A Multicenter Collaborative to Improve Postoperative Pain Management in the NICU.

OBJECTIVES: This quality improvement initiative aimed to decrease unrelieved postoperative pain and improve family satisfaction with pain management. METHODS: NICUs within the Children's Hospitals Neonatal Consortium that care for infants with complex surgical problems participated in this collaborative. Each of these centers formed multidisciplinary teams to develop aims, interventions, and measurement strategies to test in multiple Plan-Do-Study-Act cycles. Centers were encouraged to adopt evidence-based interventions from the Clinical Practice Recommendations, which included pain assessment tools, pain score documentation, nonpharmacologic treatment measures, pain management guidelines, communication of a pain treatment plan, routine discussion of pain scores during team rounds, and parental involvement in pain management. Teams submitted data on a minimum of 10 surgeries per month, spanning from January to July 2019 (baseline), August 2019 to June 2021 (improvement work period), and July 2021 to December 2021 (sustain period). RESULTS: The percentage of patients with unrelieved pain in the 24-hour postoperative period decreased by 35% from 19.5% to 12.6%. Family satisfaction with pain management measured on a 3-point Likert scale with positive responses ≥2 increased from 93% to 96%. Compliance with appropriate pain assessment and numeric documentation of postoperative pain scores according to local NICU policy increased from 53% to 66%. The balancing measure of the percentage of patients with any consecutive sedation scores showed a decrease from 20.8% at baseline to 13.3%. All improvements were maintained during the sustain period. CONCLUSIONS: Standardization of pain management and workflow in the postoperative period across disciplines can improve pain control in infants.

[Macro-social stress in adolescence--results of a repeat-interview about war anxiety and anxiety of environmental destruction]. / Makro-sozialer Stress im Jugendalter--Ergebnisse einer Wiederbefragung zu Kriegsangst und Angst vor Umweltzerstörung.

The article reports first results from a follow-up survey (N = 837) on existential anxieties with a sample of 8- to 20-year-olds from the Federal Republic of Germany who had been questioned first in 1985. The report focuses only on data gathered with the 'worry scale' by Goldenring und Doctor. Analyses based on a time-sequential-design show that (cross-sectionally as well as longitudinally) personal worries (concerned with everyday hassles, critical life-events, and micro-social stressors) decline with age. For politically based worries (concerned with so-called macro-social stressors), however, there is a strong gender difference: While in the cross-sectional analyses there is no mean difference between older and younger adolescents of both sexes, the longitudinal analyses show a possibly historical effect: Not only do girls express more personal als well as political worries (in whatever way this may be interpreted psychologically), their worries in the political field even increased at the end of the eighties whereas fears of boys in that domain remained constant. Consequences of the gulf war are briefly discussed.

Struma ovarii: a case report.

A patient with struma ovarii and hyperthyroidism is described. She was treated for Graves' hyperthyroidism at age 22 and received thyroxine for post-operative hypothyroidism. Twenty years later she became thyrotoxic and was treated with antithyroid drugs and radioiodine. Diagnosis of struma ovarii was made by radioiodine profile scanning and an ovarian tumour was removed. This had the pathological features of struma ovarii and autoradiographic evidence of pre-operatively administered 125I was seen in the lesion. The patient had positive results for long acting thyroid stimulator (LATS) and LATS-protector (LATS-P) pre- and post-operatively. Bioassays for thyroid stimulators were positive post-operatively but radioreceptor assays for TsAb were consistently negative. It is suggested that profile scanning is an appropriate investigation for diagnosis. It is not clear whether the lesion was autonomous or being stimulated by circulating thyroid stimulators.