Waiting to Cooperate?

Sometimes cooperation between two parties requires exactly one to cede to the other. If the decisions whether to cede are made simultaneously, then neither or both may acquiesce leading to an inefficient outcome. However, inefficiency may be avoided if a party can wait to see what the other does. We experimentally test whether adding a waiting option to such a two-player cooperation game enhances cooperation. Although subjects cede less overall with the waiting option, we show that they coordinate more and consequently achieve higher profits. Yet, a dark side overhangs waiting: the least cooperative pairs do worse with this option. They wait not to facilitate coordination but to disguise their entry

Upregulation of Neurotrophic Factors Selectively in Frontal Cortex in Response to Olfactory Discrimination Learning

We have previously shown that olfactory discrimination learning is accompanied by several forms of long-term enhancement in synaptic connections between layer II pyramidal neurons selectively in the piriform cortex. This study sought to examine whether the previously demonstrated olfactory-learning-task-induced modifications are preceded by suitable changes in the expression of mRNA for neurotrophic factors and in which brain areas this occurs. Rats were trained to discriminate positive cues in pair of odors for a water reward. The relationship between the learning task and local levels of mRNA for brain-derived neurotrophic factor, tyrosine kinase B, nerve growth factor, and neurotrophin-3 in the frontal cortex, hippocampal subregions, and other regions were assessed 24 hours post olfactory learning. The olfactory discrimination learning activated production of endogenous neurotrophic factors and induced their signal transduction in the frontal cortex, but not in other brain areas. These findings suggest that different brain areas may be preferentially involved in different learning/memory tasks

Development of a Short Version of the Modified Yale Preoperative Anxiety Scale

BACKGROUND: The modified Yale Preoperative Anxiety Scale (mYPAS) is the current “criterion standard” for assessing child anxiety during induction of anesthesia and has been used in \u3e100 studies. This observational instrument covers 5 items and is typically administered at 4 perioperative time points. Application of this complex instrument in busy operating room (OR) settings, however, presents a challenge. In this investigation, we examined whether the instrument could be modified and made easier to use in OR settings. METHODS: This study used qualitative methods, principal component analyses, Cronbach αs, and effect sizes to create the mYPAS-Short Form (mYPAS-SF) and reduce time points of assessment. Data were obtained from multiple patients (N = 3798; Mage = 5.63) who were recruited in previous investigations using the mYPAS over the past 15 years. RESULTS: After qualitative analysis, the “use of parent” item was eliminated due to content overlap with other items. The reduced item set accounted for 82% or more of the variance in child anxiety and produced the Cronbach α of at least 0.92. To reduce the number of time points of assessment, a minimum Cohen d effect size criterion of 0.48 change in mYPAS score across time points was used. This led to eliminating the walk to the OR and entrance to the OR time points. CONCLUSIONS: Reducing the mYPAS to 4 items, creating the mYPAS-SF that can be administered at 2 time points, retained the accuracy of the measure while allowing the instrument to be more easily used in clinical research settings

Revisiting a Common Measure of Child Postoperative Recovery: Development of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS)

Background The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children\u27s posthospitalization and postoperative new‐onset behavioral changes. However, the psychometric properties of the scale have not been re‐evaluated in the past five decades despite substantial changes in the practice of surgery and anesthesia. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. Method This study used principal components analysis, a panel of experts, Cronbach\u27s alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ‐AS). Data from previous investigations (N = 1064, Mage = 5.88) which utilized the PHBQ were combined for the purposes of this paper. Results A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ‐AS. The PHBQ‐AS demonstrated good internal consistency reliability and concurrent validity with another measure of children\u27s psychosocial and physical functioning. Conclusion Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ‐AS may provide a means for reducing the burden of postoperative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes

Children and Their Parents’ Assessment of Postoperative Surgical Pain: Agree or Disagree?

Objective The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. Methods This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child\u27s pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child\u27s pain lower than children rated their own pain). Results A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1–3 (30.05%–35.95%). Of those pairs in disagreement, the majority of parents overestimated their child\u27s pain on all three postoperative days, specifically such that a total of 24–26% parents overestimated their child\u27s pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. Conclusions Since parents overestimate their child\u27s postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A

The role of parental health and distress in assessing children’s health status

Purpose The purpose of the study was to examine the contributions of parents’ health and distress to parent’s and children’s assessments of children’s health. Methods We used baseline data from a longitudinal study of 364 children (ages 4–12) about to undergo surgery and their parents in a Southern California pediatric hospital. We used the 20-item child self-reported CHRIS 2.0 general health and the parallel parent-reported measure of the child’s health, along with a measure of parental distress about the child’s health were administered in the perioperative period. Other measures included parents’ physical and mental health, quality of life, distress over their child’s health, and number and extent of other health problems of the child and siblings. Results On average, parents’ reports about the child were consistently and statistically significantly higher than children’s self-reports across all sub-dimensions of the CHRIS 2.0 measure. Parents’ personal health was positively associated with their reports of the child’s health. More distressed parents were closer to the child’s self-reports, but reported poorer personal health. Conclusion Parent–child differences in this study of young children’s health were related to parental distress. Exploring the nature of the gap between parents and children in assessments of children’s health could improve effective clinical management for the child and enhance family-centered pediatric care. Future studies are needed to assess the generalizability of CHRIS 2.0 to other health settings and conditions and to other racial/ethnic groups

Parental Satisfaction of Child\u27s Perioperative Care

Background Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child\u27s hospital experience, parent satisfaction of their child\u27s perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child\u27s perioperative process. Methods Eight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21‐item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction. Results Descriptive statistics and correlational analysis found that sedative‐premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received. Conclusion Lower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores

Endometrial Thickness- a Practical Prospective Marker for the Risk of Surgical Intervention after RU486 Induced Abortion

Background Medical termination of pregnancy [TOP] during the early first trimester is commonly used. However, treatment failure which warrants surgical intervention occurs in small proportion of patients. Our objective was to examine the effectiveness and predictive value of sonographic measurement of endometrial thickness during a follow up visit after medical abortion as an accurate predictor of the necessity of curettage for completion of pregnancy termination. Methods Women who opted for medical TOP where treated by single dose of RU486 followed by a single dose of misoprostol. Endometrial thickness was evaluated by transvaginal U.S. at 14 days after misoprostol tretament. The data was collected prospectively for this cohort study which includes all the women undergoing medical abortion in the first seven weeks of gestation. Results In 34.7% of the patients the endometrial width was > 11 mm on the follow-up visit. Surgical intervention was performed in 18% of these patients, for a failure rate of the medical termination of pregnancy [TOP] of 6.25%, as compared with no failure rate in those with endometrium 12 mm the failure was 5.9%. In cases where the endometrium was 12-13 mm the failure rate was 27.3%, and if >13 mm the failure was 18.9%. When the endometrium was 13-14 mm the failure rate was 10%, and when >14 mm the failure was 23.7%. Half of the 18 patients who had undergone dilatation and curettage [D&C] for completion of the TOP, had endometrium > 14 mm, one to two weeks after the medical abortion. Conclusion Measurement of endometrial width after medical TOP is beneficial in segregating patient to low or high risk for surgical treatment of retained product of conception [POC]. Using a cutoff of 11 mm during the follow-up visit after medical TOP, 18% of the patients may need dilatation and curettage to complete the pregnancy termination, and if it is >14 mm, half of them may need surgical intervention. There is no difference between 11 and 14 mm regarding the risk of surgical intervention after medical TOP