Objective: This study aims to examine the relationship between emergency department patient encounter characteristics and narcotic analgesic prescribing practices in order to determine what patient characteristics, if any, influence the decision to prescribe narcotics.Methods: Cross sectional data on patients presenting to U.S. emergency departments from the 2003 and 2004 National Hospital Ambulatory Medical Care Survey were analyzed. Patients reporting moderate to severe pain were included in the sample and analysis. Chi square tests of significance were used to assess the association between individual demographic and encounter characteristics to narcotic prescription or administration. Separate multiple logistic regressions were then performed on patients presenting with one of the three most common diagnosis categories or reasons for visit, since this was thought to also influence the decision to prescribe narcotics or not. Multivariate analysis produced adjusted odds ratios and 95% confidence intervals in order to determine the independent associations between each predictor variable and narcotic medication prescription or administration.Results: Our sample included 26,248 individuals presenting to U.S. emergency departments with moderate to severe pain as recorded by the NHMCS survey. Various patient and encounter characteristics appeared to influence narcotic administration in the univariate analysis including age, race, ethnicity, alcohol use, method of payment, geographic location and whether or not visit was related to a work injury or illness. No gender differences were found. Combining the top 3 reasons for visit, we found that race, patient alcohol use, age, geographic location and ethnicity all had significant bearing on the prescription of narcotics. Much of this was true when looking at top three diagnoses. Age, race, patient alcohol use, and geographic location were all associated with significantly different rates of narcotic administration, while ethnicity dropped out of significance. Black race, in both subcategories of analysis, showed the greatest association with decreased odds of receiving narcotic drugs in the ED.Conclusion: While initiatives like Healthy People 2010 are aimed at improving health and eliminating health care disparities, it appears that disparities still do exist on many levels. As it has been concluded through various other studies, it appears that race does influence health care providers' decisions to prescribe or administer narcotics. In January of 2001 JAHCO revised their standards to better address pain management of patients in the United States. While pain may be better-evaluated and recorded and overall rates or pain medication administration or prescription may have improved, it appears that the common disparities have not.

The purpose of this study was to determine the changes in prescribing habits of active members of American Association of Endodontics (AAE) with regards to antibiotics in comparison to the findings reported by Yingling et al. in 1999. The invitations to take the online survey were sent via email to 2593 active members. A response rate of 37.75% was obtained. It was determined to be adequate for analysis and for comparison to the results obtained by Yingling et al. Comparisons between the percentages shown in this survey and the previous survey were tested using a z-test. An ANOVA model was used to determine the relationships between predictive factors and the number of prescriptions written. The change in distribution of respondents was notable with an increase in younger clinicians (25% in 1999 to 36% at present). They were more likely to be in private practice and much less in part-time academic and private practice setting. The number of patients being seen per week and the number of prescriptions written per week also decreased in comparison (p<0.001). For all the considered factors, it was also noted that board certified endodontists were prescribing less antibiotics per week. A positive correlation was noted for number of years in practice (p=0.0006), type of practice (p<0.001) and number of prescriptions written per week. Changes in choice of antibiotics were also noted. There was a decrease in use of Penicillin (61.48% to 43%), an increase in the use of Amoxicillin (27.5% to 37.6%), and an increase in use clindamycin (45.3% to 64%) for patients with no medical allergies. As for patients with medical allergies, there was a steep incline in the use of clindamycin (56.03% to 90.3%) as first choice to an increase in azithromycin (7.4% to 38%) as a second choice. An improved trend was noted with a significant decrease in use of antibiotics in managing most of the endodontic scenarios given. Antibiotic use in cases of irreversible pulpitis significantly dropped from 16.76% to 12% (p<0.05); in necrotic pulps with acute apical periodontitis with no swelling, a significant decline from 53.9% to 28.3% (p<0.001); significant decreases were also noted for necrotic pulp with chronic apical periodontitis with no/mild symptoms, 18.8% to 16.1% (p=0.029), and necrotic pulp with acute apical periodontitis with swelling and mod/severe symptoms, 99.2% to 92.4% (p<0.001). An exception was noted for necrotic pulp with chronic apical periodontitis with a sinus tract where there was a significant increase in antibiotic use from 11.9% to 29.1% (p<0.001). Many clinicians (19%) were still giving antibiotics due to soliciting of patients and referring general dentists in fear of losing referrals. A disturbing find is that 50% of the respondents were using antibiotics to manage post treatment flare-ups and pain, while 13% were using antibiotics for inter-appointment pain. As for prophylactic antibiotics, most clinicians were aware of the new AHA/ADA guidelines and were abiding by them. Most of the clinicians responding to survey were choosing the appropriate antibiotics and regimen (i.e. dosage, loading dose, and duration). Although there is an improvement in trends, it has to be noted that there is still an indiscriminate and overuse of antibiotics at large. There needs to be greater improvement in the use of antibiotics in endodontics, and a group effort as a specialty is needed in halting this alarming problem of antibiotic resistance globally.

