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Tsze DS, Lubell TR, Carter RC, Chernick LS, DePeter KC, McLaren SH, Kwok MY, Roskind CG, Gonzalez AE, Fan W, Babineau SE, Friedman BW, Dayan PS. Intranasal ketorolac versus intravenous ketorolac for treatment of migraine headaches in children: A randomized clinical trial. Acad Emerg Med 2022; 29:465-475. [PMID: 34822214 PMCID: PMC10695685 DOI: 10.1111/acem.14422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/31/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intravenous ketorolac is commonly used for treating migraine headaches in children. However, the prerequisite placement of an intravenous line can be technically challenging, time-consuming, and associated with pain and distress. Intranasal ketorolac may be an effective alternative that is needle-free and easier to administer. We aimed to determine whether intranasal ketorolac is non-inferior to intravenous ketorolac for reducing pain in children with migraine headaches. METHODS We conducted a randomized double-blind non-inferiority clinical trial. Children aged 8-17 years with migraine headaches, moderate to severe pain, and requiring parenteral analgesics received intranasal ketorolac (1 mg/kg) or intravenous ketorolac (0.5 mg/kg). Primary outcome was reduction in pain at 60 min after administration measured using the Faces Pain Scale-Revised (scored 0-10). Non-inferiority margin was 2/10. Secondary outcomes included time to onset of clinically meaningful decrease in pain; ancillary emergency department outcomes (e.g. receipt of rescue medications, headache relief, headache freedom, percentage improvement); 24-h follow-up outcomes; functional disability; and adverse events. RESULTS Fifty-nine children were enrolled. We analyzed 27 children who received intranasal ketorolac and 29 who received intravenous ketorolac. The difference in mean pain reduction at 60 min between groups was 0.2 (95% CI -0.9, 1.3), with the upper limit of the 95% CI being less than the non-inferiority margin. There were no statistical differences between groups for secondary outcomes. CONCLUSIONS Intranasal ketorolac was non-inferior to intravenous ketorolac for reducing migraine headache pain in the emergency department.
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Affiliation(s)
- Daniel S. Tsze
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Tamar R. Lubell
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Robert C. Carter
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Lauren S. Chernick
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kerrin C. DePeter
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Son H. McLaren
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Maria Y. Kwok
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Cindy G. Roskind
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ariana E. Gonzalez
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Weijia Fan
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Shannon E. Babineau
- Departments of Pediatrics and Neurology, Sidney Kimmel Medical College of Thomas Jefferson University, Morristown, New Jersey, USA
| | - Benjamin W. Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Peter S. Dayan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Brahnam S, Nanni L, McMurtrey S, Lumini A, Brattin R, Slack M, Barrier T. Neonatal pain detection in videos using the iCOPEvid dataset and an ensemble of descriptors extracted from Gaussian of Local Descriptors. APPLIED COMPUTING AND INFORMATICS 2020. [DOI: 10.1016/j.aci.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diagnosing pain in neonates is difficult but critical. Although approximately thirty manual pain instruments have been developed for neonatal pain diagnosis, most are complex, multifactorial, and geared toward research. The goals of this work are twofold: 1) to develop a new video dataset for automatic neonatal pain detection called iCOPEvid (infant Classification Of Pain Expressions videos), and 2) to present a classification system that sets a challenging comparison performance on this dataset. The iCOPEvid dataset contains 234 videos of 49 neonates experiencing a set of noxious stimuli, a period of rest, and an acute pain stimulus. From these videos 20 s segments are extracted and grouped into two classes: pain (49) and nopain (185), with the nopain video segments handpicked to produce a highly challenging dataset. An ensemble of twelve global and local descriptors with a Bag-of-Features approach is utilized to improve the performance of some new descriptors based on Gaussian of Local Descriptors (GOLD). The basic classifier used in the ensembles is the Support Vector Machine, and decisions are combined by sum rule. These results are compared with standard methods, some deep learning approaches, and 185 human assessments. Our best machine learning methods are shown to outperform the human judges.
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3
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Hindocha A, Randell P, Seery P, Rahimi T, Kirkhope N, Raghunanan S, Foster C, Tudor-Williams G, Lyall H. The optimal time to test for sero-reversion in HIV-exposed uninfected infants: the later the better? HIV Med 2020; 21:453-456. [PMID: 32441839 DOI: 10.1111/hiv.12862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES HIV-exposed uninfected (HEU) infants are tested for loss of maternal antibody (sero-reversion) at 18 months of age. Highly sensitive fourth-generation antigen/antibody assays can detect very low levels of antibody, leading to retesting. We audited serological screening outcomes in HEU infants at two National Health Service (NHS) Trusts. METHODS HEU infants born between January 2013 and August 2016 were identified via case records. Data collected included gestation; age at testing; test results and assay type. RESULTS One hundred and forty-two infants were identified, of whom 21 were excluded from analysis. One hundred and one (83%) were born at term and 20 (17%) preterm (< 37/40 weeks of gestation), and the median age at first serology was 19.1 [interquartile range (IQR) 18.1; 21.4] months. Initial serology was positive in 10 of 121 infants (8.3%), and the median age of these 10 infants was 18.3 (IQR 18.1; 18.8) months, whereas those with negative serology (n = 111) had a median age of 19.2 (IQR 18.1; 21.5) months (P = 0.12). All infants with positive HIV serology were born at term. Seven of 10 infants had reactive serology on two fourth-generation assays. Subsequent serology was available for eight of 10 infants, with a median age of 21.3 months. Five of the eight (63%) were negative. One was reactive but HIV RNA polymerase chain reaction (PCR) was negative, and one was reactive on screening but negative on confirmatory testing. The remaining child was still seropositive at 24.7 months but had a non-reactive result at 29.4 months. CONCLUSIONS Overall, 8.3% of HEU infants required repeat testing to confirm loss of antibody. Delaying testing until 22 months of age reduces retesting to < 2%, with associated resource and emotional implications. Positive serology at 22 months should prompt an HIV RNA PCR to exclude infection.
