Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians.

BACKGROUND: Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists. METHODS: The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated. The final survey was distributed by email to 134 intensivists from 17 PICUs across Canada using the Research Electronic Data Capture system. RESULTS: The response rate was 73% (98/134). The most commonly used sedation scores are Face, Legs, Activity, Cry, and Consolability (42%) and COMFORT (41%). Withdrawal scores are commonly used (65%). In contrast, delirium scores are used by only 16% of the respondents. Only 36% of respondents have routinely used sedation protocols. The majority (66%) do not use noise reduction methods, whereas only 23% of respondents have a protocol to promote day/night cycles. Comfort measures including music, swaddling, soother, television, and sucrose solutions are frequently used. The drugs most commonly used to provide analgesia are morphine and acetaminophen. Midazolam and chloral hydrate were the most frequent sedatives. CONCLUSION: Our survey demonstrates great variation in practice in the management of pain and anxiety in Canadian PICUs. Standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking. There is a need for research in this field and the development of evidence-based, pediatric sedation and analgesia guidelines.

Ethical judgments of poverty depictions in the context of charity advertising.

Aid organizations, activists, and the media often use graphic depictions of human suffering to elicit sympathy and aid. While effective, critics have condemned these practices as exploitative, objectifying, and deceptive, ultimately labeling them 'poverty porn.' This paper examines people's ethical judgments of portrayals of poverty and the criticisms surrounding them, focusing on the context of charity advertising. In Studies 1 and 2, we find that tactics that have been decried as deceptive (i.e., using an actor or staging a photograph) are judged to be less acceptable than those that have been decried as exploitative and objectifying (i.e., depicting an aid recipient's worst moments). This pattern occurs both when evaluating the tactics themselves (Studies 1a-1c) and when directly evaluating critics' arguments about them (Study 2). Studies 3 and 4 unpack the objection to deceptive tactics and find that participants' chief concern is not about manipulating the audience's responses or about distorting perceptions of reality. Participants report less concern about non-deceptive manipulation (using emotion to compel donations) and 'cherry-picked' portrayals of poverty (an ad showing an extreme, but real image) so long as there is some truth to the portrayal. Yet they are more sensitive to artificial images (e.g., an actor posing as poor), even when the image resembles reality. Thus, ethical judgments hinge more on whether poverty portrayals are genuine than whether they are representative. This work represents the first empirical investigation into ethical judgments of poverty portrayals. In doing so, this work sheds light on how people make sense of morally questionable tactics that are used to promote social welfare and deepens our understanding of reactions to deception.

Caught in a Web of Confusion: Assessing the Readability of University Webpages for Victims of Sexual Assault.

Assuring the effectiveness of Web sites in communicating critical information to a college student who has experienced sexual assault is important and complex. Recognizing that the average American reads at the eighth grade level, the National Institutes of Health and the American Medical Association recommend that information be written at a sixth-grade reading level. A sample of 10 U.S. institutions of higher education (IHE) Web sites made up the sample of the current study. The IHEs included were all participants in a project called "Cultivating Safe College Campuses," funded by the Department of Health and Human Services. This study aimed to gain more insight into the readability of college Web sites about sexual assault resources for the intended consumer-college students. The reading level of IHE Web sites with information about sexual assault should align with the reading level of their intended audience. The average readability of sexual assault Webpages for this study's sample of IHEs was over 13, well above the reading level of the average "first time in college" student. All IHEs should review the readability of their Web sites and revise them to use consistent and defined terms and present the material in a way that is clear and accessible for the student who has experienced trauma.