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Huntsman RJ, Elliott J, Lewis E, Moore-Hepburn C, Alcorn J, Mansell H, Appendino JP, Bélanger RE, Corley S, Crooks B, Denny AM, Finkelstein Y, Finley A, Fung R, Gilpin A, Litalien C, Jacobs J, Oberlander TF, Palm A, Palm J, Polewicz M, Quinn D, Rassekh SR, Repetski A, Rieder MJ, Robson-McKay A, Seifert B, Shackelford A, Siden H, Szafron M, ‘t Jong G, Vaillancourt R, Kelly LE. Removing barriers to accessing medical cannabis for paediatric patients. Paediatr Child Health 2024; 29:12-16. [PMID: 38332979 PMCID: PMC10848115 DOI: 10.1093/pch/pxac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/05/2022] [Indexed: 02/10/2024] Open
Abstract
Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
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Affiliation(s)
- Richard J Huntsman
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jesse Elliott
- Independent Researcher, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Evan Lewis
- Neurology Center of Toronto and Division of Pediatric Neurology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juan P Appendino
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Richard E Bélanger
- Départment de Pédiatrie, Faculté de medicine, Université de Laval, Québec, Québec, Canada
| | - Scott Corley
- Cannabinoid Research Initiative of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bruce Crooks
- Division of Paediatric Hematology/Oncology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - AnneMarie M Denny
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Allen Finley
- Departments of Anesthesia and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Fung
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Andrea Gilpin
- The Rosalind and Morris Goodman Family Pediatrics Formulation Centre of the CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Catherine Litalien
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, and The Rosalind and Morris Goodman Family Pediatric Formulation Centre of the CHU Sainte Justine, Montréal, Québec, Canada
| | - Julia Jacobs
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Timothy F Oberlander
- Department of Pediatrics and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Jacob Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Monika Polewicz
- Division of Pediatric Research, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Declan Quinn
- Division of Pediatric Psychiatry, Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Repetski
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Michael J Rieder
- Division of Pediatric Pharmacology, Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Amy Robson-McKay
- Division of Pediatric Psychiatry, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Blair Seifert
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | | | - Hal Siden
- Division of Palliative Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Geert ‘t Jong
- Departments of Pediatrics and Pharmacology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Régis Vaillancourt
- Department of Pediatric Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- George and Fay Yee Centre for Health Care Innovation and Children’s Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Taylor J, Forgeron P, Vandyk A, Finley A, Lightfoot S. Pediatric Health Outcome Evaluation in Low-and Middle-Income Countries: A Scoping Review of NGO Practice. Glob Pediatr Health 2021; 8:2333794X21991011. [PMID: 33614849 PMCID: PMC7868502 DOI: 10.1177/2333794x21991011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective. The purpose of this study was to explore the research on the delivery and evaluation of pediatric health services by non-governmental organizations in low-and middle-income countries to better understand how they contribute to positive and sustainable health outcomes. Methods. A scoping review was completed using a 2-step study selection procedure. Results. Of the 5742 studies, 17 met criteria, including quantitative and mixed method designs, representing 10 different non-governmental organizations with programs in 33 low-and middle-income countries. Health outcomes were reported 89 times across the studies. A total of 56 different outcomes were identified in total, of which 24 were positive, 27 were negative, and 5 were unchanged. Conclusions. Widespread variation between non-governmental organizations exist, however, comprehensive pediatric health outcome evaluation is growing. Further emphasis should be given to adolescent specific research and robust measurement of quality of life.
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Affiliation(s)
| | | | | | - Allen Finley
- Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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Beyde A, Thomas A, Sandefur B, Colbenson K, Mullan A, Finley A, Kisirwan I, Campbell R. 342 Efficacy of Empiric Antibiotic Management of Septic Prepatellar Bursitis Without Bursal Aspiration. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Finley A, Wild L, Atkinson E. SEVERE ANAPHYLACTIC REACTION TO ALLERGEN IMMUNOTHERAPY WHILE ON A BETA-BLOCKER AND SUCCESSFUL RESUMPTION OF IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Haider A, Scott JW, Gause CD, Meheš M, Hsiung G, Prelvukaj A, Yanocha D, Baumann LM, Ahmed F, Ahmed N, Anderson S, Angate H, Arfaa L, Asbun H, Ashengo T, Asuman K, Ayala R, Bickler S, Billingsley S, Bird P, Botman M, Butler M, Buyske J, Capozzi A, Casey K, Clayton C, Cobey J, Cotton M, Deckelbaum D, Derbew M, deVries C, Dillner J, Downham M, Draisin N, Echinard D, Elneil S, ElSayed A, Estelle A, Finley A, Frenkel E, Frykman PK, Gheorghe F, Gore-Booth J, Henker R, Henry J, Henry O, Hoemeke L, Hoffman D, Ibanga I, Jackson EV, Jani P, Johnson W, Jones A, Kassem Z, Kisembo A, Kocan A, Krishnaswami S, Lane R, Latif A, Levy B, Linos D, Linz P, Listwa LA, Magee D, Makasa E, Marin ML, Martin C, McQueen K, Morgan J, Moser R, Neighbor R, Novick WM, Ogendo S, Omigbodun A, Onajin-Obembe B, Parsan N, Philip BK, Price R, Rasheed S, Ratel M, Reynolds C, Roser SM, Rowles J, Samad L, Sampson J, Sanghvi H, Sellers ML, Sigalet D, Steffes BC, Stieber E, Swaroop M, Tarpley J, Varghese A, Varughese J, Wagner R, Warf B, Wetzig N, Williamson S, Wood J, Zeidan A, Zirkle L, Allen B, Abdullah F. Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance). World J Surg 2018; 41:2426-2434. [PMID: 28508237 PMCID: PMC5596034 DOI: 10.1007/s00268-017-4028-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.