<p>Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. </p><p>Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes. </p><p>Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance. </p><p>Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.</p> / Dissertation

Introdução: A dor neonatal merece atenção diferenciada pelos profissionais de saúde, uma vez que os recém-nascidos (RNs) não se expressam verbalmente. A grande dificuldade existente para avaliar e tratar a dor em RNs internados em Unidades de Terapia Intensiva Neonatal (UTIN) continua sendo uma preocupação para profissionais e pesquisadores da área. Nesse sentido, essa pesquisa tem como pergunta: Como se dão as práticas de avaliação e tratamento da dor em RNs internados em UTINs de Curitiba (PR) e Região Metropolitana? Objetivo geral: Descrever o conhecimento e as práticas de manejo da dor do RN, empregadas por enfermeiros que atuam em UTINs. Objetivos específicos: Verificar o conhecimento dos enfermeiros sobre o manejo da dor de RNs internados; caracterizar as estratégias não farmacológicas e farmacológicas adotadas pelos enfermeiros para o controle da dor de RNs internados; verificar a forma de registro da avaliação e do tratamento da dor realizada pelos enfermeiros. Metodologia: Estudo transversal realizado em seis hospitais de Curitiba (PR) e Região Metropolitana que possuem UTIN com atendimento pelo Sistema Único de Saúde (SUS), a amostra do estudo foi constituída por 51 enfermeiros. A coleta de dados se deu por meio de questionários contendo informações a respeito da caracterização das unidades, um questionário referente ao perfil dos enfermeiros, formação, atuação e qualificação profissional e outro sobre conhecimentos e práticas do manejo da dor neonatal. A análise dos dados ocorreu pelo Statistical Package for Social Sciences (SPSS versão 21.0) e o nível de significância adotado foi de 5%. Resultados: A maioria dos enfermeiros era mulheres com idade entre 20 e 30 anos e tempo de formação de 1 a 5 anos. Os profissionais responsáveis pela avaliação da dor do RN eram em sua maioria enfermeiros (84,3%), seguidos por técnicos (62,7%) e auxiliares de enfermagem (11,8%). A maioria dos enfermeiros concordou que os RNs são capazes de sentir dor, porém 34,7% afirmaram nunca utilizar escalas para avaliar a dor do RN. 98% dos enfermeiros concordaram que é importante registrar a dor no prontuário do RN, sendo a evolução e anotação de enfermagem os locais mais mencionados em que ocorre o registro. As medidas não farmacológicas para alívio da dor neonatal assinaladas pelos enfermeiros foram: glicose oral, sucção não nutritiva, posicionamento, ninho, diminuição de estímulos auditivos, método canguru, toque, diminuição de estímulos visuais, contenção, aleitamento materno, massagem e musicoterapia. O Paracetamol e o Fentanil foram as medidas farmacológicas mais assinaladas pelos enfermeiros, seguidos pela Morfina, Codeína, Midazolam, Hidrato de Cloral e Lidocaína. Conclusões: Os enfermeiros conhecem as medidas farmacológicas e não farmacológicas para alivio da dor neonatal, porém a prática difere dos conhecimentos apresentados por não utilizarem estas medidas para alívio da dor em RNs. / Introduction: The neonatal pain needs special attention by health professionals, because newborns dont verbalize. The large difficulty to assess and treat pain in newborns admitted in Neonatal Intensive Care Units (NICU) is a big concern for professionals and researchers. For this reason, this research has the question: What are the evaluation practices and treatment of pain in newborns admitted to NICUs in Curitiba (PR) and metropolitan area? General aim: To describe the knowledge and practices about newborns pain relief employed by nurses that work in NICUs. Specifics aims: To verify the knowledge of nurses on the management of hospitalized newborns pain, to characterize the pharmacological and non-pharmacological strategies used by nurses to control hospitalized newborns pain and identify the ways of registration of the evaluation and treatment of pain held by nurses. Methodology: Cross-sectional study that occurred in six hospitals in Curitiba, Paraná State and metropolitan area that have NICU with care by the Unified Health System. The study sample consisted of 51 nurses. The data collection was through questionnaires containing information about the characterization of the units, a questionnaire relating to the profile of nurses, education, experience and professional qualifications and another questionnaire about knowledge and practices of management of neonatal pain. Analysis of the data