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Affiliation(s)
- A Hindocha
- Imperial College Healthcare NHS Trust, London, UK
| | - P Randell
- Imperial College Healthcare NHS Trust, London, UK
| | - P Seery
- Imperial College Healthcare NHS Trust, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - T Rahimi
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - N Kirkhope
- Imperial College Healthcare NHS Trust, London, UK
| | - S Raghunanan
- Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- Imperial College Healthcare NHS Trust, London, UK
| | - G Tudor-Williams
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - H Lyall
- Imperial College Healthcare NHS Trust, London, UK
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4
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Poonai N, Spohn J, Vandermeer B, Ali S, Bhatt M, Hendrikx S, Trottier ED, Sabhaney V, Shah A, Joubert G, Hartling L. Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review. Pediatrics 2020; 145:peds.2019-1623. [PMID: 31862730 DOI: 10.1542/peds.2019-1623] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE To explore the effectiveness of IND for procedural distress in children. DATA SOURCES We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register. STUDY SELECTION We included randomized trials of IND for procedures in children. DATA EXTRACTION Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation. RESULTS Among 19 trials (N = 2137), IND was superior to oral chloral hydrate (3 trials), oral midazolam (1 trial), intranasal midazolam (1 trial), and oral dexmedetomidine (1 trial). IND was equivalent to oral chloral hydrate (2 trials), intranasal midazolam (2 trials), and intranasal ketamine (3 trials). IND was inferior to oral ketamine and a combination of IND plus oral ketamine (1 trial). Higher doses of IND were superior to lower doses (4 trials). Adverse effects were reported in 67 of 727 (9.2%) participants in the IND versus 98 of 591 (16.6%) in the comparator group. There were no reports of adverse events requiring resuscitative measures. LIMITATIONS The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; .,Division of Emergency Medicine and.,Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | | | - Ben Vandermeer
- Department of Pediatrics and Alberta Research Centre for Health Evidence
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, and.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Evelyne D Trottier
- Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montréal, Québec, Canada; and
| | - Vikram Sabhaney
- BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Division of Emergency Medicine and
| | - Lisa Hartling
- Department of Pediatrics and Alberta Research Centre for Health Evidence
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5
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Baumer-Mouradian SH, Gray MP, Wolfgram PM, Kopetsky M, Chang F, Brousseau DC, Frenkel MM, Ferguson CC. Improving Emergency Department Management of Diabetic Ketoacidosis in Children. Pediatrics 2019; 144:peds.2018-2984. [PMID: 31515299 DOI: 10.1542/peds.2018-2984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diagnostic delays in the pediatric emergency department (ED) can lead to unnecessary interventions and prolonged ED length of stay (LOS), especially in patients with diabetes mellitus evaluated for diabetic ketoacidosis (DKA). At our institution, baseline DKA determination time (arrival to diagnosis) was 86 minutes, and 61% of patients did not meet DKA criteria. Subsequently, intravenous (IV) placement occurred in 85% of patients without DKA. We aimed to use point-of-care (POC) testing to reduce DKA determination time from 86 to 30 minutes and to reduce IV placements in patients without DKA from 85% to 20% over 18 months. METHODS Four key interventions (POC tests, order panels, provider guidelines, and nursing guidelines) were tested by using plan-do-study-act cycles. DKA determination time was our primary outcome, and secondary outcomes included the percentage of patients receiving IV placement and ED LOS. Process measures included the rate of use of POC testing and order panels. All measures were analyzed on statistical process control charts. RESULTS Between January 2015 and July 2018, 783 patients with diabetes mellitus were evaluated for DKA. After all 4 interventions, DKA determination time decreased from 86 to 26 minutes (P < .001). In patients without DKA, IV placement decreased from 85% to 36% (P < .001). ED LOS decreased from 206 to 186 minutes (P = .009) in patients discharged from the hospital after DKA evaluation. POC testing and order panel use increased from 0% to 98% and 90%, respectively. CONCLUSIONS Using quality-improvement methodology, we achieved a meaningful reduction in DKA determination time, the percentage of IV placements, and ED LOS.
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Affiliation(s)
| | - Matthew P Gray
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Peter M Wolfgram
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Matthew Kopetsky
- Business Intelligence and Data Warehousing, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Franklin Chang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - David C Brousseau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Mogen M Frenkel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Catherine C Ferguson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Hartling L. Intranasal ketamine for anesthetic premedication in children: a systematic review. Pain Manag 2018; 8:495-503. [PMID: 30394192 DOI: 10.2217/pmt-2018-0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM In children, intravenous anesthetic premedication can be distressing. Intranasal (IN) ketamine offers a less invasive approach. MATERIALS AND METHODS We included randomized trials of IN ketamine in anesthetic premedication in children 0-19 years. We performed electronic searches of MEDLINE, EMBASE, Google Scholar, CINAHL, Cochrane Library, Web of Science, Scopus, clinical trial registries and conference proceedings. RESULTS Among the 23 trials (n = 1680) included, IN ketamine adequately sedated 220/311 (70%) for face mask application, 217/308 (70%) for caregiver separation, 200/371 (54%) for iv. insertion and 19/30 (63%) for monitor application. Vomiting was the most common adverse effect (35/1579 [2.2%]). CONCLUSION There is a need for sufficiently powered, methodologically rigorous trials, using psychometrically evaluated, objective outcome measures to meaningfully inform practice.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Kyle Canton
- Division of Emergency Medicine, Western University, London, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Women & Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | - Amit Shah
- Division of Emergency Medicine, Western University, London, Canada
| | - Michael Miller
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Susam V, Friedel M, Basile P, Ferri P, Bonetti L. Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:6-16. [PMID: 30038198 PMCID: PMC6357594 DOI: 10.23750/abm.v89i6-s.7378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture. METHODS A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to "magic gloves" group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS). RESULTS Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System. CONCLUSION The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than "magic glove" technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.
