Anna Mathew

Abstract

Aims: A randomised Controlled trial to assess the role of an individualised introduction to labour given after 37 weeks of gestation in allaying anxiety prior to delivery and birth satisfaction, in primi-gravidas Materials and Methods: After obtaining approval from ethics committee, antenatal mothers, booked for delivery in this hospital, who gave written informed consent, were randomized to Group A (Interventional group) and Group B (comparator group). The Anxiety Assessment Scale for Pregnant Woman in Labour (AASPWL) was administered to all participants at first contact in the antenatal clinic, after 37 weeks of gestation by the investigator. The post-intervention AASPWL questionnaire was administered to all participants in the first stage of labour by a blinded assessor. The birth satisfaction of all participants was assessed after delivery using the Birth Satisfaction Scale (BSS) by a blinded assessor in the ward. Results: The difference in mean anxiety score measured in the first stage of labour and during antenatal visit (>37 weeks of gestation) in Group A and Group B was analysed. It was found that the two groups were homogenous, but the increase in anxiety during labour was less in group A compared to group B, however, the difference was not statistically significant. The Birth Satisfaction Scale score in the intervention group was significantly higher compared to the comparator group (p Conclusion: An individualised structured introduction to labour reduced the AASPWL scores in first-time parturient mothers who received the intervention, compared to mothers who did not receive the intervention. This reduction, however, was not statistically significant. We also found that the individualised structured introduction to labour enhanced the birth satisfaction of first-time parturient mothers, measured by the Birth Satisfaction Scale (BSS) significantly and resulted in higher scores in the subdomains of the BSS.   Keywords: Anxiety, Antenatal pregnant women, AASPWL, Birth satisfaction, Individualised instruction.

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Abstract

Background: Preoperative anxiety and stress are inevitable in patients awaiting surgery. However it is known that larger doses of anaesthetics, higher peri- and post-operative requirement of analgesia and longer hospital stay follow higher levels of anxiety. Studies have shown that pre-operative education reduces anxiety symptoms. This studywas undertaken to answer the question: “Does a structured educational intervention to demystify anaesthesia reduce fear and anxiety prior to surgery?” Objectives: To assess the role of patient education in reducing pre-operative anxiety and fear and improving satisfaction in patients undergoing surgery using the Anesthesia- and Surgery-dependent Preoperative Anxiety Scale (ASPA)and the Visual Analog Scale for fear and the Short Assessment of Patient Satisfaction (SAPS) in patients who have received the structured educational intervention and those who have not. Materials and Methods: This is a parallel group, single blinded, randomised control trial in 56 consenting patients awaiting abdominal surgery under general anesthesia. The participants were randomized to the interventional and comparator groups and ASPA and VAS were administered. Participants in Group A were given the structured educational intervention to demystify anesthesia. The ASPA and VAS Scales were again administered by a blinded assessor to all participants. The student investigator administered SAPS on the third post-operative day or prior to discharge, whichever was earlier. Result: There was significant reduction in median scores before and after intervention for anxiety (ASPA=2) and fear (VAS=20) in intervention group compared to the comparator group. (p value= The median scores for patient satisfaction as measured by SAPS was also higher in the intervention group compared to the comparator group.(p value=0.042). Conclusion: There was a significant reduction of pre-operative fear and anxiety in the intervention group, while the patient satisfaction was also higher in the intervention group. Keywords: Demystifying anaesthesia, Educational module, Pre-operative anxiety, Fear, Patient-satisfaction, ASPA, SAPS.

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Objectives: To find the prevalence of traumatic optic nerve injury in neurosurgical patients admitted to this rural tertiary care hospital and to assess the clinical profile and visual outcomes in these patients. Materials and Methods: This case series of the prevalence, profile and outcomes of patients with Traumatic optic nerve injury (TONI) admitted to the neurosurgical department of this rural teaching hospital during the year 2014 received the approval of the Institutional Review Board and the Institutional Ethics Committee. Data was accessed from the medical records of these patients for one year. Results: Of the 3466 neurosurgical admissions, 15 were found to have traumatic optic nerve injury making the prevalence of TONI in this institution 0.43%. Of the 15 patients with TONI, 14 (93%) were males and the mean age was 33 years and more than half were over the age of 30 years. Road Traffic Accidents remained the main cause for TONI (93%). Ten of these patients (66.7%) presented with fracture skull or orbit and 5 (33.3%) had no fractures. Most of the bony injuries were lateral orbital wall fractures accounting for 7 (70%). None of the patients had evidence of optic nerve compression. Fourteen of the 15 patients with TONI (93%), received intravenous and oral corticosteroids and one patient was treated conservatively. Twelve patients showed improved visual acuity on discharge while three did not improve. Conclusion: Traumatic optic nerve injury is a vision-endangering condition which is a comorbidity of blunt head trauma. Most of the patients with optic nerve injury presented with periorbital edema, subconjunctival haemorrhage and orbital wall fracture, lateral orbital wall fracture being the commonest. Patients treated with intravenous corticosteroids followed by oral route of the same were found to have good visual outcomes. There is a great need to develop clinical databases for better understanding of the natural history and management of this condition. Keywords: Head injury, Orbital fracture, Road traffic accidents, Traumatic optic nerve injury, Visual acuity.

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