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Affiliation(s)
- Adil Haider
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - John W Scott
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Colin D Gause
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Mira Meheš
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Grace Hsiung
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Albulena Prelvukaj
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Dana Yanocha
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Lauren M Baumann
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | | | | | | | - Herve Angate
- The Pan African Association of Surgeons, Parktown, Johannesburg, South Africa
| | - Lisa Arfaa
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Horacio Asbun
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
- Society of American Gastrointestinal and Endoscopic Surgeons, Los Angeles, CA, USA
| | - Tigistu Ashengo
- St. Paul Medical College, Addis Ababa, Ethiopia
- Jhpiego, An Affiliate of Johns Hopkins University Baltimore, Baltimore, MD, USA
| | - Kisembo Asuman
- African Agency for Integrated Development, Kampala, Uganda
| | | | - Stephen Bickler
- Alliance for Surgery and Anaesthesia Presence, Lupsingen, Switzerland
| | | | - Peter Bird
- AIC Kijabe Hospital, Kijabe County, Kenya
| | - Matthijs Botman
- Netherlands Society for International Surgery, Amsterdam, The Netherlands
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA, USA
| | | | - Kathleen Casey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | - James Cobey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Michael Cotton
- International Collaboration for Essential Surgery, Angwin, CA, USA
| | - Dan Deckelbaum
- Centre for Global Surgery, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | - Miliard Derbew
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Catherine deVries
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | | | - Max Downham
- International College of Surgeons, Chicago, IL, USA
| | | | | | | | | | | | | | | | - Philip K Frykman
- Global Pediatric Surgical Technology and Education Project, Irvine, CA, USA
| | | | | | - Richard Henker
- American Association of Nurse Anesthetists, Park Ridge, IL, USA
| | - Jaymie Henry
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | | | | | - Iko Ibanga
- Pro-Health International, Edwardsville, IL, USA
| | | | - Pankaj Jani
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Walter Johnson
- WHO Global Initiative for Emergency and Essential Surgical Care, Geneva, Switzerland
| | | | | | - Asuman Kisembo
- African Agency for Integrated Development, Kampala, Uganda
| | - Abbey Kocan
- Kupona Foundation, Saratoga Springs, NY, USA
| | - Sanjay Krishnaswami
- World Journal of Surgery, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - Robert Lane
- International Federation of Surgical Colleges, Bogis-Bossey, Switzerland
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Barbara Levy
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Dimitrios Linos
- Institute of Preventive Medicine, Environmental and Occupational Health - Prolepsis, Attica, Greece
- National and Kapodistrian University, Athens Medical School, Athens, Greece
| | | | | | - Declan Magee
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Emmanuel Makasa
- Permanent Mission of the Republic of Zambia to the United Nations, Geneva, Switzerland
| | | | | | - Kelly McQueen
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - William M Novick
- University of Tennessee Health Science Center, Memphis, TN, USA
- William Novick Global Cardiac Alliance, Memphis, TN, USA
| | - Stephen Ogendo
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | | | | | - Neil Parsan
- Organization of American States, Washington, DC, USA
| | | | - Raymond Price
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | - Shahnawaz Rasheed
- The Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Steven M Roser
- International Association of Oral and Maxillofacial Surgeons, Chicago, IL, USA
| | - Jackie Rowles
- International Federation of Nurse Anesthetists, Sursee, Switzerland
| | | | - John Sampson
- Global Surgery Initiative, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - David Sigalet
- World Federation of Associations of Pediatric Surgeons, Geneva, Switzerland
| | | | | | - Mamta Swaroop
- Association for Academic Surgery, Los Angeles, CA, USA
| | - John Tarpley
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | | | - Anne Zeidan
- 2nd Chance Association Reconstructive Surgery for Life Reconstruction, Meyrin, Switzerland
| | | | - Brendan Allen
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA.
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA.
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7
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Haider A, Scott JW, Gause CD, Meheš M, Hsiung G, Prelvukaj A, Yanocha D, Baumann LM, Ahmed F, Ahmed N, Anderson S, Angate H, Arfaa L, Asbun H, Ashengo T, Asuman K, Ayala R, Bickler S, Billingsley S, Bird P, Botman M, Butler M, Buyske J, Capozzi A, Casey K, Clayton C, Cobey J, Cotton M, Deckelbaum D, Derbew M, deVries C, Dillner J, Downham M, Draisin N, Echinard D, Elneil S, ElSayed A, Estelle A, Finley A, Frenkel E, Frykman PK, Gheorghe F, Gore-Booth J, Henker R, Henry J, Henry O, Hoemeke L, Hoffman D, Ibanga I, Jackson EV, Jani P, Johnson W, Jones A, Kassem Z, Kisembo A, Kocan A, Krishnaswami S, Lane R, Latif A, Levy B, Linos D, Linz P, Listwa LA, Magee D, Makasa E, Marin ML, Martin C, McQueen K, Morgan J, Moser R, Neighbor R, Novick WM, Ogendo S, Omigbodun A, Onajin-Obembe B, Parsan N, Philip BK, Price R, Rasheed S, Ratel M, Reynolds C, Roser SM, Rowles J, Samad L, Sampson J, Sanghvi H, Sellers ML, Sigalet D, Steffes BC, Stieber E, Swaroop M, Tarpley J, Varghese A, Varughese J, Wagner R, Warf B, Wetzig N, Williamson S, Wood J, Zeidan A, Zirkle L, Allen B, Abdullah F. Erratum to: Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance). World J Surg 2017. [PMID: 28642965 DOI: 10.1007/s00268-017-4067-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adil Haider
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - John W Scott
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Colin D Gause
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Mira Meheš
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Grace Hsiung
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Albulena Prelvukaj
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Dana Yanocha
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Lauren M Baumann
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | | | | | | | - Herve Angate
