The Effect of Educational Strategies Targeted for Nurses on Pain Assessment and Management in Children: An Integrative Review

Background: Nurses play an important role in children's pain assessment and management because they spend the majority of the time with them and provide care on a 24-hour basis. However, research studies continue to report on nurses' inadequate assessment and management of children's pain, which may be partly attributed to their insufficient education in this area.Objectives: This integrative review sought to examine the effect of strategies used in educating nurses on pediatric pain assessment and management.Design: An integrative review.Data Sources: Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed/ Medline and Scopus.Review/Analysis Methods: Four databases were searched up to February 2018 based on a prescribed eligibility criteria. The review included 37 studies with varied methodologic quality.Results: Our findings revealed that various types of educational strategies improve nurses’ knowledge, attitudes, and practice of pain assessment, management, and/or documentation.Conclusions: Developing a responsive program that includes expectations of beneficiaries, integrating it into existing facility training systems and delivering it through multidisciplinary collaboration, offers the benefit of securing sustainability of the educational gains.</p

Evaluating the content validity of two versions of an instrument used in measuring pediatric pain knowledge and attitudes in the Ghanaian context

In this article, we compared the content validity of two instruments used in measuring pediatric pain knowledge and attitudes. This was considered necessary due to the universal differences in culture, semantics and healthcare resources in different parts of the globe. Thirteen (13) pediatric experts in Ghana assessed the content validity of two instruments: the 42-item Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS) and the 41-item Pediatric Healthcare Providers' Knowledge and Attitudes Survey Regarding Pain (PHPKASRP). The relevance and clarity of each item on these instruments were rated on a four-point likert scaled options from 1 (not relevant/ not clear) to 4 (very relevant/ very clear). The item-level content validity index (I-CVI) was calculated by dividing the number of experts who rated an item with 3 or 4 by the total number of experts. The average scale-level content validity index (S-CVI/Ave) was also estimated by summing up the I-CVIs of all items and dividing them by the total number of items. The I-CVIs on the PNKAS ranged from 0.62 to 1.00 for the relevance component and 0.69 to 1.00 for the clarity component. The I-CVIs on the PHPKASRP ranged from 0.62 to 1.00 for both the relevance and clarity components. The S-CVI/Ave were 0.87 and 0.89 for the relevance and clarity aspects on the PNKAS respectively. The S-CVI/Ave for the PHPKASRP instrument were 0.86 and 0.89 for the relevance and clarity aspects correspondingly. At the end of the validation process, 5 items were revised on both instruments whilst 37 and 36 items were maintained on the PNKAS and PHPKASRP instruments respectively. The PNKAS and PHPKASRP have an acceptable level of content validity in the Ghanaian context and recommended for educational and research purposes. Other forms of validity and reliability of these instruments should also be examined in future studies.</p

Effects of climate change on yak production at high altitude

Yak is considered the life-line of highland pastoral nomads who raise them on high altitude ranges under transhumance. Yak production at high-altitude alpine ranges may be affected due to the gradual increase of environmental temperature as a result of impending climate change. The mean environmental temperature of yak habitat at 3,000 m above mean sea level in Northeastern Indian Himalaya, varying from 1.2 to 11.1°C and 7.9 to 19.7°C during winter and summer seasons, respectively, evidencing the heat stress to the yaks in summer with THI more than 52. When environmental temperature exceeds 13°C, adaptive mechanisms of body accelerate respiration rate and heart rate to cope with heat stress in yaks. It was reported that the climate change is already witnessed at high altitude with average rise of environmental temperature 0.01 to 0.04°C/year and the expected increase of 2– 3°C have potentially catastrophic for high-altitude animals and ecosystem. The alpine pasture decreased in vegetative above ground biomass and composition which results in starvation or loss of body condition appeared to be manifested as reduced fertility in yak with low milk yield. Further, climate change may result in increase of pests and diseases at the lower permanent settlements of sub-alpine region thereby making these areas incompatible for yaks. Mitigation of heat stress in yak possibly can be done through three means by physical modification of the environment, improved nutritional management and genetic development of strains that would be less sensitive to heat stress

Nursing students and nurses' knowledge and attitudes regarding children's pain: A comparative cross-sectional study

IntroductionNurses encounter children who report of pain of diverse and unknown causes in their professional work. The current study therefore assessed and compared nursing students and nurses’ knowledge and attitudes pertaining to children’s pain in the Ghanaian context. The goal of this was to have a baseline information to guide the development and implementation of the content for a sustainable educational programme (short-course) for nursing students and nurses in Ghana.MethodsBetween October and December 2018, a cross-sectional study was carried out among 554 final year nursing students and 65 nurses in Ghana. The Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain (PNKAS) was used to collect data from participants who were affiliated to four educational institutions and eight hospitals. Data were descriptively and inferentially analyzed using chi-square test of independence, independent samples t-test and one-way analysis of variance (ANOVA).ResultsOur findings revealed that nursing students and nurses generally had unsatisfactory knowledge and attitudes towards pain management in children. Nursing students however, had significantly higher scores than nurses in the total PNKAS score and in 10 out of the 13 identified item-areas. Greater scores were obtained by nursing students in areas which were related to pain physiology, pharmacokinetics, pharmacology of analgesics and pain perceptions (p ConclusionFinal year nursing students and nurses have unsatisfactory knowledge and attitudes regarding children’s pain; which reiterates the need for urgent and effective educational efforts in this area. Regular in-service training should be offered to post-registration nurses to enhance their pediatric pain knowledge and attitudes for improved pain care in children.</div

Challenges of Loss to Follow-up in Tuberculosis Research.

