

The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients.

DESIGN

The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient.

SETTING

The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program.

PARTICIPANTS

Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up.

RESULTS

Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%.

CONCLUSIONS

The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive specific feedback and mentoring by program directors.

Evaluation of manual cuff palpation to confirm proper endotracheal tube depth

INTRODUCTION

In the prehospital setting, optimal endotracheal tube (ETT) depth may be approximated using the patient's sex or height, and assessed by auscultation. Even when using these methods, the ETTs still may be placed at inappropriate depths.

PROBLEM

This study assessed the inter-rater reliability and accuracy of manual cuff palpation (ballottement) at excluding an improperly placed ETT depth in adult patients.

METHODS

This is a prospective, observational, pilot study in a convenience sample of adults recently intubated in the prehospital, medical floor, intensive care unit, or emergency department settings of an urban, teaching hospital. Two physician participants separately performed ballottement on each intubated subject and rated the ballottement as none, weak, or strong prior to assessment of appropriate depth using a chest radiograph (CXR). Results were compared for simple agreement and compared to the CXR to estimate accuracy.

RESULTS

Of 163 patients, 27 (17%) had an inappropriate ETT depth. Physician assessments of ballottement agreed in 79% of patients (95% CI = 72-85%). Chest radiograph assessment found the ETT in the "strong" ballottement group properly placed in 93%, as compared to 77% in the "weak", and 42% in the "none" groups. Combining "weak" and "strong" ballottement, the sensitivity was 96% (95% CI = 93-100%), specificity was 26% (95% CI = 9-43%), and accuracy was 85% (95% CI = 79-90%).

CONCLUSIONS

Manual cuff palpation is a simple and reproducible technique that is sensitive, but nonspecific, in identifying intubations of appropriate depth.

End-of-life decisions: family views on advance directives

A cross-sectional survey was administered to family members of patients who died at 1 of the 5 Catholic institutions comprising Mercy Health Partners, a health care system in Ohio, to determine their opinions about patient and family participation in decisions about end-of-life care. Among 165 respondents, 118 (86%) of 138 agreed that the family was encouraged to join in decisions and 133 (91%) of 146 that their family member's health care choices were followed. Most agreed that nurses answered their questions (93%, 141/151) and that the doctor communicated well with family members (83%, 128/155). Seventy percent (107/152) indicated that their family member had at least 1 advance directive. There were no differences in whether health care choices were followed when patients with formal advance directives (92%, 92/100) were compared with patients without formal advance directives (88%, 35/40). A unique survey instrument can be used to measure family perceptions and opinions of participation in decisions about end-of-life care.

Self-reported pain scores in the emergency department: lack of association with vital signs

BACKGROUND

Some practitioners and investigators have presumed relationships between pain scores and heart rate, blood pressure, or respiratory rate. Previous literature has not adequately addressed the association of pain and vital signs.

OBJECTIVES

To identify any association between self-reported pain and heart rate, blood pressure, or respiratory rate.

METHODS

In this retrospective, observational study, emergency department patients older than 17 years of age presenting between May 2004 and April 2005 with verifiable painful diagnoses (including nephrolithiasis, myocardial infarction, small bowel obstruction, fracture, burn, crush injury, stab wound, amputation, corneal abrasion, and dislocation) were identified. Data were extracted from the hospital's database, including patients' age, gender, emergency department diagnosis, self-reported pain score, heart rate, blood pressure, and respiratory rate.

RESULTS

Among 1,063 subjects, the most common diagnoses were nephrolithiasis (25%; n = 267) and fracture (23%; n = 249). The mean (+/- SD) triage pain score was 7 (+/- 3). The mean (+/- SD) heart rate was 85 (+/- 16) beats/min, mean (+/- SD) systolic blood pressure was 141 (+/- 23) mm Hg, and mean (+/- SD) respiratory rate was 19 (+/- 3) breaths/min. There were no clinically significant differences in mean vital signs across the individual pain scores, as demonstrated by overlapping confidence intervals across pain scores.

CONCLUSIONS

No clinically significant associations were identified between self-reported triage pain scores and heart rate, blood pressure, or respiratory rate.

The verbal numeric pain scale: effects of patient education on self-reports of pain

BACKGROUND

Emergency department (ED) patients are frequently asked to provide a self-report of the level of pain experienced using a verbal numeric rating scale.

OBJECTIVES

To determine the effects of patient education regarding the verbal numeric rating scale on self-reports of pain among ED patients.

METHODS

In this prospective, interventional study, 310 eligible ED patients with pain, aged 18 years and older, were randomized to view either a novel educational video (n = 155) or a novel print brochure (n = 155) as an educational intervention, both developed to deliver educational information about the verbal numeric pain scale and its use. Participants initially rated their pain on a scale from 0 to 10 and then were administered the educational intervention. Following the educational intervention, participants completed a survey that included demographic information, postinterventional pain score, prior pain experience, and subjective rating of the helpfulness of the educational intervention. Fifty-five consecutive participants were enrolled as controls and received no educational intervention but gave a self-reported triage pain score and a second pain score at an equivalent time interval. Clinical significance was defined as a decrease in pain of 2 or more points following the education.