was the Statistical Package for Social Sciences (SPSS - version 21.0) and the significance level was 5%. Results: The majority of nurses are women, the ages are between 20 and 30 years and 1-5 years of graduation. The professionals responsible for newborns pain assessment are mostly nurses (84.3%), followed by technicians (62.7%) and nursing assistant (11.8%). Most of the nurses agree that newborns are capable of feeling pain, but 34.7% reported never using scales to assess newborns pain. 98% of the nurses agree that is important to register the pain on newborn s chart record, being the evolution and nursing note the most mentioned places where the registration takes place. The non-pharmacological measures to relieve neonatal pain marked by nurses were: oral glucose, non-nutritive sucking, positioning, nest, decreased auditory stimuli, kangaroo method, touch, decreased visual stimuli, containment, breastfeeding, massage and music therapy. Paracetamol and Fentanyl were the pharmacological measures more marked by nurses, followed by Morphine, Codeine, Midazolam, Chloral Hydrate and Lidocaine. Conclusions: The nurses know the pharmacological and non-pharmacological measures to relief neonatal pain, but the practice differs from the knowledge shown because they do not use these measures to relief pain in newborns.

Introdução: A dor neonatal merece atenção diferenciada pelos profissionais de saúde, uma vez que os recém-nascidos (RNs) não se expressam verbalmente. A grande dificuldade existente para avaliar e tratar a dor em RNs internados em Unidades de Terapia Intensiva Neonatal (UTIN) continua sendo uma preocupação para profissionais e pesquisadores da área. Nesse sentido, essa pesquisa tem como pergunta: Como se dão as práticas de avaliação e tratamento da dor em RNs internados em UTINs de Curitiba (PR) e Região Metropolitana? Objetivo geral: Descrever o conhecimento e as práticas de manejo da dor do RN, empregadas por enfermeiros que atuam em UTINs. Objetivos específicos: Verificar o conhecimento dos enfermeiros sobre o manejo da dor de RNs internados; caracterizar as estratégias não farmacológicas e farmacológicas adotadas pelos enfermeiros para o controle da dor de RNs internados; verificar a forma de registro da avaliação e do tratamento da dor realizada pelos enfermeiros. Metodologia: Estudo transversal realizado em seis hospitais de Curitiba (PR) e Região Metropolitana que possuem UTIN com atendimento pelo Sistema Único de Saúde (SUS), a amostra do estudo foi constituída por 51 enfermeiros. A coleta de dados se deu por meio de questionários contendo informações a respeito da caracterização das unidades, um questionário referente ao perfil dos enfermeiros, formação, atuação e qualificação profissional e outro sobre conhecimentos e práticas do manejo da dor neonatal. A análise dos dados ocorreu pelo Statistical Package for Social Sciences (SPSS versão 21.0) e o nível de significância adotado foi de 5%. Resultados: A maioria dos enfermeiros era mulheres com idade entre 20 e 30 anos e tempo de formação de 1 a 5 anos. Os profissionais responsáveis pela avaliação da dor do RN eram em sua maioria enfermeiros (84,3%), seguidos por técnicos (62,7%) e auxiliares de enfermagem (11,8%). A maioria dos enfermeiros concordou que os RNs são capazes de sentir dor, porém 34,7% afirmaram nunca utilizar escalas para avaliar a dor do RN. 98% dos enfermeiros concordaram que é importante registrar a dor no prontuário do RN, sendo a evolução e anotação de enfermagem os locais mais mencionados em que ocorre o registro. As medidas não farmacológicas para alívio da dor neonatal assinaladas pelos enfermeiros foram: glicose oral, sucção não nutritiva, posicionamento, ninho, diminuição de estímulos auditivos, método canguru, toque, diminuição de estímulos visuais, contenção, aleitamento materno, massagem e musicoterapia. O Paracetamol e o Fentanil foram as medidas farmacológicas mais assinaladas pelos enfermeiros, seguidos pela Morfina, Codeína, Midazolam, Hidrato de Cloral e Lidocaína. Conclusões: Os enfermeiros conhecem as medidas farmacológicas e não farmacológicas para alivio da dor neonatal, porém a prática difere dos conhecimentos apresentados por não utilizarem estas medidas para alívio da dor em RNs. / Introduction: The neonatal pain needs special attention by health professionals, because newborns dont verbalize. The large difficulty to assess and treat pain in newborns admitted in Neonatal Intensive Care Units (NICU) is a big concern for professionals and researchers. For this reason, this research has the question: What are the evaluation practices