- The Pan African Association of Surgeons, Parktown, Johannesburg, South Africa
| | - Lisa Arfaa
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Horacio Asbun
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.,Society of American Gastrointestinal and Endoscopic Surgeons, Los Angeles, CA, USA
| | - Tigistu Ashengo
- St. Paul Medical College, Addis Ababa, Ethiopia.,Jhpiego, An Affiliate of Johns Hopkins University Baltimore, Baltimore, MD, USA
| | - Kisembo Asuman
- African Agency for Integrated Development, Kampala, Uganda
| | | | - Stephen Bickler
- Alliance for Surgery and Anaesthesia Presence, Lupsingen, Switzerland
| | | | - Peter Bird
- AIC Kijabe Hospital, Kijabe County, Kenya
| | - Matthijs Botman
- Netherlands Society for International Surgery, Amsterdam, The Netherlands
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA, USA
| | | | - Kathleen Casey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | - James Cobey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA.,Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Michael Cotton
- International Collaboration for Essential Surgery, Angwin, CA, USA
| | - Dan Deckelbaum
- Centre for Global Surgery, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Miliard Derbew
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Catherine deVries
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | | | - Max Downham
- International College of Surgeons, Chicago, IL, USA
| | | | | | | | | | | | | | | | - Philip K Frykman
- Global Pediatric Surgical Technology and Education Project, Irvine, CA, USA
| | | | | | - Richard Henker
- American Association of Nurse Anesthetists, Park Ridge, IL, USA
| | - Jaymie Henry
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | | | | | - Iko Ibanga
- Pro-Health International, Edwardsville, IL, USA
| | | | - Pankaj Jani
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Walter Johnson
- WHO Global Initiative for Emergency and Essential Surgical Care, Geneva, Switzerland
| | | | | | - Asuman Kisembo
- African Agency for Integrated Development, Kampala, Uganda
| | - Abbey Kocan
- Kupona Foundation, Saratoga Springs, NY, USA
| | - Sanjay Krishnaswami
- World Journal of Surgery, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Robert Lane
- International Federation of Surgical Colleges, Bogis-Bossey, Switzerland
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Barbara Levy
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Dimitrios Linos
- Institute of Preventive Medicine, Environmental and Occupational Health - Prolepsis, Attica, Greece.,National and Kapodistrian University, Athens Medical School, Athens, Greece
| | | | | | - Declan Magee
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Emmanuel Makasa
- Permanent Mission of the Republic of Zambia to the United Nations, Geneva, Switzerland
| | | | | | - Kelly McQueen
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - William M Novick
- University of Tennessee Health Science Center, Memphis, TN, USA.,William Novick Global Cardiac Alliance, Memphis, TN, USA
| | - Stephen Ogendo
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | | | | | - Neil Parsan
- Organization of American States, Washington, DC, USA
| | | | - Raymond Price
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | - Shahnawaz Rasheed
- The Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Steven M Roser
- International Association of Oral and Maxillofacial Surgeons, Chicago, IL, USA
| | - Jackie Rowles
- International Federation of Nurse Anesthetists, Sursee, Switzerland
| | | | - John Sampson
- Global Surgery Initiative, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - David Sigalet
- World Federation of Associations of Pediatric Surgeons, Geneva, Switzerland
| | | | | | - Mamta Swaroop
- Association for Academic Surgery, Los Angeles, CA, USA
| | - John Tarpley
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | | | - Anne Zeidan
- 2nd Chance Association Reconstructive Surgery for Life Reconstruction, Meyrin, Switzerland
| | | | - Brendan Allen
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA. .,The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA.
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8
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Latimer M, Rudderham S, Harman K, Finley A, Dutcher L, Hutt-Macleod D, Paul K. Using Art as a Medium for First Nations Youth to Express Their Pain: A Two-Eyed Seeing Qualitative Study. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e94a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: First Nations (FN) youth in Canada have the highest rates of pain-related conditions (ear, dental, headaches) yet may be least likely to be treated for them. Untreated pain has an arresting impact on growth and development and is detrimental to the achievement of life goals. In recent research conducted by the Aboriginal Children’s Hurt & Healing Initiative (ACHH), community participants reported that First Nation children are stoic and are reluctant to talk about their pain (Latimer & Rudderham, 2013). Clinicians are trained to assess pain based on overt signs of expression (cry, facial grimace, ability to describe) however if you do not present your pain this way it may reduce the chance of proper assessment and treatment.
OBJECTIVES: Using a Two-Eyed Seeing qualitative perspective (best of Indigenous and Western knowledge) the purpose of this research was to provide FN youth with the method of art making to determine how they express their pain.
DESIGN/METHODS: Youth from four FN communities, in three Maritime Provinces were invited to participate in art workshops facilitated by internationally renowned Mi’kmaq artist Alan Syliboy. The workshop began with a conversation circle about pain experiences and then proceeded to the art making. A FN documentary cinematographer captured the workshops and the results are documented in art and film. Three team members independently themed the data using thematic analysis and the inter-rater reliability was >85%.
RESULTS: 39 youth aged 10-18 years participated in 4 community-based conversation and art sessions. The themes for the sessions were themed using the four dimensions of the Medicine Wheel. While the overwhelming theme discussed in the conversation sessions was physical pain, when provided the nonverbal, art mode of expression, the youth painted emotional pain more frequently than physical, spiritual and mental pain. There was overlap between the four themes but 70% of the artwork prominently illustrated emotional pain with 54% overlapping with physical, 30% mental and 31% spiritual.
CONCLUSION: These results present a more complicated issue regarding the integration of the different types of pain, intertwined together. The finding that when asked-youth primarily discussed physical pain but given the opportunity, more frequently painted emotional pain may shed new light on the degree to which emotional pain is a factor for these youth. The artwork and accompanying narratives are powerful and have implications for understanding the complexity of assessing the different dimensions of pain in a culturally meaningful manner and for clinician education purposes. A sample of the artwork is attached.
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Stewart S, Abidi SSR, Finley A. Pediatric pain management knowledge linkages: mapping experiential knowledge to explicit knowledge. Stud Health Technol Inform 2010; 160:1184-1188. [PMID: 20841871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The goal of this project is to augment clinician communication by connecting it to evidence-based research, providing explicit knowledge to corroborate the experiential knowledge shared between health care practitioners. The source of tacit knowledge sharing is the Pediatric Pain Mailing List (PPML), a forum for practicing clinicians to contact peers on the subject of pain in children. The messages, dating back to 1993, are processed for pertinent information and gathered together into threads. They are then parsed and connected to a set of MeSH keywords, which is used to search Pubmed and return a set of papers that correspond to the subject being discussed. The results are presented in an online forum, providing clinicians with an arena in which they can browse the archives of the PPML and connect those conversations to pertinent medical literature.
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Affiliation(s)
- Sam Stewart
- Faculty of Computer Science, Dalhousie University, Halifax, Canada.
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Gibbins S, Stevens B, McGrath PJ, Yamada J, Beyene J, Breau L, Camfield C, Finley A, Franck L, Johnston C, Howlett A, McKeever P, O'Brien K, Ohlsson A. Comparison of pain responses in infants of different gestational ages. Neonatology 2008; 93:10-8. [PMID: 17630493 DOI: 10.1159/000105520] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 04/02/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a plethora of infant pain measures; however, none of them have been validated for extremely low for gestational age (ELGA) infants (<27 weeks' gestation). To date, clinicians, researchers and parents use information gleaned from more mature infants to make inferences about pain in ELGA infants. Using physiological or behavioral pain indicators derived from more mature infants may lead to inaccurate assessments and management. OBJECTIVES To compare physiological (heart rate, oxygen saturation) and behavioral (9 facial activities, cry) pain indicators of ELGA infants with infants of varying more mature gestational ages (GAs). METHODS The aim was to determine the effects of GA on pain response. GA was categorized into four mutually exclusive strata: <27 6/7 weeks, 28-31 6/7 weeks, 32-35 6/7 weeks and >36 weeks. Physiological data during four phases of a routine heel lance were collected by placing disposable ECG electrodes and pulse oximetry probes on the infant's chest. Behavioral data were collected by videotaping facial activities, and cry data were collected by audio recording. RESULTS Four facial activities (brow bulge, eye squeeze, nasolabial furrow, vertical mouth stretch) in response to acute pain were present in ELGA infants. Facial activities increased following painful procedures and the magnitude of responses was proportional to GA with the youngest infants (<27 6/7 weeks GA) showing the least amount of change. Decreased oxygen saturation and increased heart rate were associated with the most invasive phase of the heel lance; however, the differences were neither clinically or statistically significant across age groups. Cry was not a sensitive pain indicator in ELGA infants, due to the presence of endotracheal tubes in this high-risk population. DISCUSSION ELGA infants have similar pain responses to older infants, but the responses are dampened. Other factors such as severity of illness, frequency of painful procedures or medication use should be examined, as they may influence the pain responses in ELGA infants.
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Affiliation(s)
- Sharyn Gibbins
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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11
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Hamdy RC, Montpetit K, Ruck-Gibis J, Thorstad K, Raney E, Aiona M, Platt R, Finley A, Mackenzie W, McCarthy J, Narayanan U. Safety and efficacy of botox injection in alleviating post-operative pain and improving quality of life in lower extremity limb lengthening and deformity correction. Trials 2007; 8:27. [PMID: 17903262 PMCID: PMC2151066 DOI: 10.1186/1745-6215-8-27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 09/28/2007] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Distraction osteogenesis is the standard treatment for the management of lower limb length discrepancy of more than 3 cm and bone loss secondary to congenital anomalies, trauma or infection. This technique consists of an osteotomy of the bone to be lengthened, application of an external fixator, followed by gradual and controlled distraction of the bone ends. Although limb lengthening using the Ilizarov distraction osteogenesis principle yields excellent results in most cases, the technique has numerous problems and is not well tolerated by many children. The objective of the current study is to determine if Botulinum Toxin A (BTX-A), which is known to possess both analgesic and paralytic actions, can be used to alleviate post-operative pain and improve the functional outcome of children undergoing distraction osteogenesis. METHODS/DESIGN The study design consists of a multi centre, randomized, double-blinded, placebo-controlled trial. Patients between ages 5-21 years requiring limb lengthening or deformity correction using distraction will be recruited from 6 different sites (Shriners Hospital for Children in Montreal, Honolulu, Philadelphia and Portland as well as DuPont Hospital for Children in Wilmington, Delaware and Hospital for Sick Children in Toronto, Ont). Approximately 150 subjects will be recruited over 2 years and will be randomized to either receive 10 units per Kg of BTX-A or normal saline (control group) intraoperatively following the surgery. Functional outcome effects will be assessed using pain scores, medication dosages, range of motion, flexibility, strength, mobility function and quality of life of the patient. IRB approval was obtained from all sites and adverse reactions will be monitored vigorously and reported to IRB, FDA and Health Canada. DISCUSSION BTX-A injection has been widely used world wide with no major side effects reported. However, to the best of our knowledge, this is the first time BTX-A is being used under the context of limb lengthening and deformity correction. TRIAL REGISTRATION NCT00412035.