RESULTS

Following the educational interventions, there were statistically significant, although not clinically significant, decreases in mean pain scores within each intervention group (video: mean change, 1 point [95% confidence interval [CI] = 0.7 to 1.2]; printed brochure: mean change, 0.6 points [95% CI = 0.4 to 0.8]). For participants in the control group (no intervention), there was no significant change (mean change, 0.2 points [95% CI = -0.2 to 0.5]). A clinically significant decrease in pain was seen in 28% of the video group, 23% of the brochure group, and 5% of controls. Most patients had no change (71% of the video group, 73% of the brochure group, and 89% of controls). Participants rated the helpfulness of the video educational intervention as 7.1 (95% CI = 6.7 to 7.5) and the print educational intervention as 6.7 (95% CI = 6.2 to 7.1) on a scale from 0 (least effective) to 10 (most helpful).

CONCLUSIONS

Among ED participants with pain, both educational interventions (video and printed brochure) resulted in statistically and clinically significant decreased self-reported pain scores by 2 or more points in 26% of participants compared with 5% of controls. The educational interventions were rated as helpful by participants, with no appreciable difference between the two intervention groups.

End-of-life care: perspectives of family members of deceased patients

This study was undertaken to determine the opinions of family members of deceased patients regarding end-of-life care. This multisite cross-sectional survey was administered to 969 volunteer participants during 1997 to 2000. Eligible participants included immediate family members of deceased patients at five local institutions in a regional health system. Among 969 respondents, most (84.4 percent) indicated that the care for their family member was excellent. Reasons cited for satisfaction included overall care (40.2 percent), staff effort (23.2 percent), and communication (16.4 percent). Reasons cited for dissatisfaction included perceived incompetence (9.7 percent), perceived uncaring attitude (8.4 percent), and perceived understaffing (3.7 percent). Respondents were more satisfied with communication from nursing staff (88 percent) than physicians' communication (78 percent, p < 0.001, Bowker's test). Respondents indicated higher overall satisfaction with nursing (90 percent) and pastoral care (87 percent), than with physician care (81 percent, p < 0.001 and p = 0.006, Bowker's test). A unique survey instrument can be used to measure family perceptions and opinions regarding end-of-life care.

Comparison of oxycodone and hydrocodone for the treatment of acute pain associated with fractures: a double-blind, randomized, controlled trial

BACKGROUND

Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of acute pain. However, to the best of the authors' knowledge, no previous reports have compared the efficacies of these commonly prescribed agents.

OBJECTIVES

To compare the efficacies of oxycodone and hydrocodone for the treatment of acute pain associated with fractures in emergency department (ED) patients.

METHODS

This prospective, double-blind, randomized, controlled trial was conducted at an urban trauma center with an annual census of 65,000. Eligible participants included ED patients over the age of 12 years with fractures who consented to participate. Subjects were randomized to receive either oxycodone (5 mg orally [po]) with acetaminophen, or hydrocodone (5 mg po) with acetaminophen. Measurements included demographic information; pain scores on a verbal numeric rating scale at baseline and at 30 and 60 minutes; vital signs at baseline and at 30 and 60 minutes; and adverse effects. Ninety-five-percent confidence intervals (95% CIs) constructed about means and proportions were used to assess differences between the oxycodone and hydrocodone groups in analgesic efficacy and side effects.

RESULTS

Seventy-three subjects were randomized to receive oxycodone or hydrocodone. Sixty-seven subjects completed the ED study period (n = 35, oxycodone; n = 32, hydrocodone). There was no difference between the two groups in age, weight, gender, ethnicity, diagnoses, baseline pain scores, or vital signs. Patients in both groups had pain relief from baseline to 30 minutes (oxycodone mean change 3.7, 95% CI = 2.9 to 4.6; hydrocodone mean change 2.5, 95% CI = 1.7 to 3.3), and from baseline to 60 minutes (oxycodone mean change 4.4, 95% CI = 3.2 to 5.6; hydrocodone mean change 3.0, 95% CI = 2.1 to 3.9). There was no difference in pain between the patients treated with oxycodone and hydrocodone at 30 minutes (mean difference between groups -0.6, 95% CI = -1.8 to 0.5) or at 60 minutes (mean difference -0.5, 95% CI = -2.0 to 1.0). There was no difference between the groups in nausea, vomiting, itching, or drowsiness; however, the hydrocodone patients had a higher incidence of constipation (oxycodone 0%, hydrocodone 21%, difference in proportions 21%, 95% CI = 3% to 39% more with hydrocodone).

CONCLUSIONS

Treatment with acetaminophen and either oxycodone, 5 mg po, or hydrocodone, 5 mg po, resulted in pain relief among ED patients with acute fractures, and there was no difference between the two agents at 30 and 60 minutes. Adverse effect profiles were similar, with the exception of a higher incidence of subsequent constipation with the use of hydrocodone. These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures.