Using acupuncture for acute pain in hospitalized children.

OBJECTIVE: Clinical study to determine the acceptability and feasibility of acupuncture for acute postoperative pain control in hospitalized children. DESIGN: Nonrandomized clinical trial. SETTING: A single, tertiary referral pediatric intensive care unit. PATIENTS: A total of 20 patients aged 7 months to 18 years. Eleven of the patients had posterior spinal fusion surgery and the remaining nine patients had other surgical diagnoses. INTERVENTIONS: Two 10- to 15-minute sessions of acupuncture 24-48 hours apart. OUTCOME MEASURES AND RESULTS: The treatment was highly accepted (27 patients were approached and 4 patients refused; of the 23 patients enrolled, 20 patients completed the study). Acupuncture was well tolerated by patients without adverse events related to treatment. In follow-up interviews, 70% of both parents and patients believed acupuncture helped the child's pain. Eighty-five percent of the parents said they would pay out of pocket for acupuncture if not covered by insurance. The pain scores, vital signs, and narcotic usage were recorded before and several times after acupuncture. In posterior spinal fusion patients, the mean pain scores (0-10) immediately before and 4 and 24 hours after acupuncture were: 3.7, 1.7, and 3.1, respectively, after the first acupuncture session and 3.7, 2.2, and 3.1, respectively, after the second session. In the other surgical cohort, the mean pain scores immediately before and 4 and 24 hours after the first session of acupuncture were 2.5, 0.3, and 1.6, respectively. CONCLUSIONS: Our results support that acupuncture is highly accepted and feasible in critically ill, postoperative pediatric patients with acute pain. Our findings suggest that acupuncture may be a potentially useful adjunctive tool for acute pediatric postoperative pain management. A randomized, controlled clinical trial is warranted to confirm these findings.

Timing and directions for administration of questionnaires affect outcomes measurement.

We used data from two pilot studies to compare the change in patients' self-reported health-related quality of life after participation in two nearly identical Department of Veterans Affairs (VA) Blind Rehabilitation Center (BRC) programs, the Southwestern BRC in Tucson, Arizona, and the BRC at the VA hospital in Hines, Illinois. Researchers at the Southwestern BRC administered the National Eye Institute Visual Functioning Questionnaire as directed by the developer. Researchers at the Hines BRC modified the directions to consider use of low-vision devices. Interval person-ability and item-difficulty measures estimated from patient responses pre- and postrehabilitation were compared with these same measures obtained at follow-up. At the Southwestern BRC, no change was reported in either person or item measures 3 months after rehabilitation. At the Hines BRC, improvement was seen in both the person and item measures when measurements were made immediately following rehabilitation. Because a temporary halo effect may explain the higher ratings at discharge, veterans from the Hines cohort were contacted by telephone and administered the same instrument 3 years later. For these subjects, the improvement noted in the person measure disappeared at follow-up, while the improvement in the item measure was maintained.

Is "whole eye" wavefront analysis helpful to corneal refractive therapy?

PURPOSE: To examine how corneal refractive therapy (CRT) affects the balance between corneal surface and whole eye spherical aberration (Z4) and to identify whether corneal aberrations alone can accurately predict optical outcomes of CRT. METHODS: Whole eye and corneal spherical aberrations were measured at baseline and 1 month after CRT in 12 dilated eyes (baseline myopia range, -2.25 to -6.00 diopters [D]; mean, -3.23 +/- 1.06D). Whole eye aberrations were measured under cycloplegia using a Shack-Hartmann aberrometer, and corneal aberrations were measured using Keratron corneal topography elevation maps converted to wavefront Zernike polynomials using VOL-CT. Whole eye and corneal surface aberrations were scaled for 6-mm pupil diameters. RESULTS: No statistically significant correlation existed between corneal and whole eye spherical aberration at baseline. Corneal and whole eye spherical aberration increased in all eyes after CRT. A statistically significant and moderately positive correlation was found between corneal and whole eye spherical aberration after CRT (R = 0.632, P = 0.004). The linear regression slope was positive (m = +1.449) and indicated that whole eye spherical aberration exceeds corneal spherical aberration after CRT. CONCLUSIONS: Whole eye wavefront analysis is essential to methods designed to optimize visual performance with CRT; results indicate that CRT affects the entire optical system and not just the anterior corneal surface. Moreover, because CRT-induced whole eye spherical aberration cannot be explained by corneal aberrations alone, commonly accepted beliefs that the mechanism of action is limited to corneal tissue redistribution may need to be revisited.

Higher-order wavefront aberrations in corneal refractive therapy.

PURPOSE: To assess the changes in higher-order (third through sixth) ocular wavefront aberrations produced by Corneal Refractive Therapy (CRT; Paragon Vision Sciences, Mesa, AZ). METHODS: Eighteen eyes of nine myopic subjects were fit with CRT contact lenses. Baseline subjective spherical refraction ranged from -2.25 to -6.00 D (mean +/- SD, -3.33 +/- 1.26 D), and baseline logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity was -0.13 +/- 0.06 (20/15 Snellen equivalent). Whole-eye ocular wavefront aberrations were measured using a previously validated Shack-Hartmann aberrometer. Measurements were taken at baseline and 1 month after treatment initiation. Nine measurements per dilated subject were taken and averaged. Zernike coefficients were used to calculate the third-, fourth-, fifth-, and sixth-order root-mean-square values for each eye for both 3- and 6-mm pupil sizes, and aberrations were averaged and compared with prior baseline readings. RESULTS: The mean (+/-SD) myopia reduction was 3.08 +/- 0.93 D, resulting in a subjective refraction of -0.22 +/- 0.38 D after 1 month of lens wear. Both logMAR uncorrected visual acuity (-0.07 +/- 0.18; 20/15- Snellen equivalent) and best-corrected visual acuity (-0.14 +/- 0.09) after CRT wear were not significantly different from baseline logMAR best-corrected visual acuity (paired two-tailed t-test; p = 0.41 and 0.65, respectively). Whole-eye aberrations showed a statistically significant increase in higher-order aberrations for both 3-mm (factor of 2.66; p = 0.01) and 6-mm pupils (factor of 2.50; p = 0.005). Each individual higher-order aberration also increased, ranging from a factor of 2.01 to 3.20 for 3-mm pupil sizes and 2.52 to 2.98 for 6-mm pupil sizes. Spherical-like aberrations (S4 and S6) increased by a factor of 1.79 for 3-mm pupil sizes and 2.42 for 6-mm pupil sizes. The Zernike coefficient most affected by CRT was spherical aberration (Z40), which increased from 0.084 +/- 0.16 to 0.39 +/- 0.16 microm (p = 0.0002) for 6-mm pupils. CONCLUSIONS: Use of current CRT lenses for the reduction of myopia increased higher-order wavefront aberrations and spherical aberration (Z40) in particular.