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Affiliation(s)
- Reggie C Hamdy
- Orthopaedics. Shriners Hospital for Children, 1529 Cedar Avenue, Montreal H3G 1A6, Canada
| | - Kathleen Montpetit
- Occupational Therapy, Shriners Hospital for Children, 1529 Cedar Avenue, Montreal H3G 1A6, Canada
| | - Joanne Ruck-Gibis
- Physical Therapy, Shriners Hospital for Children, 1529 Cedar Avenue, Montreal H3G 1A6, Canada
| | - Kelly Thorstad
- Nursing Unit, Shriners Hospital for Children, 1529 Cedar Avenue, Montreal H3G 1A6, Canada
| | - Ellen Raney
- Orthopaedics. 1310 Punahou Street. Honolulu, Hawaii 96826-1099, USA
| | - Michael Aiona
- Orthopaedics. Shriners Hosptial for children. 3101 S.W. Sam Jackson Park Rd, Portland, Oregon 97239-3095, USA
| | - Robert Platt
- Biostatistics, Research Institute of Montreal Childrens Hospital, 2300 Tupper St., Montreal QC H3H 1P3, Canada
| | - Allen Finley
- Pediatric Pain Management Service, Isaac Walton Killam Health Center, 5850 University Avenue Halifax NS, Canada
| | - William Mackenzie
- Orthopaedics. Alfred I. duPont Hospital for Children 1600 Rockland Road, Wilmington, DE 19803-3607, USA
| | - James McCarthy
- Orthopaedics. Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA
| | - Unni Narayanan
- Orthopaedics. Hospital for Sick Children. 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, Johnston C, McKeever P, O'Brien K, Ohlsson A, Yamada J. Determining behavioural and physiological responses to pain in infants at risk for neurological impairment. Pain 2006; 127:94-102. [PMID: 16997468 DOI: 10.1016/j.pain.2006.08.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 07/13/2006] [Accepted: 08/03/2006] [Indexed: 01/10/2023]
Abstract
Multiple researchers have validated indicators and measures of infant pain. However, infants at risk for neurologic impairment (NI) have been under studied. Therefore, whether their pain responses are similar to those of other infants is unknown. Pain responses to heel lance from 149 neonates (GA>25-40 weeks) from 3 Canadian Neonatal Intensive Care units at high (Cohort A, n=54), moderate (Cohort B, n=45) and low (Cohort C, n=50) risk for NI were compared in a prospective observational cohort study. A significant Cohort by Phase interaction for total facial action (F(6,409)=3.50, p=0.0022) and 4 individual facial actions existed; with Cohort C demonstrating the most facial action. A significant Phase effect existed for increased maximum Heart Rate (F(3,431)=58.1, p=0.001), minimum Heart Rate (F(3,431)=78.7, p=0.001), maximum Oxygen saturation (F(3,425)=47.6, p=0.001), and minimum oxygen saturation (F(3,425)=12.2, p=0.001) with no Cohort differences. Cohort B had significantly higher minimum (F(2,79)=3.71, p=0.029), and mean (F(2,79)=4.04, p=0.021) fundamental cry frequencies. A significant Phase effect for low/high frequency Heart Rate Variability (HRV) ratio (F(2,216)=4.97, p=0.008) was found with the greatest decrease in Cohort A. Significant Cohort by Phase interactions existed for low and high frequency HRV. All infants responded to the most painful phase of the heel lance; however, infants at moderate and highest risk for NI exhibited decreased responses in some indicators.
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Affiliation(s)
- Bonnie Stevens
- Faculty of Nursing, University of Toronto, Toronto, Ont., Canada.
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Stevens B, McGrath P, Yamada J, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, Johnston C, McKeever P, O'Brien K, Ohlsson A. Identification of pain indicators for infants at risk for neurological impairment: a Delphi consensus study. BMC Pediatr 2006; 6:1. [PMID: 16457711 PMCID: PMC1413531 DOI: 10.1186/1471-2431-6-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 02/02/2006] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI. METHODS A 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI. RESULTS The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squeeze, and inconsolability. Increased heart rate from baseline in the moderate and severe groups demonstrated high concordance. In the severe risk group, fluctuations in heart rate and reduced oxygen saturation were also highly rated. CONCLUSION These data constitute the first step in contributing to the development and validation of a pain measure for infants at risk for NI. In future research, we will integrate these findings with the opinions of (a) health care providers about the importance and usefulness of infant pain indicators and (b) the pain responses of infants at mild, moderate and high risk for NI.
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Affiliation(s)
- Bonnie Stevens
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Patrick McGrath
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Yamada
- Research Institute, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Sharyn Gibbins
- Interdisciplinary Practice Reseach and Evidence Based Practice, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Joseph Beyene
- Statistics in Medicine Unit-Research Institute, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Lynn Breau
- Pediatric Pain Service, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Carol Camfield
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Allen Finley
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatric Pain Service, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Anesthesiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Franck
- Centre for Nursing and Allied Health Professions Research, Great Ormond Street Hospital for Children, London, UK
| | - Alexandra Howlett
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Karel O'Brien
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Arne Ohlsson
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
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14
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Finkel JC, Finley A, Greco C, Weisman SJ, Zeltzer L. Transdermal fentanyl in the management of children with chronic severe pain: results from an international study. Cancer 2006; 104:2847-57. [PMID: 16284992 DOI: 10.1002/cncr.21497] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current study was conducted to assess the safety and tolerability of a transdermal fentanyl delivery system for the relief of chronic pain in a pediatric population, and also to validate titration recommendations and conversion to transdermal fentanyl from oral opioid therapy. METHODS This 15-day (with 3-month extension), single-arm, open-label trial was conducted at 66 sites in 10 countries. A total of 199 pediatric patients (ages 2-16 years) with both malignant and nonmalignant conditions who were receiving oral or parenteral opioids for moderate to severe chronic pain were enrolled. Transdermal fentanyl doses were titrated upward according to the rescue medication consumed during the previous application period. Degree of pain was assessed by patients and parents/guardians using visual and numeric scales. Level of play and quality of life were assessed using the Play Performance Scale (PPS) and the Child Health Questionnaire (CHQ). Adverse events were monitored on Days 1-15. Hypoventilation and sedation were monitored every 4 hours during the first 72 hours of the study. RESULTS A total of 173 patients completed the primary treatment period and 130 entered the extension phase. The average daily pain intensity scores were reported to have decreased by Day 16 and improvements in the mean PPS scores were observed to the end of the extension period. The CHQ scores demonstrated improvements in 11 of 12 domains after Month 1 of the extension period. CONCLUSIONS Transdermal fentanyl was found to be a safe and well tolerated alternative to oral opioid treatment for children ages 2-16 years who were previously exposed to opioid therapy.