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Affiliation(s)
- Volkan Susam
- General Medical Ward, ASST Monza-San Gerardo, San Gerardo Hospital, Italy..
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8
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Walco GA, Kopecky EA, Weisman SJ, Stinson J, Stevens B, Desjardins PJ, Berde CB, Krane EJ, Anand KJS, Yaster M, Dampier CD, Dworkin RH, Gilron I, Lynn AM, Maxwell LG, Raja S, Schachtel B, Turk DC. Clinical trial designs and models for analgesic medications for acute pain in neonates, infants, toddlers, children, and adolescents: ACTTION recommendations. Pain 2018; 159:193-205. [PMID: 29140927 PMCID: PMC5949239 DOI: 10.1097/j.pain.0000000000001104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinical trials to test the safety and efficacy of analgesics across all pediatric age cohorts are needed to avoid inappropriate extrapolation of adult data to children. However, the selection of acute pain models and trial design attributes to maximize assay sensitivity, by pediatric age cohort, remains problematic. Acute pain models used for drug treatment trials in adults are not directly applicable to the pediatric age cohorts-neonates, infants, toddlers, children, and adolescents. Developmental maturation of metabolic enzymes in infants and children must be taken into consideration when designing trials to test analgesic treatments for acute pain. Assessment tools based on the levels of cognitive maturation and behavioral repertoire must be selected as outcome measures. Models and designs of clinical trials of analgesic medications used in the treatment of acute pain in neonates, infants, toddlers, children, and adolescents were reviewed and discussed at an Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) Pediatric Pain Research Consortium consensus meeting. Based on extensive reviews and continuing discussions, the authors recommend a number of acute pain clinical trial models and design attributes that have the potential to improve the study of analgesic medications in pediatric populations. Recommendations are also provided regarding additional research needed to support the use of other acute pain models across pediatric age cohorts.
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Affiliation(s)
- Gary A. Walco
- University of Washington, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Ernest A. Kopecky
- Collegium Pharmaceutical, Inc., Canton, MA, USA
- Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | | | - Elliot J. Krane
- Stanford University School of Medicine, Stanford, CA, USA
- Stanford Children’s Health, Palo alto, CA, USA
| | - Kanwaljeet JS Anand
- Stanford University School of Medicine, Stanford, CA, USA
- Stanford Children’s Health, Palo alto, CA, USA
| | - Myron Yaster
- Johns Hopkins University Hospital, Baltimore, MA, USA
| | | | | | - Ian Gilron
- Queen’s University, Kingston, ON, Canada
| | - Anne M. Lynn
- University of Washington, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
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Cardinal FG, Arroyo GM, Magbanua S, Sajnani AK. Measurement of Anxiety in 3-9 Year Old Children Receiving Nursing Intervention. J Caring Sci 2018; 6:293-302. [PMID: 29302569 PMCID: PMC5747588 DOI: 10.15171/jcs.2017.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction: Nurses are in an ideal position to provide special care for anxious
children admitted in hospital wards. Thus, the objectives of the study were to identify
the common nursing procedures done for children and to measure their level of
anxiety.
Methods: A cross-sectional descriptive study was conducted at a district hospital in
Philippines. The respondents of the study were 235 children aged 3 – 9 years old
admitted in the pediatric ward. The descriptive characteristics of the children were
recorded. Venham Picture Test was used to assess the level of anxiety in children. The
instrument was validated using the Good and Scates criteria and pre-tested on 30
pediatric respondents. The chi-square test and t-test were used to determine the
significance of difference between the scores given by the children across different age
groups and the P-value was set at 0.05.
Results: The mean age of the respondents was 5.1 (3.5) years. Males obtained an
"average" mean score of anxiety 4.0 (2.0) whilst females demonstrated a "low" mean
score of anxiety 3.6 (2.3). There was a highly statistical difference between the mean
anxiety scores amongst patients who had a prior experience and those who had none.
Conclusion: Temperature measurement and pulse measurement were the most
common procedures performed on children and demonstrated very low level of
anxiety. Peripheral cannula insertion caused the maximum anxiety amongst all the
procedures performed. Children aged 3 to 4 years old demonstrated the maximum
anxiety when compared to children aged 5 to 9 years.