In studies evaluating methods for diagnosing tuberculosis (TB), follow-up to verify the presence or absence of active TB is crucial and high dropout rates may significantly affect the validity of the results. In a study assessing the diagnostic performance of the QuantiFERON®-TB Gold In-Tube test in TB suspect children in Tanzania, factors influencing patient adherence to attend follow-up examinations and reasons for not attending were examined. In 160 children who attended and 102 children who did not attend scheduled 2-month follow-up baseline health characteristics, demographic data and risk factors for not attending follow-up were determined. Qualitative interviews were used to understand patient and caretakers reasons for not returning for scheduled follow-up. Being treated for active tb in the dots program (OR: 4.14; 95% CI:1.99-8.62;p-value<0.001) and receiving money for the bus fare (OR:129; 95% CI 16->100;P-value<0.001) were positive predictors for attending follow-up at 2 months, and 21/85(25%) of children not attending scheduled follow-up had died. Interviews revealed that limited financial resources, i.e. lack of money for transportation and poor communication, were related to non-adherence. Patients lost to follow-up is a potential problem for TB research. Receiving money for transportation to the hospital and communication is crucial for adherence to follow-up conducted at a study facility. Strategies to ensure follow-up should be part of any study protocol

Passive movement therapy in patients with moderate to severe paratonia; study protocol of a randomised clinical trial (ISRCTN43069940)

Contains fulltext : 65492.pdf ( ) (Open Access

The repulsive lattice gas, the independent-set polynomial, and the Lov\'asz local lemma

We elucidate the close connection between the repulsive lattice gas in equilibrium statistical mechanics and the Lovasz local lemma in probabilistic combinatorics. We show that the conclusion of the Lovasz local lemma holds for dependency graph G and probabilities {p_x} if and only if the independent-set polynomial for G is nonvanishing in the polydisc of radii {p_x}. Furthermore, we show that the usual proof of the Lovasz local lemma -- which provides a sufficient condition for this to occur -- corresponds to a simple inductive argument for the nonvanishing of the independent-set polynomial in a polydisc, which was discovered implicitly by Shearer and explicitly by Dobrushin. We also present some refinements and extensions of both arguments, including a generalization of the Lovasz local lemma that allows for "soft" dependencies. In addition, we prove some general properties of the partition function of a repulsive lattice gas, most of which are consequences of the alternating-sign property for the Mayer coefficients. We conclude with a brief discussion of the repulsive lattice gas on countably infinite graphs.Comment: LaTex2e, 97 pages. Version 2 makes slight changes to improve clarity. To be published in J. Stat. Phy

Vault changes after cyclopentolate instillation in eyes with posterior chamber phakic intraocular lens

Posterior chamber phakic intraocular lens (pIOL) implantation is a common option for correcting moderate-to-high ocular refractive defects. Because this pIOL is implanted on ciliary sulcus, the distance between the back surface of the pIOL and the anterior surface of the crystalline lens, that it is known as vault, should be measured in different conditions to ensure the technique's safety. Cyclopentolate is a drug that dilates the pupil and relaxes accommodation (cycloplegia). It is often used for different ocular examinations and for other medical purposes. However, there is no evidence of the effect of this drug on vault. This study quantified central vault changes associated with cyclopentolate instillation. We measured the vault under normal conditions (pre-cycloplegic instillation) and after instilling cyclopentolate on 39 eyes of 39 patients with implanted pIOL. Our results suggest that cyclopentolate instillation may induce changes to vault in eyes with implanted pIOL. These changes seem safe and are mainly associated with vault under normal conditions, but also with anterior chamber depth, pupillary diameter and pIOL size.- European Fund for Regional Development (FEDER) through the COMPETE Program and the Portuguese Foundation for Science and Technology (FCT) provided financial support in the framework of projects PTDC/SAU-BEB/098391/2008, PTDC/SAU-BEB/098392/2008 and the Strategic Project PEST-C/FIS/UI607/2011

SEARCH FOR SLOWLY MOVING MAGNETIC MONOPOLES WITH THE MACRO DETECTOR

A search for slowly moving magnetic monopoles in the cosmic radiation was conducted from October 1989 to November 1991 using the large liquid scintillator detector subsystem of the first supermodule of the MACRO detector at the Gran Sasso underground laboratory. The absence of candidates established an upper limit on the monopole flux of 5.6 x 10(-15) cm-2 sr-1 s-1 at 90% confidence level in the velocity range of 10(-4) less than or similar to beta < 4 x 10(-3). This result places a new constraint on the abundance of monopoles trapped in our solar system