and treatment of pain in newborns admitted to NICUs in Curitiba (PR) and metropolitan area? General aim: To describe the knowledge and practices about newborns pain relief employed by nurses that work in NICUs. Specifics aims: To verify the knowledge of nurses on the management of hospitalized newborns pain, to characterize the pharmacological and non-pharmacological strategies used by nurses to control hospitalized newborns pain and identify the ways of registration of the evaluation and treatment of pain held by nurses. Methodology: Cross-sectional study that occurred in six hospitals in Curitiba, Paraná State and metropolitan area that have NICU with care by the Unified Health System. The study sample consisted of 51 nurses. The data collection was through questionnaires containing information about the characterization of the units, a questionnaire relating to the profile of nurses, education, experience and professional qualifications and another questionnaire about knowledge and practices of management of neonatal pain. Analysis of the data was the Statistical Package for Social Sciences (SPSS - version 21.0) and the significance level was 5%. Results: The majority of nurses are women, the ages are between 20 and 30 years and 1-5 years of graduation. The professionals responsible for newborns pain assessment are mostly nurses (84.3%), followed by technicians (62.7%) and nursing assistant (11.8%). Most of the nurses agree that newborns are capable of feeling pain, but 34.7% reported never using scales to assess newborns pain. 98% of the nurses agree that is important to register the pain on newborn s chart record, being the evolution and nursing note the most mentioned places where the registration takes place. The non-pharmacological measures to relieve neonatal pain marked by nurses were: oral glucose, non-nutritive sucking, positioning, nest, decreased auditory stimuli, kangaroo method, touch, decreased visual stimuli, containment, breastfeeding, massage and music therapy. Paracetamol and Fentanyl were the pharmacological measures more marked by nurses, followed by Morphine, Codeine, Midazolam, Chloral Hydrate and Lidocaine. Conclusions: The nurses know the pharmacological and non-pharmacological measures to relief neonatal pain, but the practice differs from the knowledge shown because they do not use these measures to relief pain in newborns.

A dor é um fenômeno que está presente na assistência em saúde aos neonatos, e sua identificação, avaliação e tratamento pela equipe de saúde são ações relevantes para o bem estar do bebê, visto que interfere no restabelecimento de sua saúde e pode gerar consequências deletérias a curto, médio e longo prazo. O presente trabalho trata-se de um estudo quali-quantitativo, descritivo exploratório, cujo objetivo foi identificar o manejo da dor neonatal sob a perspectiva da equipe de saúde de uma maternidade de Ribeirão Preto - SP. Na etapa quantitativa do estudo, participaram 81 profissionais de saúde da maternidade: 12 pediatras, 1 técnica do laboratório, 22 enfermeiras e 46 auxiliares/técnicas de enfermagem, que responderam a um questionário de autopreenchimento com questões objetivas sobre dados pessoais, profissionais e dados específicos sobre o conhecimento e a prática da avaliação e manejo não farmacológico da dor neonatal. Na segunda etapa, profissionais considerados líderes de equipe foram convidados a participar, de forma individual, de uma entrevista semiestruturada gravada em áudio que após a transcrição foram submetidas à análise de conteúdo. Da análise dos dados quantitativos, constatou-se que todos os médicos, enfermeiras, técnica do laboratório e a grande maioria (89,1%) das auxiliares/técnicas de enfermagem referiram que o recém-nascido é capaz de sentir dor. 83,3% dos médicos, 77,3% das enfermeiras e 54,3% das auxiliares/técnicas de enfermagem, acreditam que procedimentos potencialmente dolorosos repetidos podem gerar alguma consequência ao neonato. A maioria dos profissionais afirmou que avaliam a dor do recém-nascido, tendo como parâmetros mais frequentes o choro, a mímica facial, e movimentos, construindo uma avaliação subjetiva sem o uso de escalas. As medidas não farmacológicas de alívio da dor mais citadas pelos profissionais foram: a oferta de sacarose a 25%, a sucção não nutritiva e a amamentação, com um predomínio da utilização da sacarose como principal método de escolha. Poucos profissionais de saúde se preocupam em realizar o registro adequado sobre a avaliação e o manejo da dor aguda do recém-nascido. Da análise dos dados qualitativos, 5 categorias e 15 subcategorias