Perception of pediatric pain: a comparison of postoperative pain assessments between child, parent, nurse, and independent observer.

INTRODUCTION: Pain is a subjective experience. In children with limited understanding and communication skills, reliable assessment of pain is challenging. Self-reporting of pain is the gold standard of pain measurement. For children who are unable to self-report their pain, assessments made by their parents are often used as a proxy measure. The validity of this approach has not been conclusively determined. AIM: To investigate differences in the assessment of pediatric pain between children, parents, nurses, and independent observers in the acute postoperative setting. METHOD: Three hundred and seven children (207 verbal, 100 nonverbal) undergoing elective day-case surgery were asked to participate in this quality of care audit. Pain scores given by verbal children, their parents, nurses, and independent observers were collected. A numerical rating scale or the Wong-Baker Faces Pain Scale was used. All participants were blinded from other scorers. RESULTS: For verbal children, scores reported by patients and their parents did not differ significantly. Median [inter-quartile range (IQR)] scores by children, parents, nurses, and independent observers were, respectively, 2.0 (0-4.0), 2.0 (1.0-4.0), 0.0 (0-2.0), and 1.0 (0-2.0). In nonverbal children, median (IQR) scores by parents, nurses, and independent observers were 1.0 (0-3.0), 0 (0-1.0), and 0 (0-2.0), respectively. The agreement between the different scorers was statistically significant. CONCLUSION: Children's pain self-reports should be used wherever possible to guide management, but in their absence, parental pain scores can be reliably used as a surrogate measure. Nurses and independent observers produce lower pain scores than parents or children, which may result in inadequate treatment of pain.

Perioperative analgesia in pediatric surgery.

PURPOSE OF REVIEW: Poor pain management has continued to be a problem after pediatric surgery. This review examines the current situation and recent advances in the area. RECENT FINDINGS: Nonopioids such as paracetamol and NSAIDs play an increasing role as components of multimodal analgesia in children. However, studies on the safety and efficacy of many adjuvants in pediatrics are still lacking. The use of opioids is influenced understandably by safety concerns about respiratory depression, but data on its incidence are poor. The role of regional techniques in the treatment of pain after pediatric surgery is growing in line with the developments in adults; the emphasis here is more on peripheral techniques too. SUMMARY: The concept of multimodal analgesia including the use of regional analgesic techniques is governing the current developments and discussions in the area of pediatric postoperative analgesia.

Spiritual assessment in healthcare practice Wilfred McSherry Spiritual assessment in healthcare practice and Linda Ross M&K Publishing £27 190pp 9781905539277 1905539274 [Formula: see text].

OLD AGE, sickness and death were defining moments in Buddha's search for spiritual enlightenment, and so it is for many of us faced with suffering as we start to question life and our place in it. Healthcare workers are frequently the ones who find themselves supporting the troubled person and their family. This book explores the nature of spirituality, in particular spiritual assessment.

Quantification of denitrification potential in carbonaceous trickling filters.

Biofilm samples from a carbonaceous trickling filter (TF) were evaluated in bench scale reactors to determine their maximum potential denitrification rates. Intact, undisturbed biofilms were placed into 0.6 L bench-scale reactors filled with sterilized, primary clarifier effluent spiked with nitrate to a final concentration of 16-18 mg/L as N. Dissolved oxygen concentrations were maintained between 2 and 4 mg/L in the bulk aqueous phase. Nitrate loss from the reactors was monitored over a 5h period. Denitrification rates of 3.09-5.55 g-N/m(2)day were observed with no initial lag period. This suggests that the capacity for denitrification is inherent in the biofilm and that denitrification can take place even when oxygen is present in the bulk aqueous phase. There were no significant differences in denitrification rates per unit area of media (g-N/m(2)day) either between (a). experimental runs or (b). sampling locations over the trickling filter. This suggests that denitrification potentials are uniform over the entire volume of the full-scale TF. For wastewater treatment plants with TFs that currently nitrify downstream, this approach may be used to meet less stringent permitted discharge concentrations and may allow some facilities to postpone or eliminate construction of additional unit processes for denitrification.

Effort after meaning and the hedonic value of paintings.

Two experiments tested the prediction that providing the viewer with information about abstract and semi-abstract paintings, in the form of titles and descriptions, would increase the paintings' perceived meaningfulness and hedonic value. The meaningfulness prediction was supported in both experiments. The results of one experiment, using a between-participants design, failed to support the hedonic value prediction, but the results of the other, using a within-participants design, supported the prediction. Failure to find an effect of information on hedonic value in other experiments may result from the use of between-participants designs that are relatively insensitive to the effects of different evaluative conditions. The results are discussed in the light of the 'effort after meaning' theory that part of the pleasure derived from looking at a painting stems from making a successful interpretation of it and picking up the artist's message.

Linking nitrifying biofilm structure and function through fluorescent in situ hybridization and evaluation of nitrification capacity.

Fluorescent in situ hybridization (FISH) was used to quantify the ammonia-oxidizing populations within intact biofilm samples collected from a full-scale nitrifying trickling filter (NTF). Ammonia, nitrite, and nitrate concentrations were measured for aqueous samples taken in conjunction with biofilm samples at multiple filter depths. The ammonia removal capability of collected biofilms was evaluated by transferring the biofilms to laboratory batch reactors. Nitrate plus nitrite generation rates were calculated for the full-scale NTF and for the bench-scale reactors. Correlation coefficients for individual sampling events, calculated by simple linear regression of FISH signal area and nitrate plus nitrite generation rates for the full-scale NTF, ranged from -0.882 to 0.984. Correlation coefficients obtained for FISH signal area and nitrate plus nitrite generation rates for the bench-scale reactors ranged from 0.853 to 0.994 when using probe Nso190 and from 0.919 to 0.986 when using probe Neu23a. Occasional differences between the number of ammonia-oxidizing bacteria quantified by the probe Nso190 versus the NEU23a probe with depth suggest that genera other than Nitrosomonas are present in the NTF.

Effect of alkalinity type and concentration on nitrifying biofilm activity.

The effect of alkalinity on nitrifying biofilm activity was determined by collecting 21-day-old biofilm samples from the top of a full-scale nitrifying trickling filter and evaluating bench-scale nitrate plus nitrite generation rates at (1) various initial carbonate alkalinity concentrations and (2) with four types of available alkalinity: carbonate only, phosphate only, phosphate plus hydroxide, and phosphate plus carbonate. Initial carbonate alkalinity concentrations were varied between 308 and 20 mg/L as calcium carbonate (CaCO3). Ammonia, nitrite, and nitrate concentrations were measured at time zero, 90 minutes, 180 minutes, and 270 minutes. Generation rates in grams of nitrogen per square meter per day were calculated for each time period and normalized against dry-weight biomass. Generation rates were impaired at initial carbonate alkalinity concentrations of 40 mg/L and lower (as CaCO3) and were unaffected at concentrations of 45 mg/L and greater. For reactor runs with different alkalinity types, ammonia, nitrite, and nitrate concentrations were measured at time zero and at 375 minutes. The type of alkalinity, carbonate versus phosphate, affected nitrification rates. When the carbonate alkalinity was less than 45 mg/L, nitrification rates were impaired regardless of the total alkalinity concentration. This effect seems to be independent of pH for the range of 6.92 to 7.99 evaluated here. This suggests that in addition to neutralizing the acid generated by the nitrification process, a minimum level of carbonate alkalinity is necessary to meet the ammonia-oxidizer's inorganic carbon requirement for cellular synthesis and growth.