Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study.

BACKGROUND: Evidence suggests that a significant number of children receive less than optimal management of procedure-related pain. OBJECTIVES: To determine if there was a difference in the perceived pain associated with a venipuncture procedure in a group of pediatric patients based on the preparatory intervention used during the procedure and, to determine if age, sex, or ethnic group were associated with the effectiveness of the preparatory interventions used. DESIGN: A quasi-experimental, 3×4 factorial design was used. SETTING: Participants were recruited from a non-profit, regional hospital in the southeast United States. PARTICIPANTS: Participants were recruited from children between the ages of 18 months and 17 years who were admitted to the facility. Criteria for inclusion was the first needle stick during admission with a parent or guardian present, English as the primary language. Potential participants were excluded if they had previous experience with any of the preparatory interventions, were sedated, unconscious, hemodynamically unstable, developmentally delayed for their age, or had a known chronic condition. Of the 285 participants consented to participate, 173 children completed the process including 35 (20.2%) toddlers, 34(19.7%) preschool and 65 (37.6%) school age children, and 39 (22.5%) adolescents. There were 77 (44.5%) females and 96 (55.5%) males; and 101 (58.4%) non-Hispanic white children and 72 (41.6%) minority children. METHODS: Children were randomized to one of three treatment interventions. There was a purposeful effort to include representative numbers of each age group, ethnic group, and sex and in each treatment group. Measures of pain before and after the procedure included an observational measure completed by the parent/guardian and a self-report measure completed by the two older age groups. FINDINGS: There were no statistically significant differences among treatment groups based on the observational measures of pain or the self-report measures of pain. There was a statistically significant interaction between ethnic group and treatment group (p=0.006) based on the observational measure of pain which was also found between ethnic group and treatment group (p=.04) based on self-report scores in school age children and adolescents. CONCLUSION: Findings support the use of both mechanical vibration and topical anesthetic as effective in children regardless of age group or sex. Further, the interaction between ethnic group and treatment contributes to a growing body of knowledge that suggests ethnic group is an important factor in the pain response and requires further study in an effort to better customize approaches to pain management in children.

The relationships among anxiety, anger, and blood pressure in children.

Relationships between anger and anxiety have been examined in adults but less frequently in children. This investigation explored relationships among trait anxiety, trait anger, anger expression patterns, and blood pressure in children. The participants were 264 third- through sixth-grade children from five elementary schools who completed Jacob's Pediatric Anger and Anxiety Scale and Jacob's Pediatric Anger Expression Scale and had their blood pressure measured. Data were analyzed using descriptive and correlational statistics and hierarchical regression. Results have implications for the way in which anxiety and anger are perceived in children and the importance of teaching children to deal with emotions.

The use of computers and the Internet as a source of health information for people with disabilities.

It becomes increasingly obvious that computers and the Internet will play a prominent role in healthcare in the 21st century in America. The use of these tools in telecommunications technology to inform and educate has resulted in the emerging field of interactive health communication (IHC). The value of this new field is heightened by its potential to make health-related information and services more accessible to vulnerable populations such as people with disabilities. The assessment of user needs is one of the first activities necessary in the development of IHC applications. This article reports our findings from a survey conducted as the first step in developing a program of interactive health applications for people with disabilities resulting from brain and spinal cord injuries. A rehabilitation center conducted a 3-year retrospective survey of patients who had completed rehabilitation from brain or spinal cord injury. The survey found that 73% of respondents surveyed had access to and used computers, and 68% had access to the Internet. Our findings show that people with disabilities are using computers and the Internet, suggesting these tools' potential as a medium for the dissemination of health-related information and services for this underserved population. Further findings and key issues related to IHC design and application are discussed.

Telerehabilitation support for families at home caring for individuals in prolonged states of reduced consciousness.

OBJECTIVE: To investigate the use of telerehabilitation to support families caring at home for individuals with prolonged states of reduced consciousness. DESIGN: A comparison group approach. PARTICIPANTS: Participants were recruited from a special program that is part of a Model Systems brain injury program located in the Southeast. Five patients, ranging from Rancho 1 to Rancho 3 were discharged home with family members as the primary caregivers. PROCEDURES: Participant families were followed for 4 to 8 weeks via videophone. Follow-up telephone surveys were conducted with a family member 6 to 9 months after discharge and compared with a similar group that had not received the videophone follow-up. MAIN OUTCOME MEASURES: Present living status, number of emergency room visits, number of hospitalizations, the caregivers' perceptions of functional status and care needs, readmission for rehabilitation and perceived family needs as measured by the Family Needs Questionnaire (FNQ). RESULTS: More patients in the videoconferencing group were still living at home and had returned for rehabilitation. On the FNQ, families in the videophone group reported more of their needs met than families in the comparison group. CONCLUSIONS: The use of videoconferencing to bridge the transition to home for families caring for a family member at the Rancho 1 to Rancho 3 level may assist families in successfully caring for the individual in the home and reducing the number of perceived family needs.