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Affiliation(s)
- Febby G Cardinal
- Department of Nursing, Sanko Mambukal Life Home Care Inc., Mambukal, Philippines
| | - Golda Myra Arroyo
- Deaprtment of Nursing, Lorenzo D. Zayco District Hospital, Kabankalan city, Philippines
| | - Sheilla Magbanua
- Department of Nursing, College of Nursing, University of La Salle, Bacolod, Philippines
| | - Anand K Sajnani
- Deaortment of Paediatric and Preventive Dentistry, KIMS Qatar Medical Centre, Wakra, Qatar
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10
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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Rieder M, Hartling L. Intranasal ketamine for procedural sedation and analgesia in children: A systematic review. PLoS One 2017; 12:e0173253. [PMID: 28319161 PMCID: PMC5358746 DOI: 10.1371/journal.pone.0173253] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ketamine is commonly used for procedural sedation and analgesia (PSA) in children. Evidence suggests it can be administered intranasally (IN). We sought to review the evidence for IN ketamine for PSA in children. METHODS We performed a systematic review of randomized trials of IN ketamine in PSA that reported any sedation-related outcome in children 0 to 19 years. Trials were identified through electronic searches of MEDLINE (1946-2016), EMBASE (1947-2016), Google Scholar (2016), CINAHL (1981-2016), The Cochrane Library (2016), Web of Science (2016), Scopus (2016), clinical trial registries, and conference proceedings (2000-2016) without language restrictions. The methodological qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively. RESULTS The review included 7 studies (n = 264) of children ranging from 0 to 14 years. Heterogeneity in study design precluded meta-analysis. Most studies were associated with a low or unclear risk of bias and outcome-specific ratings for quality of evidence were low or very low. In four of seven studies, IN ketamine provided superior sedation to comparators and resulted in adequate sedation for 148/175 (85%) of participants. Vomiting was the most common adverse effect; reported by 9/91 (10%) of participants. CONCLUSIONS IN ketamine administration is well tolerated and without serious adverse effects. Although most participants were deemed adequately sedated with IN ketamine, effectiveness of sedation with respect to superiority over comparators was inconsistent, precluding a recommendation for PSA in children.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Kyle Canton
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Amit Shah
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Miller
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Rieder
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta
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11
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Schmitz ML, Zempsky WT, Meyer JM. Safety and Efficacy of a Needle-free Powder Lidocaine Delivery System in Pediatric Patients Undergoing Venipuncture or Peripheral Venous Cannulation: Randomized Double-blind COMFORT-004 Trial. Clin Ther 2015; 37:1761-72. [DOI: 10.1016/j.clinthera.2015.05.515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/30/2015] [Accepted: 05/27/2015] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Closed reduction and K-wire fixation is standard treatment for displaced supracondylar fractures in children. The purpose of this study is to evaluate pain using 2 pediatric pain scales when removing K-wires from the distal humerus in children in the office setting. METHODS A total of 98 percutaneous smooth K-wires were removed from 47 patients who had sustained displaced supracondylar fractures of the elbow. Pain was measured using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The maximum score is 13 and the minimum score is 4 points. In addition, after K-wire removal, each child indicated on a numbered pain-face diagram (Wong-Baker FACES: a scale consisting of faces with varying emotional expressions and corresponding numbers on a scale from 0 to 5) the amount of pain that they felt. RESULTS The average age of the patients treated was 7.1 years (range, 2 to 14 y). There were 28 males and 19 females. Thirty patients (64%) had a CHEOPS score of ≤6. The average CHEOPS was 6 (range, 4 to 10). Seventeen patients (37%) had a FACES score of ≤1. The average FACES score was 2 (range, 1 to 5). Higher CHEOPS and FACES scores correlated with younger patient age and higher number of K-wires removed. CONCLUSIONS K-wire removal in the clinic is common practice. The pain associated with K-wire removal and the safety of this practice has received minimal previous study in the literature. In the present manuscript, 64% of patients had little or no pain measured by the CHEOPS scale--score of ≤6 and 36% had little or no pain self-reported by the FACES scale--score of ≤1. No patient reported severe pain by the CHEOPS scores (CHEOPS 11 to 13) and only 1 patient reported having severe pain with a FACES of 5. No complications occurred. The results of this study suggest that the removal of K-wires in the office setting is safe and acceptable. LEVEL OF EVIDENCE Retrospective analysis.
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Chebroux A, Leece EA, Brearley JC. Ease of intravenous catheterisation in dogs and cats: a comparative study of two peripheral catheters. J Small Anim Pract 2015; 56:242-6. [DOI: 10.1111/jsap.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/22/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Chebroux
- Department of Veterinary Medicine; University of Cambridge; Cambridge CB3 0ES
| | - E. A. Leece
- Dick White Referrals; Station Farm; Newmarket Suffolk CB8 0UH
| | - J. C. Brearley
- Department of Veterinary Medicine; University of Cambridge; Cambridge CB3 0ES
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Abstract
BACKGROUND The Adolescent Pediatric Pain Tool (APPT) is a multidimensional pain assessment tool designed to assess pain location (body outline diagram), intensity (word graphic rating scale) and quality (list of pain descriptors) in hospitalized children eight to 17 years of age. OBJECTIVES To identify the age range, health conditions, settings and purpose for which APPT has been used; the components of the APPT that have been used; and the reported clinical and research utility of the APPT. METHODS A systematic review of published studies using the APPT was performed. Studies were identified through electronic searches in CINAHL, Medline, PubMed, SciELO and PsycInfo. RESULTS Twenty-three studies were analyzed. APPT has been used in patients between two and 68 years of age, with various acute and chronic conditions, in and out of hospital. All but six studies used the three components of the APPT. Most of the studies used the total number of sites marked, mean pain intensity and mean number of pain descriptors selected as main outcome measures; however, scoring methods varied. Studies report that the use of the APPT is relevant for clinical practice and for research. CONCLUSION Obtaining self-report of pain using the APPT may help clinicians to tailor pain management interventions. It may also be used in studies to provide a deeper understanding of the pain experience and to examine the effectiveness of pain management interventions. However, outcome measures and methods of scoring the different components of the APPT need to be clearly identified.
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Abstract
PURPOSE OF REVIEW To review recent research on the management of acute procedural pain in pediatric patients. RECENT FINDINGS Pediatric patients experience pain with the same or greater intensity as their adult counterparts. Recent studies have acknowledged the importance of people's beliefs about pain and of a multidisciplinary approach to the assessment and treatment of acute pain. SUMMARY Pediatric patients experience pain from procedures related to their care. Pediatricians should educate themselves regarding the accurate assessment of pain, and the pharmacologic and nonpharmacologic methods of managing acute pain.
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Kipping B, Rodger S, Miller K, Kimble RM. Virtual reality for acute pain reduction in adolescents undergoing burn wound care: A prospective randomized controlled trial. Burns 2012; 38:650-7. [DOI: 10.1016/j.burns.2011.11.010] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 11/30/2022]
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Sikorova L, Hrazdilova P. The effect of psychological intervention on perceived pain in children undergoing venipuncture. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 155:149-54. [PMID: 21804624 DOI: 10.5507/bp.2011.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS The main objective of the study was to determine the effect of structured psychological intervention on the level of perceived pain in children undergoing venipuncture. A second goal was to investigate how pain behavior during venipuncture is affected by age, sex, previous number of venipunctures, the presence of parents during the procedure and reason for the venipuncture. METHODS Children with indications for venipuncture aged 5-10 years, were randomly divided into a control group and an intervention group. The control group was prepared for the venipuncture routinely. Children in the intervention group were prepared according to prior structured psychological consultation. Perceived pain levels were assessed by the CHEOPS scale and the self report Wong and Baker faces pain rating scale. RESULTS A significant difference in evaluated pain between the intervention group and the control group was found. The psychological intervention carried out by a nurse proved to lower pain levels from venipuncture as measured by the CHEOPS scale and evaluated using the self-report scale. A greater level of pain was found in children in the age group 5-7 years, in children where peripheral venous catheter was introduced and in children where the parents were present. Special consultation with the child one day before venipuncture reduced pain levels, especially in children below the age-category mentioned. Consultation should be part of the standard of care for children with indications for venipuncture.
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Affiliation(s)
- Lucie Sikorova
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Czech Republic.
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18
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Auf dem Weg zur schmerzarmen Kinderklinik. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Techniques for Hyaluronidase-Facilitated Subcutaneous Fluid Administration With Recombinant Human Hyaluronidase. JOURNAL OF INFUSION NURSING 2011; 34:300-7. [DOI: 10.1097/nan.0b013e31822860d9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Abstract
Peripherally inserted central catheters are increasingly used in the pediatric and adolescent population for long-term central access. This article reviews the indications, insertion techniques, and complications of peripherally inserted central catheter lines.
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Shaw S, Lee A. Student Nurses' Misconceptions of Adults with Chronic Nonmalignant Pain. Pain Manag Nurs 2010; 11:2-14. [DOI: 10.1016/j.pmn.2008.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 10/22/2008] [Indexed: 11/17/2022]
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Rauch D, Dowd D, Eldridge D, Mace S, Schears G, Yen K. Peripheral difficult venous access in children. Clin Pediatr (Phila) 2009; 48:895-901. [PMID: 19423876 DOI: 10.1177/0009922809335737] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Daniel Rauch
- Pediatric Hospitalist Program, New York University School of Medicine, New York, NY 10016, USA.
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Abstract
Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress associated with acute medical procedures, postoperative pain, critical care, analogue pain induction procedures and other sources. Two recent scholarly reviews of behavioural assessment methods were conducted by the Society of Pediatric Psychology Evidence-Based Assessment Task Force and the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, which classified various instruments as well established, approaching well established or promising. The characteristics of the eight behavioural assessment scales that were recommended by one of these task forces are further reviewed in the present paper. The results indicate that behavioural assessment scales have been used flexibly to assess pain in a wide variety of situations, across different pediatric populations and for patients of different ages. In the present review, there appears to be no basis for designating the scales as measures of distress versus pain; both emotional and sensory components of pain seem to be assessed by each of the scales. There is considerable overlap among the behavioural indicators of pain used in the different scales. Furthermore, the behavioural codes indicative of pain may occur before, during and after painful events. Recommendations for future research are provided, including using behavioural assessment to focus on children's coping and adults' behaviours, as well as pain.
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Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics 2008; 122 Suppl 3:S130-3. [PMID: 18978006 DOI: 10.1542/peds.2008-1055e] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Increasing evidence has demonstrated that pain from venipuncture and intravenous cannulation is an important source of pediatric pain and has a lasting impact. Ascending sensory neural pain pathways are functioning in preterm and term infants, yet descending inhibitory pathways seem to mature postnatally. Consequently, infants may experience pain from the same stimulus more intensely than older children. In addition, painful perinatal procedures such as heel lancing or circumcision have been found to correlate with stronger negative responses to venipuncture and intramuscular vaccinations weeks to months later. Similarly, older children have reported greater pain during follow-up cancer-related procedures if the pain of the initial procedure was poorly controlled, despite improved analgesia during the subsequent procedures. Fortunately, both pharmacologic and nonpharmacologic techniques have been found to reduce children's acute pain and distress and subsequent negative behaviors during venipuncture and intravenous catheter insertion. This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.