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Affiliation(s)
- Julia C Finkel
- Department of Anesthesiology, George Washington University, Washington, DC, USA.
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15
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Abidi SSR, Finley A, Milios E, Shepherd M, Zitner D. Knowledge management in pediatric pain: mapping on-line expert discussions to medical literature. Stud Health Technol Inform 2004; 107:3-7. [PMID: 15360763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Clinical decision-making can be vastly improved with the availability of the right medical knowledge at the right time. This concept paper presents a knowledge management re-search program to (a) identify, capture and organize the tacit knowledge inherent within on-line problem-solving discussions between pediatric pain practitioners; (b) establish linkages between topic-specific pediatric pain discussions and corresponding published medical literature on children's pain available at PubMed--i.e. linking tacit expert knowledge to explicit medical literature; and (c) make these knowledge re-sources available to pediatric pain practitioners via the WWW for timely access to various modalities of clinical knowledge.
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Affiliation(s)
- Syed Sibte Raza Abidi
- Health Infomatics Lab, Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia B3H 1W5, Canada.
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16
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Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, McKeever P, O'Brien K, Ohlsson A, Yamada J. Procedural pain in newborns at risk for neurologic impairment. Pain 2003; 105:27-35. [PMID: 14499417 DOI: 10.1016/s0304-3959(03)00136-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the past decade, our knowledge of pain in newborn infants has advanced considerably. However, infants at significant risk for neurologic impairment (NI) have been systematically excluded from almost all research on pain in neonates. The objectives of this study were to compare: (a). the nature, frequency and prevalence of painful procedures, (b). analgesics and sedatives administered, and (c). the relationship between painful procedures and analgesia for neonates at risk for NI. One hundred and ninety-four infants at high (cohort A, n=67), moderate (cohort B, n=59) and low (cohort C, n=68) risk for NI from two tertiary level Neonatal Intensive Care Unit's in Canada were included in a retrospective cohort study on the first 7 days of life. Data were collected from medical records and analyzed using chi-square, ANOVA and regression approaches. All cohorts had a mean of >10 painful procedures per day during the first 2 days of life. There was an interaction effect between cohort group and day of life (F(5,188)=2.13, P<0.06) with cohort A having significantly more painful procedures on day 1 (F(2,191)=4.79, P<0.009). There was no statistical difference in the number of infants who received continuous infusion (F(2,20)=1.9, P=0.13) or bolus (F(2,20)=1.3, P=0.25) opioids or sedatives (F(2,20)=0.45, P=0.84) by cohort over the 7 day period. There was a statistical difference in bolus opioid administration for days 1 (P<0.05) and 2 (P<0.001) with less than 10% of infants in cohort A receiving bolus opioids compared with approximately 22-33% of infants in cohorts B and C. There was a statistically significant correlation between painful procedures and analgesic use (r=0.29, P<0.001), although significant associations existed for cohorts B and C only. The number of painful procedures and study site primarily accounted for the variance (61% in cohort B and 35% in cohort C) in analgesic use, while in cohort A, only study site contributed to the variance (16%). Neonates at the highest risk for NI had the greatest number of painful procedures and the least amount of opioids administered during the first day of life. There was no relationship between painful procedures and analgesic use in this group. As these infants are vulnerable to pain and its consequences, the rational underlying health professional strategies regarding painful procedures and analgesic use for procedural pain in this population urgently awaits exploration.
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Affiliation(s)
- Bonnie Stevens
- Faculties of Nursing and Medicine, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Room 4734c, Toronto, Ontario, Canada M5G 1X8.
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17
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Whittingstall K, Stroink G, Gates L, Connolly JF, Finley A. Effects of dipole position, orientation and noise on the accuracy of EEG source localization. Biomed Eng Online 2003; 2:14. [PMID: 12807534 PMCID: PMC166138 DOI: 10.1186/1475-925x-2-14] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2003] [Accepted: 06/06/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The electroencephalogram (EEG) reflects the electrical activity in the brain on the surface of scalp. A major challenge in this field is the localization of sources in the brain responsible for eliciting the EEG signal measured at the scalp. In order to estimate the location of these sources, one must correctly model the sources, i.e., dipoles, as well as the volume conductor in which the resulting currents flow. In this study, we investigate the effects of dipole depth and orientation on source localization with varying sets of simulated random noise in 4 realistic head models. METHODS Dipole simulations were performed using realistic head models and using the boundary element method (BEM). In all, 92 dipole locations placed in temporal and parietal regions of the head with varying depth and orientation were investigated along with 6 different levels of simulated random noise. Localization errors due to dipole depth, orientation and noise were investigated. RESULTS The results indicate that there are no significant differences in localization error due tangential and radial dipoles. With high levels of simulated Gaussian noise, localization errors are depth-dependent. For low levels of added noise, errors are similar for both deep and superficial sources. CONCLUSION It was found that if the signal-to-noise ratio is above a certain threshold, localization errors in realistic head models are, on average the same for deep and superficial sources. As the noise increases, localization errors increase, particularly for deep sources.