surgiram a partir das verbalizações das participantes: 1) \"Fatores facilitadores do manejo da dor neonatal\" (atuação dos profissionais; a utilização de métodos não farmacológicos; o uso sacarose como principal escolha para o alívio da dor neonatal; outras intervenções não farmacológicas), 2) \"Fatores dificultadores do manejo da dor neonatal\" (falhas em como lidar com a dor; excesso de procedimentos dolorosos; fluxo de trabalho e quantidade de recursos humanos), 3) \"Avaliação da dor\" (como e quando avaliar a dor; a importância da avaliação a dor), 4) \"Mudanças necessárias para melhorar o manejo da dor na instituição\" (treinamentos; protocolos e utilização de escalas para avaliação da dor; mudança na atitude dos profissionais e sensibilização da equipe), 5) \"Participação dos pais e/ou família no manejo da dor neonatal\" (vantagens e apoio ao manejo da dor neonatal com participação da família; dificuldades na participação da família no manejo da dor neonatal). Concluiu-se que há um conhecimento superficial dos profissionais de saúde quanto à avaliação e o manejo não farmacológico da dor neonatal aguda nesta maternidade, assim como há falta de protocolos clínicos formais, registros e capacitação dos profissionais de saúde. Considerando-se as propostas do cuidado atraumático, desenvolvimental e humanizado ao recém-nascido, torna-se imperativo mudanças de ações e condutas da equipe de saúde no que se refere ao manejo da dor neonatal, que deverá ser movida e estimulada a partir capacitações profissionais fundamentadas na transferência de conhecimento / Pain is a phenomenon that is present in the health care provided to neonates, and its identification, assessment and treatment by the health team are relevant actions for the welfare of the baby, since they interfere in the reestablishment of their health and may produce harmful consequences in the short, medium and long term. This is a quali-quantitative, descriptive and exploratory study with the aim to identify the management of neonatal pain from the perspective of the health team of a maternity hospital in Ribeirão Preto, São Paulo, Brazil. The quantitative stage of the study involved the participation of 81 health professionals from the maternity: 12 pediatricians, 1 laboratory technician, 22 nurses and 46 nursing technicians/aides, who answered a self-administered questionnaire containing objective questions regarding personal, professional and specific data on the knowledge and practice of the assessment and non-pharmacological management of neonatal pain. In the second stage, professionals who were considered to be team leaders were invited to participate, individually, in a semi-structured interview whose audio was recorded, transcribed and submitted to content analysis. The analysis of the quantitative data evidenced that all physicians, nurses, the laboratory technician and most of the nursing technicians/aides (89.1%) stated the newborn is capable of feeling pain. A total of 83.3% of the physicians, 77.3% of the nurses and 54.3% of the nursing technicians/aides believe that repetitive potentially painful procedures may bring some consequence to the neonate. Most of the professionals stated they assess the pain of the newborn, using their crying, facial mimics and movements as parameters, building a subjective assessment without the use of scales. The non-pharmacological measures for pain relief most commonly cited by the professionals were: offering a 25% sucrose solution, non-nutritional suction and breastfeeding, with prevalence for the use of sucrose as the main chosen method. Few health professionals care to make an appropriate record regarding the assessment and management of acute pain in the newborn. The analysis of the qualitative data generated 5 categories and 15 subcategories, based on the speeches of the participants: 1) \"Facilitating factors in the management of neonatal pain\" (performance of the professionals; use of non- pharmacological methods; use of sucrose as the main choice for relieving neonatal pain; other non- pharmacological interventions), 2) \"Complicating factors in the management of neonatal pain\" (failures in how to deal with the pain; excess of painful procedures; workflow and quantity of personnel), 3) \"Pain assessment\" (how and when to assess; the importance of pain assessment), 4) \"Necessary changes to improve pain management in the institution\" (trainings; protocols and the use of scales to assess pain; changing the attitude of professionals and making the team more sensitive), 5) \"Participation of the parents and/or family in