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Affiliation(s)
- Robert M Kennedy
- Department of Pediatrics, Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
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Zempsky WT, Robbins B, Richards PT, Leong MS, Schechter NL. A novel needle-free powder lidocaine delivery system for rapid local analgesia. J Pediatr 2008; 152:405-11. [PMID: 18280850 DOI: 10.1016/j.jpeds.2007.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 05/11/2007] [Accepted: 07/13/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the analgesic effect and tolerability of a novel needle-free powder lidocaine delivery system in children undergoing venipuncture. STUDY DESIGN In this double-blind, placebo-controlled, single-center trial, 306 children age 3 to 18 years were randomized to receive a needle-free powder lidocaine delivery system or matching sham placebo at the back of the hand 2 to 3 minutes before venipuncture. Venipuncture pain was self-reported using the Wong-Baker FACES scale (in 3- to 12-year-olds) and a 100-mm visual analog scale (in 8- to 18-year-olds). Safety was assessed by adverse events, investigator skin site assessments, and children's self-report of the administration comfort of study treatments. Effect sizes were compared by 2-sample t test and Glass's Delta approach. RESULTS Subjects receiving the needle-free powder lidocaine delivery system exhibited mean pain reductions (effect size) of 33% to 46% relative to sham placebo. Pain reductions were statistically significant for all ages combined and also for the youngest and oldest age strata. Self-reported administration comfort levels were similar in the active system and sham placebo groups. Incidences of adverse events and dermal reactions were low; the most common dermal reaction was mild erythema. CONCLUSIONS The needle-free powder lidocaine delivery system was well tolerated and provided effective local analgesia when administered 2 to 3 minutes before venipuncture.
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Affiliation(s)
- William T Zempsky
- Pain Relief Program, Connecticut Children's Medical Center, Hartford, CT, USA
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Barría RM, Lorca P, Muñoz S. Randomized controlled trial of vascular access in newborns in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs 2007; 36:450-6. [PMID: 17880315 DOI: 10.1111/j.1552-6909.2007.00171.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of two methods of vascular access in newborns. DESIGN Randomized controlled trial. SETTING Neonatal intensive care unit in Regional Hospital of Valdivia, Chile. PARTICIPANTS Seventy-four high-risk newborns. INTERVENTIONS Peripherally inserted central catheter and peripheral intravenous catheter. MAIN OUTCOME MEASURES Length of neonatal intensive care unit stay and incidence of sepsis and phlebitis. RESULTS/DATA ANALYSIS: There were no statistically significant differences in the length of the neonatal intensive care unit stay and in the incidence of sepsis between groups. There was a significant higher incidence of phlebitis in the peripheral intravenous catheter group. CONCLUSIONS Although there was not a significant effect of the kind of catheter on length of neonatal intensive care unit stay, the peripherally inserted central catheter is recommended because of the decreased risk of phlebitis and the decreased number of venipuncture attempts and catheters needed to complete intravenous therapy.
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MESH Headings
- Analysis of Variance
- Birth Weight
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/statistics & numerical data
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/statistics & numerical data
- Catheters, Indwelling/adverse effects
- Catheters, Indwelling/statistics & numerical data
- Chile/epidemiology
- Clinical Nursing Research
- Cross Infection/epidemiology
- Cross Infection/etiology
- Female
- Gestational Age
- Humans
- Incidence
- Infant, Newborn
- Infection Control
- Intensive Care Units, Neonatal/statistics & numerical data
- Intensive Care, Neonatal/methods
- Intensive Care, Neonatal/statistics & numerical data
- Length of Stay/statistics & numerical data
- Male
- Patient Selection
- Phlebitis/epidemiology
- Phlebitis/etiology
- Risk Factors
- Sepsis/epidemiology
- Sepsis/etiology
- Time Factors
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Affiliation(s)
- R Mauricio Barría
- Instituto de Enfermería, Facultad de Medicina at the Universidad Austral de Chile, Valdivia, Chile.
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Senner AM, Johnston K, McLachlan AJ. A Comparison of Peripheral and Centrally Collected Cyclosporine A Blood Levels in Pediatric Patients Undergoing Stem Cell Transplant. Oncol Nurs Forum 2007; 32:73-7. [PMID: 15660145 DOI: 10.1188/05.onf.73-77] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To measure differences in cyclosporine A (CSA) trough concentrations from blood collected as a peripheral sample and from a CSA-uncontaminated (naive) lumen of a double-lumen central line. DESIGN Prospective, comparative study. SETTING Pediatric university teaching hospital in metropolitan Australia. SAMPLE 71 paired central and peripheral CSA blood samples from a convenience sample of 14 pediatric allogeneic stem cell transplant recipients receiving IV CSA as prophylaxis or treatment for graft-versus-host disease. Ages ranged from 2 months to 14 years, 5 months. METHODS Comparing blood samples collected from a peripheral site and a CSA-naive lumen of a double-lumen central line. Data were analyzed using a paired student t test and calculation of the 95% confidence interval of the concentration ratio from different sampling sites. MAIN RESEARCH VARIABLES Site of blood sampling and CSA trough concentrations. FINDINGS No significant difference existed between CSA concentration in samples collected from the different sites in children receiving intermittent infusions of CSA (p = 0.13). The 95% confidence interval of the CSA concentration ratio was 0.92 1.04. CONCLUSIONS When CSA is administered on an intermittent dosing schedule, comparable CSA trough concentrations can be determined from blood collected via the CSA-naive lumen of a double-lumen central line or at a peripheral sampling site. IMPLICATIONS FOR NURSING Pediatric allogeneic stem cell transplant recipients who require regular CSA trough concentrations no longer will require peripheral blood samples when receiving an intermittent dosing schedule.