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Affiliation(s)
| | - Gerhard Stroink
- Department of Physics, Dalhousie University, Halifax NS, Canada
| | - Larry Gates
- Department of Radiation Oncology, QEII Health Centre, Halifax, Canada
| | - JF Connolly
- Department of Psychology, Dalhousie University, Canada
| | - Allen Finley
- Department of Anaesthesia, Dalhousie University, Halifax, Canada
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Abstract
PURPOSE Our goal was to develop a rapid, simple, near-real-time method of functional MRI (fMRI) to measure brain activation in response to olfactory stimuli, to use it to identify patients with smell loss (hyposmia), and to differentiate their types of hyposmia. METHOD fMRI was obtained in 16 patients with Type I hyposmia (who could detect but not recognize odors), 5 patients with Type II hyposmia (who could both detect and recognize odors, albeit with less than normal acuity), and 2 volunteers with normal olfactory acuity by use of a rapid echo planar imaging technique in which one coronal brain section from the anterior cortical region was studied and a single olfactory stimulus was used. Actual scanning time performed by a variation of methods previously published required 26 s. Three patients with Type I hyposmia were treated with theophylline 250-500 mg for 4-6 months and were studied before and after treatment. RESULTS Brain activation in response to olfactory stimuli was demonstrated using a new, rapid, and simple fMRI technique. Patients with Type I hyposmia had less activation than patients with Type II hyposmia. Both patient groups had less activation than normal volunteers. Activation in patients with Type I hyposmia was essentially absent from regions of the middle frontal, orbitofrontal, and temporal cortex and was totally absent in regions of inferior frontal, insular, and cingulate cortex. Activation in patients with Type II hyposmia was greatest in the middle frontal cortex and the orbitofrontal cortex bilaterally and was present in regions of inferior frontal, temporal, and cingulate cortex. Each patient with Type I hyposmia treated with theophylline had improved smell function to Type II hyposmia and after treatment demonstrated activation in inferior frontal and cingulate cortex bilaterally, whereas before treatment, no activation in these regions was apparent. CONCLUSION We describe a simple, rapid technique that can be used in a practical clinical setting to identify patients with hyposmia and to differentiate patients with different types of olfactory loss. These studies confirm the presence and classification of patients with Type I and Type II hyposmia. Results of this study suggest that regions of the frontal cortex may act to guide or direct olfactory signals to other brain areas such as temporal and cingulate regions. Although these latter regions are involved with olfactory recognition, their role in olfactory memory, olfactory meaning, and attention needs to be considered.
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Affiliation(s)
- L M Levy
- Georgetown University Medical Center, Washington, DC, USA
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Abstract
PURPOSE Our goal was to use functional MRI (fMRI) to measure brain activation in response to imagination of tastes in humans. METHOD fMR brain scans were obtained in 31 subjects (12 men, 19 women) using multislice FLASH MRI and echo planar imaging (EPI) in response to imagination of tastes of salt and sweet in coronal sections selected from anterior to posterior temporal brain regions. Activation images were derived using correlation analysis, and ratios of areas of brain activated to total brain areas were calculated. Total activated pixel counts were used to quantitate regional brain activation. RESULTS Activation was present in each section in all subjects after imagination of each tastant. Activation was similar in response to imagination of either salt or sweet and was quantitatively similar to that previously reported in response to imagination of odors of banana and peppermint. Activation was similar in both men and women as opposed to previous results of odor memory in which activation in men was greater than in women. However, subjective responses of intensity of imagined tastes were significantly greater than those previously obtained for odor memory and were consistently, albeit not significantly, greater in women than in men, similar to results previously reported for odor memory. Brain regions activated in response to taste imagination were consistent with regions previously described as involved with actual taste perception in both humans and animals. Regional brain localization for salt and sweet memories could not be differentiated. CONCLUSION These studies indicate that (a) tastes can be imagined, (b) brain regions activated for taste imagination are consistent with regions previously described for actual taste perception, and (c) similar to odor memory for banana and menthone, regional brain localization for salt or sweet taste memories could not be differentiated.
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Affiliation(s)
- L M Levy
- Department of Radiology, Georgetown University Medical Center, Washington, DC, USA
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20
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Silbart LK, McAleer F, Rasmussen MV, Goslinoski L, Keren DF, Finley A, Van Kruiningen HJ, Winchell JM. Selective induction of mucosal immune responses to 2-acetylaminofluorene. Anticancer Res 1996; 16:651-60. [PMID: 8687111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Mucosal vaccination with chemical carcinogens coupled to enterotoxins such as cholera toxin (CT) can elicit carcinogen-specific immunoglobulin secretion into the intestinal lumen. The present study examines the ability of several related bacterial enterotoxins and their subunits to act as adjuvants or carrier proteins in stimulating an intestinal secretory IgA (S-IgA) response to 2-acetylaminofluorene (AAF). Using Thiry-Vella loops in rabbits, CT, cholera toxin B subunit (CTB) and the recombinant B subunit of the heat labile enterotoxin from E. coli (rLTB) were all found to be effective carrier proteins and adjuvants for eliciting S-IgA anti-AAF. However, marked differences in the ratio of mucosal S-IgA to serum IgG production were observed. CT elicited the highest luminal S-IgA anti-AAF titers as well as the highest ratio of intestinal S-IgA/serum IgG when used as an adjuvant. Conversely, rLTB elicited a high serum IgG anti-AAF titer but only a modest intestinal S-IgA response. Dialysis studies using monoclonal IgA versus IgG anti-AAF on opposing sides of a semipermeable membrane demonstrated the potential importance of the intestinal S-IgA/serum IgG ratio. A high "intestinal" IgA/"serum" IgG ratio abolished carcinogen transfer to the "serum" side of the membrane, while a low ratio enhanced transfer. Thus, to generate an active mucosal immune response capable of blocking carcinogen absorption, the carrier protein or adjuvant should be selected to optimize the intestinal S-IgA/serum IgG ratio.
