Review of the Accuracy of Two Pain Assessment Tools in Nonverbal Adult Patients

Intensive care units frequently have patients that are unable to verbally communicate their pain, thus negating conventional pain assessment techniques and making pain assessment difficult. Pain management is often a priority in all patients’ circumstances and therefore, assessment and reassessment are included in the plan of care. Different observational pain scales have been used in intensive care units, but often times these scales must be adapted to fit the patient’s circumstances. Pain scales that are used for nonverbal patients typically include behavioral indicators and some are adapted to incorporate physiologic indicators such as vital signs. The aim of this review is to determine if the use of the Critical-Care Pain Observation Tool (CPOT), an assessment tool that is strictly observational, leads to more accurate pain assessment scores for nonverbal adult patients in comparison to the Adult Nonverbal Pain Scale (NVPS), a tool that incorporates vital signs. A search was conducted using five databases and the key words included, but are not limited to, Critical-Care Pain Observation Tool, Adult Nonverbal Pain Scale, nonverbal patients, and pain assessment. It was found that the CPOT was more accurate in determining pain assessment scores due to a discrepancy regarding the inconsistency of vital signs

Plasma prekallikrein levels are positively associated with circulating lipid levels and the metabolic syndrome in children.

Plasma prekallikrein (PK) has been shown to be associated with cardiovascular disease (CVD) and its risk factors, but these associations have not been investigated in children. The present study examined PK activity in relation to well-established cardiovascular risk factors in a cohort of children aged 9–11 years (N = 97). We found a significant and positive association between PK and fasting levels of total cholesterol (p \u3c 0.01), non-high-density lipoprotein cholesterol (p \u3c 0.01), and triglycerides (p \u3c 0.001). In addition, there was a significant association between PK activity and the metabolic syndrome, a clustering of risk factors considered to have an impact on atherosclerosis and CVD mortality. Finally, we found that children with a family history of CVD had significantly elevated PK activity. These novel findings warrant further investigations into the relationship between circulating PK levels and CVD risk factors because PK may be involved in the progression of the disease state. Il est bien connu que la pre´kallicre´ine (PK) est associe´e a` la maladie cardiovasculaire (CVD) et a` ses facteurs de risque, mais ces associations n’ont pas e´te´ ve´rifie´es chez les enfants. Cette e´tude se propose de ve´rifier l’association entre l’activite´ de la PK et les facteurs de risque de CVD aupre`s d’une cohorte d’enfants aˆge´s de 9 a` 11 ans (N = 97). On observe une corre´lation positive significative entre la PK et les variables suivantes : la concentration totale de choleste´rol a` jeun (p \u3c 0,01), les concentrations des lipoprote´ines non a` haute densite´ (p \u3c 0,01) et la concentration des triglyce´rides (p \u3c 0,001). De plus, on observe une corre´lation significative entre l’activite´ de la PK et le syndrome me´tabolique constitue par un ensemble de facteurs ayant un effet sur l’athe´roscle´rose et la mortalite´ due a` la CVD. En dernier lieu, les enfants avec des ante´ce´dents familiaux de CVD pre´sentent une plus importante activite´ de la PK, et ce, de fac¸on significative. Ces premie`res observations sugge`rent d’autres e´tudes sur la relation entre la concentration sanguine de PK et les facteurs de risque de CVD, car la PK pourrait eˆtre implique´e dans la progression de la malad

Self-Reported Dietary Habits and Barriers Among First Responders

Firefighters (FFs) and law enforcement officers (LEOs) have a high, lifestyle-related, risk for health conditions such as cardiovascular disease (CVD). Nutritional intervention has been identified as a critical area to improve these risk factors. However, there are limited data regarding the dietary habits and barriers of FFs and LEOs. PURPOSE: This study aimed to investigate the dietary habits of first responders and the factors or barriers influencing them. METHODS: Cross-sectional data were obtained from 21 first responders regarding nutritional habits, factors, and barriers via validated paper-based questionnaires which include; the Perceived Barriers to Healthy Eating, Food Choice Questionnaire, and Rapid Eating Assessment for Participants - Short Version. The questionnaire data were analyzed using SPSS version 29 software. Shapiro-Wilk Test was used to assess normality for all continuous variables. Categorical data are reported as frequencies (n) and total percentages. A chi-square analysis was also used to determine independence (p\u3c0.05) between the groups. RESULTS: A total of 21 FFs (n=7) and LEOs (n=13) (age = 37.7±2.1; height = 180.8±1.4 cm; weight = 94.3±2.1 kg) completed the questionnaires. Commonly reported barriers to healthy eating included busy lifestyles (n=18, 85.7%), irregular working hours (n=12, 61.9%), cost (n=8, 38.09%), and willpower (n=10, 47.6%). Overall, 17 (80.9%) of the respondents placed importance on consuming nutritious food, and 9 (42.8%) placed high importance on having easily accessible food options; 18 (85.7%) emphasized the importance of high protein content, yet 9 (42.8%) followed a high protein diet, while 11 (52.3%) did not follow any particular diet, and 15 (71.4%) reported a willingness to change their eating habits to be healthier. The chi-square analysis revealed no significant differences between groups. CONCLUSION: The cohort of FFs and LEOs appear to be knowledgeable regarding what food to consume and value healthy eating. However, busy lifestyles, irregular shift work, cost of food, and willpower are perceived barriers that may challenge first responders when practicing good dietary behaviors, despite the majority expressing the willingness to change their current dietary habits to healthier ones. On the whole, these data provide insight into the barriers experienced by first responders and may aid in further investigation of the implementation of healthy eating strategies in these populations

Free-living dietary intake in tactical personnel and implications for nutrition practice: a systematic review

Tactical personnel (including military, law enforcement, and fire and rescue) are responsible for ensuring national and public safety. Dietary intake is an important consideration to support optimal health and performance. The aims of this systematic review were to: (1) describe the reported free-living dietary intake (energy and macronutrients) of tactical personnel, and (2) describe the practical implications of reported dietary intakes to support the physical and dietary requirements of tactical personnel. A systematic search of databases (MEDLINE, EMBASE, CINAHL and Web of Science) was conducted following the PRISMA guidelines. English and full text research articles were identified and screened against inclusion and exclusion criteria. Demographic and dietary intake data were extracted, tabulated, and synthesized narratively. The quality of the studies was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Twenty-two studies (15 military, 4 law enforcement, and 2 fire and rescue) were eligible to inform this review. The volume of evidence suggested that tactical personnel met dietary protein and exceeded dietary fat recommendations but failed to meet energy and carbohydrate recommendations. Therefore, practical approaches to support optimized energy, fat and carbohydrate intake in tactical personnel is important