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Affiliation(s)
- Anne Mary Senner
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, New South Wales, Australia.
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MacLean S, Obispo J, Young KD. The gap between pediatric emergency department procedural pain management treatments available and actual practice. Pediatr Emerg Care 2007; 23:87-93. [PMID: 17351407 DOI: 10.1097/pec.0b013e31803] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To describe the spectrum of procedures performed and the pain management methods used in our pediatric emergency department. METHODS Encounter records were retrospectively reviewed for all patients presenting to our pediatric emergency department, a stand-alone pediatric department with 20,000 patient visits per year, located in an urban, public teaching hospital, between March and June 2004. Data collected included patient demographics, provider type, procedures performed, and pharmacological pain management methods documented used. For intravenous catheter placement, the time lag between order and placement was noted. RESULTS There were 1727 procedures performed in 1210 patients (18% of the total 6545 patients seen). Few to no patients undergoing venipuncture, intravenous catheter placement, fingersticks, intramuscular or subcutaneous injections, urethral catheterization, or nasogastric tube placement received pain management. The median time between order and placement of intravenous catheters was 30 minutes. Nearly all patients undergoing fracture reductions received procedural sedation with ketamine, and most of the lacerations repaired with sutures and nail avulsions received injected local anesthetic. Pain management of abscess incision and drainage and lumbar punctures was more variable. For lumbar punctures, of the patients aged 4 months or younger with a procedure note written, only 29% (7/24) had pain management documented versus 85% (22/26) of those aged 1 year or older (P < 0.0001). CONCLUSIONS Several minor painful procedures are commonly performed in the emergency department without pharmacological pain management. There remains a gap between what we know to be effective, easily implemented pain management strategies, and what is actually practiced. We must work to close this gap.
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Affiliation(s)
- Steven MacLean
- University of Washington School of Medicine, Seattle, WA, USA
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29
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Introduction to Neonatal Facial Pain Detection Using Common and Advanced Face Classification Techniques. ADVANCED COMPUTATIONAL INTELLIGENCE PARADIGMS IN HEALTHCARE – 1 2007. [DOI: 10.1007/978-3-540-47527-9_9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Brahnam S, Chuang CF, Shih FY, Slack MR. Machine recognition and representation of neonatal facial displays of acute pain. Artif Intell Med 2006; 36:211-22. [PMID: 15979291 DOI: 10.1016/j.artmed.2004.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 12/01/2004] [Accepted: 12/06/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE It has been reported in medical literature that health care professionals have difficulty distinguishing a newborn's facial expressions of pain from facial reactions to other stimuli. Although a number of pain instruments have been developed to assist health professionals, studies demonstrate that health professionals are not entirely impartial in their assessment of pain and fail to capitalize on all the information exhibited in a newborn's facial displays. This study tackles these problems by applying three different state-of-the-art face classification techniques to the task of distinguishing a newborn's facial expressions of pain. METHODS The facial expressions of 26 neonates between the ages of 18 h and 3 days old were photographed experiencing the pain of a heel lance and a variety of stressors, including transport from one crib to another (a disturbance that can provoke crying that is not in response to pain), an air stimulus on the nose, and friction on the external lateral surface of the heel. Three face classification techniques, principal component analysis (PCA), linear discriminant analysis (LDA), and support vector machine (SVM), were used to classify the faces. RESULTS In our experiments, the best recognition rates of pain versus nonpain (88.00%), pain versus rest (94.62%), pain versus cry (80.00%), pain versus air puff (83.33%), and pain versus friction (93.00%) were obtained from an SVM with a polynomial kernel of degree 3. The SVM outperformed two commonly used methods in face classification: PCA and LDA, each using the L1 distance metric. CONCLUSION The results of this study indicate that the application of face classification techniques in pain assessment and management is a promising area of investigation.
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Affiliation(s)
- Sheryl Brahnam
- Department of Computer Information Systems, Missouri State University, 3rd Floor Glass Hall, 901 South National, Springfield, MO 65804, USA.
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McCarthy AM, Kleiber C. A conceptual model of factors influencing children's responses to a painful procedure when parents are distraction coaches. J Pediatr Nurs 2006; 21:88-98. [PMID: 16545669 DOI: 10.1016/j.pedn.2005.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this article is to present a model of factors that may influence a child's response to a painful procedure when parents are distraction coaches during the procedure. Nonpharmacological interventions, in particular, distraction, and parents as coaches for their children during procedures are discussed. A conceptual model is presented that illustrates the multiple factors and their possible relationships. A selected review of studies is provided that supports the inclusion of these factors in the model. The model and literature review focus on three major areas: characteristics of the child, characteristics of the parent, and procedural variables. The model presented is currently being tested in a large multisite study on the use of distraction during intravenous line insertion.