the management of neonatal pain\" (advantages and support in the management of neonatal pain with the participation of the family; difficulties in the participation of the family for managing neonatal pain). In conclusion, health professionals have a superficial knowledge regarding the assessment and non-pharmacological management of acute neonatal pain in the studied maternity hospital. In addition, there is a lack of formal clinical protocols, records and qualification of health professionals. Considering the proposals for non-traumatic, developmental and humanized care to the neonate, it becomes imperative to make changes in actions and conducts of the health team in terms of neonatal pain management, as these professionals must be driven and encouraged based on professional qualifications grounded on knowledge transfer

O alívio da dor humana é preceito defendido há milênios e considerado importante missão dos profissionais da saúde. No entanto, milhões de pacientes todos os anos sofrem de dor aguda como resultado de um trauma, doença ou cirurgia. A dor aguda em pós-operatório, decorrente de lesões teciduais, pode gerar alterações fisiológicas que, se não forem resolvidas podem resultar em dor crônica, trazendo prejuízos à saúde e à qualidade de vida. A cirurgia de mastectomia, principal abordagem terapêutica para o tratamento primário do câncer de mama, é responsável por uma série de alterações vivenciadas pelos pacientes que a enfrentam, pois é um processo cirúrgico agressivo que pode levar à ocorrência de dor persistente no pós- operatório. O presente estudo consiste de uma revisão integrativa de literatura com o objetivo de analisar as evidências disponíveis na literatura sobre o manejo da dor pós-operatória em pacientes submetidos à mastectomia. A busca dos estudos primários foi realizada nas bases de dados LILACS, PubMed e CINAHL e compreendeu o período de julho de 2007 a julho de 2012. A amostra constituiu de 21 artigos científicos, que foram reunidos em quatro categorias temáticas: intervenções farmacológicas (5 artigos), intervenções não farmacológicas (4 artigos), técnicas anestésicas (11 artigos) e mensuração da dor (1 artigo). Os resultados evidenciaram que nos estudos com intervenções farmacológicas para o controle da dor pós- operatória, os fármacos utilizados como adjuvantes, associados aos analgésicos, AINEs, anestésicos e opioides, foram os anticonvulsivantes, os corticosteroides e os antidepressivos, que demonstraram ser adjuvantes seguros e eficazes para o manejo da dor após a mastectomia; algumas intervenções não farmacológicas, como medidas educacionais, musicoterapia e hipnose para analgesia pós-operatória foram investigadas com resultados positivos, mas esses achados necessitam de confirmação com estudos maiores e controlados para comprovar os benefícios dessas terapias sobre o manejo da dor em pacientes submetidos à mastectomia; apesar de mais pesquisas serem necessárias para avaliar o impacto do tratamento da dor pós-operatória sobre a síndrome da dor crônica pós-mastectomia, estudos demonstraram que o manejo adequado e eficaz da dor pós-operatória pode evitar o desenvolvimento dessas síndromes; as técnicas anestésicas foram a estratégia mais frequentemente utilizada para o manejo da dor pós-mastectomia e demonstraram ser eficazes na diminuição da dor aguda e na redução da necessidade de opioide intra e pós-operatório; há poucos estudos científicos que abordam a assistência de enfermagem no manejo da dor pós- mastectomia, evidenciando a necessidade de um número maior de publicações sobre o tema, por enfermeiros. Que estes resultados sirvam como estímulo para o desenvolvimento de novas pesquisas, no intuito de contribuir para o manejo eficaz e efetivo da dor pós-operatória em pacientes submetidos à mastectomia / Human pain relief is precept defended for millennia and considered important mission of heath care provider. However, millions of patients each year suffer acute pain as a result of trauma, disease or surgery. Acute pain in the postoperative period, resulting in tissue lesions, can cause physiological changes that, if not solved can result in chronic pain, impairing the health and quality of life. The mastectomy surgery, the main therapeutic approach for the treatment of primary breast cancer, is responsible for several changes experienced by patients because it is an aggressive surgical process that may result persistent pain in postoperative period. This study is an integrative literature review that aimed to analyze the evidence available in the literature on the postoperative pain management in