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I Schaffer

Publications and source records attributed to I Schaffer.

3 recordsLinked to original sources
PubMed2001

Validation of a telephone-administered geriatric depression scale in a hispanic elderly population.

OBJECTIVE: To develop and validate a Spanish version of the Geriatric Depression Scale (GDS) for telephone administration. DESIGN, SETTING, AND PATIENTS: The original version of the GDS was translated into Spanish. A random sample of 282 ambulatory elderly individuals was contacted by phone. Those completing the phone GDS (GDS-T) were asked to schedule an appointment within two weeks in which we collected data on demographics, physical exam, functional and mental status, and a face-to-face version of the GDS (GDS-P). We estimated question-to-question kappa statistics and the Pearson correlation coefficient between the GDS-T and GDS-P scores. We evaluated reliability of the GDS-T and GDS-P using the Cronbach's alpha coefficient. We estimated the sensitivity, specificity, and criterion validity of the GDS using the DSM IV criteria for depression as our gold standard. RESULTS: Thirty patients (11%) refused to participate. Of the remaining 252 patients, 169 (67%) attended the personal interview. The Cronbach's alpha coefficient was 0.85 for GSD-P and 0.88 for GDS-T. Sensitivity and specificity were 88% and 82% for GDS-P and 84% and 79% for GDS-T. The prevalence of depression in the group completing both scales was 12.8% using the GDS-P and 14.9% using the GDS-T (P >.05). Among those who only completed the GDS-T, the prevalence was 22.7% (P <.05) suggesting that depressed patients kept their appointments less frequently. CONCLUSIONS: The telephone GDS had high internal consistency and was highly correlated with the validated personal administration of the scale, suggesting that it could be a valid instrument for screening of depression among elderly ambulatory Spanish-speaking patients. Because the depression rate was significantly higher among those not presenting to the personal evaluation, the adoption of GDS-T may help detect and plan early interventions in patients who otherwise would not be identified.

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PubMedDate not supplied

[Postoperative pain as the fifth vital parameter].

INTRODUCTION: Acute postoperative pain and its therapy is a great challenge for all health-care providers in operative medicine today. Despite development of new analgesic drugs and different therapeutic modalities in pain treatment, acute postoperative pain represents a negative experience for many surgical patients. MATERIAL AND METHODS: By reviewing relevant medical articles on this topic, we tried to find answers on the reasons why many surgical patients have pain in the postoperative period despite implementation of modern and powerful analgesic therapy like patient-controlled analgesia (PCA), spinal/epidural opioids and regional analgesia. RESULTS: The reasons of inefficacy of many analgesic therapeutic methods are multiple. One of them is the attitude of patients and healthcare workers to pain. Many of them consider pain is a natural and physiological consequence of different diseases and pathological conditions and moderate to severe pain is considered as acceptable consequence of surgery. Another important factor contributing to undertreatment is that pain is invisible in most hospital wards: severity of pain is not assessed, and patients are reluctant to "complain." Unless severity of pain is assessed on a routine basis, pain cannot be effectively treated. Thus, one of the most important changes in the process of improving the efficacy of pain treatment is to introduce pain assessment as the fifth vital sign in addition to the traditional four vital signs (temperature, pulse, blood pressure and respiratory rate). DISCUSSION: Introduction of the "fifth vital parameter" would solve many problems in postoperative pain therapy, because healthcare workers take vital signs very seriously both for monitoring and treatment. By frequent measuement and registration of pain intensity and by organization of teams for treatment of postoperative pain, analgesic therapy would be more efficient, and whole therapy of surgical patients would be more qualitative. Undertreatment of pain can have very serious consequences; delayed improvement, change of immune system, changed answer to stress, appearance of vegetative symptoms and possibility of permanent changes in peripheral and central nervous system resulting in chronic pain syndrome. These effects are very harmful, changing quality of life of the whole family because the treatment of chronic pain syndrome is very difficult and expensive. CONCLUSION: Anesthesiologists have a central role in perioperative treatment of surgical patients (from the preoperative preparation through anesthesia and intraoperative monitoring to postoperative treatment and monitoring at the department of the intensive care and at the department of postanesthetic care). Due to abovementioned and familiarity with many therapeutic modalities, like spinal/epidural application of analgesics, regional anesthesia/analgesia many clinicians and pain specialists consider anesthesiologists are those who can organize and supervise teams for acute postoperative pain services.

Humans↗