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Hasanpour M, Tootoonchi M, Aein F, Yadegarfar G. The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.acpain.2005.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Knue M, Doellman D, Rabin K, Jacobs BR. The efficacy and safety of blood sampling through peripherally inserted central catheter devices in children. JOURNAL OF INFUSION NURSING 2005; 28:30-5. [PMID: 15684902 DOI: 10.1097/00129804-200501000-00004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The peripherally inserted central catheter (PICC) is commonly used in children for medication and fluid administration. In addition, PICCs are used occasionally for blood sampling as an alternative to venipuncture. Blood sampling from these catheters carries the hypothetical risk of catheter occlusion caused by blood remaining in the catheter, and this practice is not supported by PICC manufacturers. Children often undergo multiple needle punctures, which are associated with pain, anxiety, and dissatisfaction with care. The authors hypothesized that blood sampling through 3-Fr PICC devices is effective and safe for children. METHODS After placement of a 3-Fr PICC, all the children were sequentially enrolled in one of two groups. The control group included patients that had 3-Fr PICC devices without blood sampling. The blood sampling group included patients with 3-Fr PICC devices through which blood samples were obtained. Demographic data, PICC placement and sampling data, infusate composition, catheter occlusion, mechanical complications, and blood stream infections were recorded. The primary outcome variable was the difference in occlusion rates between the two groups. RESULTS The analysis included 204 children with 3-Fr PICCs (120 in the blood sampling group and 84 in the control group) who had a mean age, 117.7 +/- 4.9 months. The mean PICC duration was 15.6 +/- 1.0 days. Blood sampling was successful more than 98% of the time from all blood sampling group catheters, with a mean of 4.4 +/- 0.5 samples removed from each catheter. There was a higher occlusion rate in the blood sampling group. However, this result did not reach statistical significance. There were no significant differences between the groups in terms of infection or mechanical complication rates. CONCLUSIONS Blood sampling is feasible and effective through 3-Fr PICC devices in children. This practice is not associated with a significant increase in occlusion, infection, or mechanical complication rates.
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Affiliation(s)
- Marianne Knue
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Gharaibeh M, Abu-Saad H. Cultural validation of pediatric pain assessment tools: Jordanian perspective. J Transcult Nurs 2002; 13:12-8. [PMID: 11776010 DOI: 10.1177/104365960201300103] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to examine the cultural validity, reliability, and preference of three pain assessment tools among 95 Jordanian children. Pain intensity was assessed using the Poker Chip, the Faces, and the Word Description Scales. The test-retest reliability and the convergent validity were supported for the three scales. Jordanian children preferred the Poker Chip Tool to the Faces Scale and the Word Descriptive Scale. Gender differences in relation to scale preference were evident: female children preferred the Poker Chip Tool and male children preferred the Faces Scale; such differences were contributes of the socialization process within the Arab culture. The three scales are valid, reliable, and can be used with confidence to assess pain among Jordanian children. Findings also showed that children have a subculture of their own regardless of their cultural orientation. Findings have implication to nurses in Jordan as well as to transcultural nursing.
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Affiliation(s)
- Muntaha Gharaibeh
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Sigsby LM. Effective learning about the concept of pain from a perioperative clinical rotation. Pain Manag Nurs 2001; 2:19-24. [PMID: 11705157 DOI: 10.1053/jpmn.2001.22037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One of the major concepts that permeates all of nursing practice is the assessment and treatment of pain. Although the concept is simple in statement, its practice has proven to be difficult for seasoned nurses for a variety of reasons. New graduate nurses may have particular difficulty because of their lack of experience with pain. Forty-nine baccalaureate students provided qualitative statements about patients' pain after participating in a 6- to 8-week perioperative clinical rotation. Findings from this study show how the perioperative setting can enhance student nurses' understanding of pain and promote more effective and proactive pain management interventions.
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Affiliation(s)
- L M Sigsby
- College of Nursing, University of Florida, PO Box 100187, HSC, Gainesville, FL 32610-0187, USA.
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Cash M, Schafhauser B, Byers JF. Venipuncture versus central venous access: a comparison of methotrexate levels in pediatric leukemia patients. J Pediatr Oncol Nurs 1999; 16:189-93. [PMID: 10565107 DOI: 10.1177/104345429901600403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients receiving methotrexate (MTX) therapy for treatment of acute lymphocytic leukemia (ALL) consistently have venipuncture MTX levels drawn twice during each hospitalization. The purpose of this study was to compare MTX levels drawn from central venous catheters (CVCs) with those drawn by venipuncture. A convenience sample of 14 pediatric patients was used, with a total of 33 peak levels and 33 trough level sample pairs collected. Venipuncture and CVC levels were compared by using the paired t-test and analyzing the peak and trough data pairs separately. Results confirmed there was no difference in MTX level results (peak, p = .502; trough, p = .114). However, the CVC trough levels would have changed clinical management for 5 of the 33 patients. Therefore, it is recommended that all MTX levels be drawn from the CVC but that trough MTX levels that would alter clinical management be verified by a venipuncture sample. This method will safely minimize the number of venipunctures for children with ALL.
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Affiliation(s)
- M Cash
- Nemours Children's Clinic, Orlando, FL, USA
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Abstract
Guided by the Roy Adaptation Model of Nursing, the relationship of children's age, gender, exposure to past painful experiences, temperament, fears, and child-rearing practices to their pain responses to a venipuncture was examined. A sample of 94 children aged 8 to 12 years and their female caregivers were recruited from three outpatient clinics. During the venipuncture, children's behavioral and heart rate responses were monitored; immediately after, their subjective responses were recorded. Canonical correlation revealed two variates. In the first, age and threshold (temperamental dimension) correlated with pain quality, behavioral responses, and heart rate responses, explaining 12% of the variance. In the second, age, the temperamental dimensions of distractibility and threshold, and medical fears explained only 5.7% of the variance in pain quality and heart rate magnitude. Significant correlations between pain intensity, quality, behavioral responses, and heart rate responses support the multidimensionality of pain.
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Affiliation(s)
- M C Bournaki
- Université de Montréal, Faculté des Sciences Infirmières, Quebec, Canada
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