patients undergoing mastectomy. The search of the primary studies was performed in the databases LILACS, PubMed and CINAHL and included the period between from July 2007 to July 2012. The sample consisted of 21 papers, which were grouped in four thematic categories: pharmacological interventions (5 studies), non-pharmacological interventions (four studies), anesthetic techniques (11 studies) and pain measurement (1 study). The results showed that in studies of pharmacological interventions for the postoperative pain control, the drugs used as adjuvants, associated with analgesics, nonsteroidal anti-inflammatory drugs, anesthetics and opioids were anticonvulsants, corticosteroids and antidepressants, which have proven to be safe and effective adjuvants for pain management after mastectomy; some non- pharmacological interventions for postoperative analgesia were investigated and the results were positive, but these findings need to be confirmed by larger and controlled studies to prove the benefits of these therapies for pain management in patients undergoing mastectomy, although more research is needed to assess the impact of treatment of postoperative pain on the syndrome of chronic post-mastectomy pain, studies have shown that proper and effective postoperative pain management may avoid the development of these syndromes; anesthetic techniques were the most frequently used strategy for the pain management after mastectomy and shown to be effective in decreasing acute pain and reduced need for opioid intra and postoperative; there are few scientific studies on nursing care in the management of pain after mastectomy, evident the need for a greater number of works on the theme, by nurses. It is expected that the results encourage the development of new research that may contribute to the efficient and effective management of postoperative pain in patients undergoing mastectomy

Introdução: Os recém-nascidos (RNs) compõem uma população vulnerável à dor, e a vivência repetida desta experiência pode resultar em prejuízos para seu desenvolvimento. Estudos retratam realidade alarmante vivenciada na Unidade de Terapia Intensiva Neonatal (UTIN), onde o número de procedimentos dolorosos realizados diariamente é expressivo. Objetivo geral: verificar a incidência de dor durante os primeiros sete dias de internação na UTIN. Objetivos específicos: determinar a prevalência da dor; identificar o tipo e a frequência de procedimentos invasivos aos quais os RN são submetidos, e verificar as medidas não farmacológicas e farmacológicas implementadas no alívio da dor. Metodologia: Estudo retrospectivo e longitudinal composto por todos os RNs internados na UTIN durante período de 12 meses. Das 188 internações ocorridas, 15 foram excluídas conforme os critérios estabelecidos e houve 2 perdas, o que resultou em 171 internações referentes a 150 RNs. A coleta dos dados foi realizada em impresso próprio por meio de leitura dos prontuários e a presença de dor foi avaliada com base na escala NIPS (Neonatal Infant Pain Scale) e presença de anotação de enfermagem sugestiva de dor. Para a análise estatística, utilizou-se o programa Statistical Package for the Social Sciences (SPSS) e foi adotado nível de significância de 5%. Resultados: Os RNs foram submetidos à média de 6,6 procedimentos invasivos por dia, e os mais frequentes foram punção de calcâneo (35,75%) e aspiração de vias aéreas (26,02%). Somente 3,6% dos procedimentos foram realizados sob analgesia ou sedação realizadas especificamente para sua realização. Apenas 32,5% dos registros de dor (NIPS ou anotação de enfermagem sugestiva de dor) resultaram na adoção de condutas para seu alívio, e os fármacos mais administrados para esta finalidade foram: o hidrato de cloral, o midazolam e a dipirona. As intervenções não farmacológicas mais frequentes foram a sucção não nutritiva e o posicionamento ventral. Conclusões: Em 50,3% das internações foi realizado, ao menos, 1 registro de dor, conforme a aplicação da NIPS, ou a anotação de enfermagem sugestiva de dor. A associação da NIPS com anotação de enfermagem sugestiva de dor implicou em melhores índices de intervenção. Contudo, a presença de dor, de acordo com a NIPS, não resultou em maiores taxas de intervenção para seu alívio. / Introduction: Newborns are vulnerable to pain, and repeated experiences can result in damage to their development. Studies portray an alarming reality experienced in the Neonatal Intensive Care Unit (NICU), where the number of painful procedures performed daily is significant. General aim: To determine the incidence of pain during the first