Pain Unheard? Postoperative Pain Assessment in Neonates and Infants

Study aim: The study aimed at answering two questions: • How reliable. valid, and feasible is the multidimensional COMFORT scale to assess postoperative pain in infants and toddlers 0-3 years of age? • What is the difference between intermittent morphine administration and continuous intravenous morphine in terms of quality and effectiveness of analgesia for postoperative pain in infants and toddlers 0-3 years of age? The studies described in this thesis deal primarily with the first question. The differences between the two morphine conditions in relation to hormonal and metabolic plasma levels and morphine plasma levels will be reported elsewhere. During data collection a third research question came up, inspired by the eventful hospital history of some children combined with the individual differences in pain response and morphine requirement after surgery in our sample. This question was also justified by publications on subsequent and long-tenn consequences of neonatal pain. The third, additional question is: • Are the present postoperative pain and stress response related to past experiences with pain

The Misprediction of emotions in Track Athletics.: Is experience the teacher of all things?

People commonly overestimate the intensity of their emotions toward future events. In other words, they display an impact bias. This research addresses the question whether people learn from their experiences and correct for the impact bias. We hypothesize that athletes display an impact bias and, counterintuitively, that increased experience with an event increases this impact bias. A field study in the context of competitive track athletics supported our hypotheses by showing that athletes clearly overestimated their emotions toward the outcome of a track event and that this impact bias was more pronounced for negative events than for positive events. Moreover, with increased athletic experience this impact bias became larger. This effect could not be explained by athletes’ forecasted emotions, but it could be explained by the emotions they actually felt following the race. The more experience athletes had with athletics, the less they felt negative emotions after unsuccessful goal attainment. These findings are discussed in relation to possible underlying emotion regulation processes

The Management of Pediatric Polytrauma: Review

Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was con- ducted based on a search in the Embase, Medline OVID-SP, Web of Science, Cochrane central, and Pubmed databases. Only studies with “paediatric population” and “polytrauma” as criteria were included. A total of 3310 citations were retrieved. Of these, 3271 were excluded after screening, based on title and abstract. The full texts of 39 articles were assessed; further selection left 25 articles to be included in this review. The most crucial point in the management of PPPs is preparedness of the staff and an emergency room furnished with age-appropriate drugs and equipment combined with a systemic approach

An evaluation of nutritional practice in a paediatric burns unit

Introduction. Burn injuries evoke a systemic metabolic response with profound effects on organ function, susceptibility to infection

Motor-function and exercise capacity in children with major anatomical congenital anomalies

__Background:__ Children with major anatomical congenital anomalies (CA) often need prolonged hospitalization with surgical interventions in the neonatal period and thereafter. Better intensive care treatment has reduced mortality rates, but at the cost of more morbidity. __Aim:__ To study motor-function and exercise capacity in five-year-old children born with CA, and to determine whether motor-function and exercise capacity differ according to primary diagnosis. __Study design:__ Descriptive study. __Subjects:__ One-hundred-and-two children with the following CA: congenital diaphragmatic hernia (CDH) n=24, esophageal atresia (EA) n=29, small intestinal anomalies (SIA) n=25, and abdominal wall defects (AWD) n=24. __Outcome measures:__ Overall and subtest percentile scores of the Movement-Assessment Battery for Children (M-ABC) were used to measure motor skills. Endurance time on the Bruce treadmill test was used to determine maximal exercise capacity. __Results:__ Motor-function: Seventy-three children (71.6%) had an overall percentile score within the normal range, 18 (17.6%) were classified as borderline, and 11 (10.8%) had a motor problem. This distribution was different from that in the reference population (Chi square: p=0.001). Most problems were encountered in children with CDH and EA (p=0.001 and 0.013, respectively). Ball skills and balance were most affected. __Exercise capacity:__ Mean standard deviation score (SDS) endurance time=-. 0.5 (SD: 1.3); p=0.001; due to poor exercise performance in CDH and EA patients. __Conclusions:__ Children with major anatomical CA and especially those with CDH and EA are at risk for delayed motor-function and disturbed exercise capacity

Functional capillary density decreases after the first week of life in term neonates

Background: Changes in the microcirculation have been recognized to play a crucial role in many disease processes. In premature neonates, functional capillary density (FCD) decreases during the first months of life. Objectives: The aims of this study were to obtain microcirculatory parameters in term neonates and older children who did not present with compromised respir

Effects of Pleasant Ambient Fragrances on Dental Fear: Comparing Apples and Oranges

Previous studies showed that orange odor reduces the anticipatory anxiety and improves the mood of patients waiting for scheduled appointments in small dental practices. We replicated these previous studies in the setting of three large dental clinics. In addition, we investigated whether another pleasant fruity smell (apple odor) is similarly associated with reduced anxiety. We included 219 patients (117 males, 102 females) between the ages of 18 and 81 in this study. While they were waiting for dental treatment, the participants were either exposed to the ambient odor of orange (N = 81) or apple (N = 69), or they received no stimulation. State anxiety, mood, and perceived level of pain of the participants were assessed using questionnaires. Statistical analysis showed no significant difference between the responses of patients in each of the three experimental groups. We therefore conclude that orange and apple odors have no effect on the anticipatory anxiety or mood of patients waiting for scheduled appointments in large dental clinics

Pain in Intellectually Disabled Children: Towards Evidence-Based Pharmacotherapy?

This critical opinion article deals with the challenges of finding the most effective pharmacotherapeutic options for the management of pain in intellectually disabled children and provides recommendations for clinical practice and research. Intellectual disability can be caused by a wide variety of underlying diseases and may be associated with congenital anomalies such as cardiac defects, small-bowel obstructions or limb abnormalities as well as with comorbidities such as scoliosis, gastro-esophageal reflux disease, spasticity, and epilepsy. These conditions themselves or any necessary surgical interventions are sources of pain. Epilepsy often requires chronic pharmacological treatment with antiepileptic drugs. These antiepileptic drugs can potentially cause drug–drug interactions with analgesic drugs. It is unfortunate that children with intellectual disabilities often cannot communicate pain to caregivers. Although these children are at high risk of experiencing pain, researchers nevertheless often have to exclude them from trials on pain management because of ethical considerations. We therefore make a plea for prescribers, researchers, patient organizations, pharmaceutical companies, and policy makers to study evidence-based, safe and effective pharmacotherapy in these children through properly designed studies. In the meantime, parents and clinicians must resort to validated pain assessment tools such as the revised FLACC scale