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

Jugend auf der Suche nach Gott

"In der modernen pluralen Gesellschaft gibt es für die Jugendlichen eine große Auswahl an Lebenskonzepten und Glaubensüberzeugungen. Die Säkularisierung in Westeuropa bedeutet, dass die Religion nicht mehr exklusiv die Funktion der Sozialintegration des individuellen und gesellschaftlichen Lebens übernimmt. Religion und Moderne ist aber auch nicht notwendigerweise inkompatibel. Die Werte und Normen sind allerdings nicht mehr allein auf christlichen Glauben begründet. Für Jugendliche im Jahr 2006 ist es normal, dass man eine individuelle Auswahl hat aus vielen Glaubens- und Sinndeutungen. Die Verfasser nennen das auch bricolage oder Lego-Bildung. Es gibt aber keine religiöse Indifferenz, wie ihre Forschung unter 1.250 Jugendlichen in den Niederlanden zeigt. Die Normen und Werte der Jugendlichen sind nicht 'gottlos'. Noch immer ist Solidarität eine wichtige Sache für die Jugendlichen. Dass dies mit dem christlichen Glauben und mit der Kirche im Besonderen zu tun hat, ist vielen überhaupt nicht mehr bekannt. Trotzdem sahen sie, dass über 3.000 Jugendliche an den Weltjugendtagen in Köln teilgenommen haben. Ist das eine besondere Gruppe, ganz anders als alle anderen im gleichen Lebensalter? Sind diese Jugendlichen alle sehr aktiv in der Kirche? Oder hatte sie etwas anderes dazu bewogen, an den Weltjugendtagen teilzunehmen? Und außerdem: Was kann die Kirche genau dieser Gruppe in ihrer Suche nach sich selbst und nach einem höheren Lebensziel anbieten? Die niederländischen Jugendlichen haben die Vorbereitungen auf den Weltjugendtag ein Jahr vorab begonnen. In Gruppen sind sie dann am 13. August 2005 auf die Reise nach Köln gegangen, manche sogar mit dem Boot. Es gibt dabei viele Jugendliche, die sich mit der Kirche identifizieren, aber auch die, die 'nur' wegen der internationalen Begegnung dabei sind und sie vielleicht mit Freunden zusammen an dem Event teilnehmen. Die Erwartungen sind ganz verschieden. Insgesamt überwiegen jedoch Motive wie Spaßhaben und Menschen kennen lernen. Aber fast alle Jugendliche nehmen sehr gute Erfahrungen mit nach Hause. Und was dann?" (Autorenreferat

Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms

Background: Although stimulating patients’ mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. Methods: Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. Results:Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9–93.6). The median total daily step count was 1326 (range 22-5362). Conclusion: We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.</p

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

Association of Interosseous Tendon Inflammation in the Hand With Different Early Arthritides in a 10-Year Magnetic Resonance Imaging Study

Objective: Inflammation around the tendons of the hand interosseous muscles (interosseous tendon inflammation [ITI]) was recently identified on magnetic resonance imaging (MRI) in a set of patients with rheumatoid arthritis (RA) and arthralgia. We conducted a large MRI study to assess the prevalence of ITI at diagnosis of RA and of other arthritides, as well as its relationship with clinical signs. Methods: A total of 1,205 patients presenting with various types of early arthritis between 2010 and 2020 underwent contrast-enhanced hand MRI as part of the prospective Leiden Early Arthritis Cohort. MRI was evaluated with blinding for clinical data, for ITI lateral of metacarpophalangeal (MCP) joints 2–5, and for synovitis/tenosynovitis/osteitis. We assessed ITI presence at baseline per diagnosis and its relationship with clinical characteristics (ie, presence of hand arthritis, increased acute phase reactants, and local joint swelling and tenderness). Logistic regression and generalized estimating equations were used with adjustment for age and established local inflammation features (synovitis/tenosynovitis/osteitis). Results: A total of 36% of patients with early RA (n = 532) had ITI; this was similar in patients with anti–citrullinated protein antibody (ACPA)-negative RA (37%) and those with ACPA-positive RA (34%; P = 0.53). ITI occurred regularly in remitting seronegative symmetrical synovitis with pitting edema (60%) and connective tissue diseases (44%) and less frequently in undifferentiated arthritis (14%), psoriatic arthritis (14%), inflammatory osteoarthritis (8%), reactive arthritis (7%), crystal arthritis (7%), and peripheral spondylarthritis (4%). ITI occurred more often in diagnoses with frequent arthritis of the hands (P &lt; 0.001) and increased acute-phase reactants (P &lt; 0.001). Within RA, ITI occurred together with local MCP joint synovitis (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.7–3.4), tenosynovitis (OR 2.4, 95% CI 1.8–3.3), and osteitis (OR 2.2, 95% CI 1.6–3.1) on MRI. Moreover, ITI presence was associated with local MCP joint tenderness (OR 1.6, 95% CI 1.2–2.1) and swelling (OR 1.8, 95% CI 1.3–2.6), independent of age and MRI-detected synovitis/tenosynovitis/osteitis. Conclusion:ITI occurs regularly in RA and other arthritides with preferential involvement of hand joints and increased acute-phase reactants. At the MCP joint level, ITI associates independently with joint tenderness and swelling. Hence, ITI is a newly identified inflamed tissue mainly found in arthritides with particularly extensive and symptomatic inflammation.</p

Implementation of a nursing oral health care protocol in a university teaching hospital:A cluster-randomized stepped-wedge design

Introduction: Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. Methods: We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0–100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. Results: At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. Conclusion: Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.</p

Evaluation of pain incidence and pain management in a South African paediatric trauma unit

OBJECTIVES: To evaluate pain incidence and pain management in a South African paediatric trauma unit, and to compare the usefulness of 5 different assessment tools. DESIGN: A prospective observational study, using the Numerical Rating Scale for pain (NRS pain), Numerical Rating Scale for anxiety (NRS anxiety), the Alder Hey Triage Pain Score (AHTPS), the COMFORT behaviour scale and the Touch Visual Pain Scale (TVPS). All patients were assessed at admission; those who were hospitalised were again assessed every 3 hours until discharge. RESULTS: A total of 165 patients, with a mean age of 5.3 years (range 0 - 13), were included. NRS scores were indicative of moderate to severe pain in 13.3% of the patients, and no pain in 24% at admission. Two-thirds of the patients received no analgesics; for them, NRS pain, AHTPS and TVP scores were lower than the scores for the other children. CONCLUSION: Pain and anxiety incidences in this paediatric trauma unit are relatively low. Implementation of a standard pain assessment tool in the emergency department triage system can improve pain management. The AHTPS is the most promising for use in non-Western settings