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Affiliation(s)
- L K Silbart
- University of Connecticut, Center for Environmental Health, Storrs 06269, USA
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21
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Finley A. Looking out for older Americans. Interview by Barbara Feiner. Emerg Med Serv 1996; 25:54-56. [PMID: 10156454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Finley
- Senior Life, Boca Raton, FL, USA
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22
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Bryan H, Hawrylyshyn P, Hogg-Johnson S, Inwood S, Finley A, D'Costa M, Chipman M. Perinatal factors associated with the respiratory distress syndrome. Am J Obstet Gynecol 1990; 162:476-81. [PMID: 2309834 DOI: 10.1016/0002-9378(90)90415-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Perinatal factors related to the incidence of respiratory distress syndrome were analyzed by the multiple logistic regression statistical method in 263 mothers and their 298 offspring delivered between 24 and 35 weeks' gestation in a 1-year period in a regional referral perinatal center. The risk of respiratory distress syndrome in white infants rose with decreasing gestational age (p less than 0.0001) while prolonged rupture of membranes of greater than 24 hours in the absence of maternal infection (28% of cases) was highly protective (p less than 0.0001). Compared with vaginal delivery, cesarean delivery without labor increased the risk of respiratory distress syndrome (p = 0.03). The administration of tocolytic drugs was unrelated to the incidence of respiratory distress syndrome, but corticosteroid therapy given at least 72 hours before delivery was protective (p = 0.03). Male and female infants were equally at risk for respiratory distress syndrome as were black and white infants, but other races had a lower incidence (p = 0.004). Infants with respiratory distress syndrome were on mechanical ventilators longer than those with other respiratory illnesses.
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Affiliation(s)
- H Bryan
- Division of Neonatology, Mount Sinai Hospital, Toronto, Ontario, Canada
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23
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Kane MA, Elwood PC, Portillo RM, Antony AC, Najfeld V, Finley A, Waxman S, Kolhouse JF. Influence on immunoreactive folate-binding proteins of extracellular folate concentration in cultured human cells. J Clin Invest 1988; 81:1398-406. [PMID: 3366900 PMCID: PMC442570 DOI: 10.1172/jci113469] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The influence of extracellular folate concentration on cellular levels of the folate transport protein and its soluble product was studied directly in cultured human nasopharyngeal carcinoma (KB) cells. As determined by radioimmunoassay, levels of the folate transport protein and the soluble folate-binding protein were 58 +/- 17 (mean +/- SD) and 5 +/- 2 pmol/mg cell protein, respectively, in KB cells maintained in standard medium (containing 2,300 nM folic acid). These levels significantly increased to 182 +/- 34 and 26 +/- 6 pmol/mg cell protein, respectively, in KB cells serially passaged in low folate medium (containing 2-10 nM 5-methyltetrahydrofolate). Increases in folate-binding protein levels occurred more rapidly in KB cells serially passaged in very low folate medium containing less than 2 nM folate and were prevented by the addition of 100 nM 5-methyltetrahydrofolate or 0.1-1 microM 5-formyltetrahydrofolate to this medium. When KB cells which had been passaged in low folate medium were passaged back into either standard medium or low folate medium supplemented with reduced folates, the levels of both folate-binding proteins fell linearly towards the levels in KB cells continuously maintained in standard medium. The folate transport protein was identified in and underwent similar changes in human and mouse mammary tumor cells. These studies indicate that the folate transport system is probably regulated by the extracellular folate concentration through changes in intracellular metabolite levels.
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Affiliation(s)
- M A Kane
- Cancer Chemotherapy Foundation Laboratory, Mt. Sinai Medical Center, New York 10029
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24
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Durtschi MB, Kohler TR, Finley A, Heimbach DM. Burn injury in infants and young children. Surg Gynecol Obstet 1980; 150:651-6. [PMID: 7368048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Scalding, most often self-precipitated, is the most common cause of burn injuries in children. Flame burns are much less common but are more severe and have a higher mortality than do scalds. Most burns in this age group are small, but affect areas functionally and cosmetically sensitive to burn injury. Abused infants and toddlers have a much higher mortality than do unabused children. Younger children have a higher mortality after serious burns than do older children. Common infections include otitis media, viral gastroenteritis and viral infections of the upper part of the respiratory tract, many of which are established prior to injury. Hyperthermia and leukocytosis are common and may be misleading as indicators of infection. Fluid needs are greater than predicted by the Parkland formula. Hypertension is uncommon and resolves spontaneously.
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25
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Finley A, Andorsky M, Davidson M. Pediatric gastroenterology 1/1/69-12/31/75: a review. Part II. The liver and biliary tract. Am J Dig Dis 1977; 22:155-67. [PMID: 835558 DOI: 10.1007/bf01072961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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26
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Andorsky M, Finley A, Davidson M. Pediatric gastroenterology 1/1/69-12/31/75: a review. Part I. Hollow viscera and the pancreas. Am J Dig Dis 1977; 22:56-68. [PMID: 138361 DOI: 10.1007/bf01077399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Samson JH, Apthorp J, Finley A. Febrile seizures and purulent meningitis. JAMA 1969; 210:1918-9. [PMID: 5394954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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