seven days in the NICU. Specific aims: To determine the prevalence of pain; identify the type and frequency of invasive procedures to which newborns are subjected, and verify the non-pharmacological and pharmacological measures implemented to relieve it. Methodology: Retrospective study composed of all newborns admitted to the NICU for 12 months. Of the 188 admissions, 15 were excluded according to the criteria established, and there were two losses, which resulted in 171 hospitalizations related to 150 newborns. Data collection was carried out in a printed form by reading their records, and the presence of pain was evaluated based on the NIPS (Neonatal Infant Pain Scale) and records suggestive of pain reported by the nursing staff. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) and a 5% significance level was adopted. Results: Newborns underwent an average of 6.6 invasive procedures per day, and the most frequent ones were heel lancing (35.75%) and airways aspiration (26.02%). Solely 3.6% of the procedures were performed under analgesia or sedation specifically made for its realization, and only 32.5% of pain records (NIPS or nursing records indicating pain) resulted in the adoption of conducts to its relief, and the drugs most administered for this purpose were: Chloral Hydrate, Midazolam and dipyrone. The most frequent non-pharmacological interventions were non-nutritive sucking and ventral position. Conclusions: In 50.3% of admissions, there was at least 1 record of pain according to NIPS or nursing records indicating pain. The association of NIPS with nursing records indicating pain resulted in better rates of intervention. However, the presence of pain according to NIPS did not result in higher intervention rates for its relief.

Chan, Hoi Sze Gloria. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 204-241). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese.

Bakgrund: Höftartroplastik är rankad som nummer 11 på listan över de mest smärtsamma kirurgiska ingreppen. Att utveckla kronisk smärta postoperativt rapporteras vara så hög som 10%. Syfte: Studera vuxna patienters upplevelser av postoperativ smärta efter planerad höftoperation samt patienternas erfarenhet av smärtbehandlingen. Metod: En litteraturöversikt baserad på 10 vetenskapliga artiklar publicerade mellan år 2000 och 2019. Fem artiklar har kvantitativ ansats och fem av artiklarna har kvalitativ ansats. Resultat: Patienters upplevelser av postoperativ smärta efter en elektiv höftoperation är individuell och beskrivs både kvantitativt med hjälp av smärtskattningsskalor och kvalitativt med egna ord. Majoriteten av studierna visar att patienterna upplever sig tillräckligt smärtlindrade av de läkemedel de får i syfte att minska den postoperativa smärtan och i andra fall där religiösa åskådningar spelar in, så förlitar sig patienterna på sin tro och med hjälp av sin familj. Slutsats: Postoperativ smärta efter elektiv höftoperation är ett faktum. Patienterna upplever sig smärtlindrade eller i andra fall står ut med smärtan av kulturella och religiösa skäl. Patienternas delaktighet under sin vårdtid, bättre uppföljning av vården efter utskrivning och ytterligare forskning kring effektivare postoperativ smärtbehandling, krävs i framtiden. / Introduction: Hip arthroplasty is ranked number 11 on the list of the most painful surgical procedures. Developing chronic pain postoperatively is reported to be as high as 10%. Aim: Study adult patients' experiences of postoperative pain after planned hip surgery and the patients' experience of pain management. Methods: A review of literature based on 10 scientific articles published between 2000 and 2019. Five articles have quantitative approach and five of the articles has qualitative approach.   Results: Patients' experiences of postoperative pain after an elective hip operation are individual and described both quantitatively by means of pain estimation scales and qualitatively in their own words. The majority of the studies show that the patients feel sufficiently pain-relieved by the drugs they receive in order to reduce the postoperative pain and in other cases where religious views are recorded, the patients rely on their faith and with the help of their family. Conclusion: Postoperative pain after elective hip surgery is a fact. The patients feel pain-relieved or in other cases stand out with the pain for cultural and religious reasons. Patients' involvement during their care period, better follow-up of care after discharge and further research in more effective postoperative pain treatment, are required in the future.