Routine procedures in NICUs: factors influencing pain assessment and ranking by pain intensity

BACKGROUND: Pain associated with routine procedures in NICUs is often inadequately managed. Barriers to more appropriate pain management are nurses' and physicians' knowledge and the challenges of collaborative decision-making. Few studies describe the differing perceptions of procedural pain intensity among nurses and physicians in NICUs which could complicate common decision-making. This study set out to explore the factors influencing pain intensity assessment and to gain insight into a possible pain intensity classification of routine procedures in the NICU. METHOD: A survey was conducted among 431 neonatal health care professionals from 4 tertiary level NICUs. Each routine procedure was assessed on a 10-point visual analogue scale (VAS) assuming absence of analgesia. RESULTS: Multiple ANCOVA models showed that nurses rated 19 of the 27 procedures as significantly more painful than did physicians (p<0.05). We found no differences in pain assessment based on professional experience, gender or age. Of the 27 procedures listed, 70% were rated as painful and 44% were judged very painful. Ranking and classification of the pain intensity of routine procedures were drawn up. The general ranking of the median across all procedures shows that "insertion of a thoracic drain" is assessed as the most painful procedure. CONCLUSIONS: The majority of routine procedures in an NICU are considered to be painful. Nurses generally rate procedures as more painful than do physicians. This difference in assessment deserves exploration in regard to its impact on collaborative decision-making in neonate pain management.     

辛芩颗粒治疗变态反应性鼻炎685例临床观察

变态反应性鼻炎(过敏性鼻炎)是耳鼻喉科常见病,近年来发病率有升高趋势.虽然有许多抗过敏药物对其发作时控制和缓解症状有一定作用,但往往疗效不够巩固,许多药物又有一定副作用.我科自1997年起采用四川志远广和制药有限公司生产的纯中药制剂无糖型颗粒制剂辛芩颗粒(冲剂)治疗本病,收到较好效果,总结报道如下.     

儿童睡眠呼吸状况调查以及睡眠呼吸障碍相关症状分析

目的调查分析学龄前儿童的睡眠呼吸状况,了解学龄前儿童经常打鼾、睡眠呼吸困难或障碍的发病率。方法对1964名3～7岁儿童父母发送儿童睡眠呼吸情况调查表,收回完整填写的调查表1514份,返回率为77．08％。结果1514名儿童中,睡眠中经常打鼾为93名（6．14％）,不经常打鼾（包括偶尔打鼾和从不打鼾）为1421名（93．86％）。经常打鼾儿童中夜间睡眠呼吸困难或暂停等呼吸障碍症状的发病率为31．2％,显著高于不经常打鼾儿童的1．2％（P〈0．01）。经常打鼾儿童夜间睡眠不稳定的发生率为57．0％,显著高于不经常打鼾儿童的20．1％（P〈0．01）。经常打鼾儿童好动、学习成绩和学习能力差的发生率为64．5％,显著高于不经常打鼾儿童的14．8％（P〈0．01）。结论经常打鼾儿童有较高的呼吸障碍发病率,其日间症状好动以及学习能力和学习成绩较差,夜间较容易出现惊醒和遗尿。     

Tetrasomy 9p due to an intrachromosomal triplication of 9p13-p22

To date, approximately 30 patients have been described with a tetrasomy 9p, all being caused by the presence of an isochromosome 9p. We now report on a 3-year-old boy with a de novo intrachromosomal triplication of 9p13-p22, resulting in partial tetrasomy 9p. We compared his phenotype with cases of tetrasomy 9p caused by the presence of an extra isochromosome 9p. He has facial anomalies similar to those of cases of tetrasomy 9p, central nervous system abnormalities, and severe psychomotor retardation but no other major congenital anomalies. Fluorescence in situ hybridization with region-specific probes showed that the middle repeat of the triplicated part is inverted. Microsatellite analysis demonstrated an involvement of both paternal chromosome 9 homologues in the triplication. This is compatible with either unequal crossing over of three of the four chromatids in paternal meiosis I or with a double crossing over in meiosis I and II (or an early mitotic division). Am. J. Med. Genet. 86:168–173, 1999. © 1999 Wiley-Liss, Inc.     

G-CSF administration is neuroprotective following transient cerebral ischemia even in the absence of a functional NOS-2 gene

Granulocyte colony-stimulating factor (G-CSF) is a candidate neuroprotective factor following cerebral ischemia. To determine whether G-CSF acts partly through the inhibition of nitric oxide synthase (NOS)-2 expression, we administered G-CSF to male NOS-2−/− mice after cerebral ischemia. Although male NOS-2−/− mice exhibit resistance to the gross effects of cerebral ischemia, they display neuronal loss and skilled motor deficits following cerebral ischemia. Administration of G-CSF during reperfusion reduced motor deficit and neuronal loss. Thus, G-CSF is still effective in NOS-2 gene-deficient mice, suggesting that part of the mechanism of action is independent of NOS-2.     

Triple antiplatelet therapy for preventing vascular events: a systematic review and meta-analysis

Background  

Dual antiplatelet therapy is usually superior to mono therapy in preventing recurrent vascular events (VEs). This systematic review assesses the safety and efficacy of triple antiplatelet therapy in comparison with dual therapy in reducing recurrent vascular events.