Comparison of three preverbal scales for postoperative pain assessment in a diverse pediatric sample

The purposes of this study were to compare the reliability and validity of three pain measurement scales for assessing pain in preverbal and nonverbal children and to determine which of the scales was mos tappropriate in a clinical setting to evaluate pain for infants and young children regardless of developmental stage or cognitive or physical disability. Pain scales tested were revised versions of the Riley Infant Pain Scale (RIPS), the Nursing Assessment of Pain Intensity (NAPI), and the Postoperative Pain Score (POPS). Purposive sampling of 391 postoperative infants and children was used for evaluation of pain in a midwestern children's hospital. Four assessments with each scale were done 1 hr apart by trained observers blinded to pain medications. Data analyses supported high inter-rater reliability, satisfactory discrimination between pain and no-pain observations, and suggested acceptability for all three scales with lower caregiver burden for RIPS and NAPI.     

Portal vein reflectors: Duplex sonographic appearance

Duplex sonography has established utility in the noninvasive evaluation of the portal venous system. Recently, the duplex sonographic features of suspected portal venous air have been described. We report on an experimental study in dogs undertaken to establish if the same sonographic features could be reproduced in a laboratory setting and to determine if small fragments of clot emboli could produce similar gray-scale and Doppler findings. Injections of microbubbles of air and clot fragments into the portal venous system were monitored using duplex ultrasound. The gray-scale and Doppler features of flow in the main portal vein were indistinguishable in both microbubble and clot injections. Superimposition of high-amplitude spikes on the normal portal venous waveform was seen in 19 of 24 (79%) microbubble and 13 of 23 (56%) clot fragment injections. We conclude that the appearance of rapidly moving, bright intraluminal echoes coupled with spike-like aberrations of the portal venous waveform can be associated with portal venous air bubbles or small blood clot emboli.     

Ultrasonography to Evaluate Adults for Appendicitis: Decision Making Based on Meta-analysis and Probabilistic Reasoning

Objectives: To review ultrasonography (US) test performance and to develop recommendations for the use of US to aid in the evaluation of potential appendicitis.
Methods: A meta-analysis was conducted using all English-language articles published since 1986 (17 studies; 3,358 patients) to ascertain sensitivity and specificity of US for diagnosing appendicitis in adults and teenagers. Calculation of the predictive value of US was performed for three groups of patients: group I—usually operated on (prevalence of appendicitis = 80%); group II—usually observed in hospital (prevalence = 40%); and group III—usually released home (prevalence 2%).
Results: Overall sensitivity was 84.7% (95% CI: 81.0–87.8%), and specificity 92.1% (88.0–95.2). The accuracy and usefulness of US were related to the likelihood of appendicitis. In group I, a positive test was accurate [positive predictive value (PPV) = 97.6%], but a negative study could not rule out appendicitis [negative predictive value (NPV) = 59.5%]. The converse was true for group III patients (PPV = 19.5%, NPV = 99.7%). Test performance accuracy was balanced only for group II patients (PPV = 87.3%, NPV = 89.9%).
Conclusions: 1) US should not be used to exclude appendicitis for patients who have "classic" signs/symptoms, due to the underlying high false-negative rate. 2) US is most useful for patients who have an indeterminate probability of disease after the initial evaluation—if US is positive, the patient should have an operation; otherwise, he or she should be observed. 3) US is not recommended for screening patients who have a low probability of appendicitis, due to the low prevalence of disease and high false-positive rate in this group.     

Clinical research priorities in oncology nursing: An Australian perspective

The aims of this research project were to identify areas for research in oncology nursing that have potential for improvement in patient care and to advise about nursing-research policy and priorities that have relevance to areas of patients'needs. Research participants included 10 Clinical Nurse Consultants (CNC) representing 10 area health authorities in New South Wales, Australia. The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and more than 31 high priorities were identified. Quality of life and symptom management emerged as the top two priority categories in the study. The findings of the study provide direction for clinical nursing research in oncology.     

Caring for the wounded healer—nurturing the self

Health professionals have to deal with a “wounded society”, for example, violence, natural disasters and displaced people. Shortage of health professional groups and the high use of complementary therapies may reflect professional wounds, such as stress and burnout. Self-care is an important aspect of health professionals’ lives, given modern-day work stressors that can affect an individual's physical, mental and spiritual health. Often people become healers through personal suffering. Each person wounded or not, needs to understand his or her own need to be nurtured, and develop and implement a self-care health programme. Personal and professional reflection are important to understanding the nature of events that lead to “wounds” and how they can be transcended and the experiences used in holistic care. Aromatherapy can be a useful addition to self-care especially in managing stress and minor self-limiting conditions.     

Doppler and color Doppler ultrasonography in renal transplants: chronic rejection.

Although Doppler and color Doppler ultrasonography has been used extensively to examine acute changes in renal allograft function, there have been few reports on the role of Doppler ultrasonography in the assessment of chronic rejection. In those studies that have addressed chronic rejection, there is agreement that changes in renal function are not accompanied by consistent changes in flow wave-form shape. The pathology of chronic rejection may be very different from the changes seen in acute rejection and its onset is usually gradual. Some authors have suggested that the decline in function is accompanied by lower Doppler frequency shifts (corresponding to lower velocities) in intra-renal arteries. In a preliminary study comparing grafts with normal renal function and with biopsy-proven chronic rejection, it has been shown that for grafts with chronic rejection, observed intra-renal velocities are lower, especially at segmental and interlobar levels. This may be a more reliable reflection of reduced renal blood flow in chronic rejection than conventional Doppler ultrasound analysis of flow waveform shape. However, the diagnostic use of changes to intra-renal flow velocities in chronic rejection is currently very limited.