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.

Objetivo: Avaliar os efeitos da estimulação elétrica nervosa transcutânea (TENS) comparada com TENS placebo e grupo controle sobre a dor, função pulmonar, força muscular respiratória e medicações analgésicas no pós-operatório de cirurgias torácicas em uma Unidade de Tratamento Intensivo (UTI). Método: Pacientes entre 31 e 76 anos submetidos a toracotomia póstero-lateral, foram incluídos e alocados aleatoriamente em três grupos: TENS (GE), TENS placebo (GP) e controle (GC). O GE recebeu a aplicação da TENS (frequência=100 Hz, duração de pulso=100 μs, intensidade no nível sensorial, durante 30 minutos, três vezes ao dia, durante a internação na UTI), associada a fisioterapia convencional (respiratória e motora). No GP foi realizada a TENS placebo além de fisioterapia convencional; e o GC recebeu apenas a fisioterapia convencional. Os desfechos foram avaliados no pré-operatório, pós-operatório (PO), e 48 horas após a internação na UTI: dor através da Escala Visual Analógica, função pulmonar através de espirometria (VEF1 e CVF), força muscular respiratória através de manovacuometria (PImáx e PEmáx), e medicações através da análise dos prontuários. Resultados: Foram incluídos 45 pacientes, sendo 15 em cada grupo. Em relação a percepção dolorosa, não houve diferença entre os grupos (P=0,172), porém houve redução na dor após o término do primeiro atendimento no GE (4,7±3,2 vs. 3,3±2,6; P<0,05). Em relação a função pulmonar e força respiratória não houve diferença significativa entres os grupos nos momentos avaliados. Entretanto, nas avaliações intragrupo, observou-se melhora na CVF, todos os grupos apresentaram redução no momento PO e 48 horas comparado com o pré (P<0,001), e somente o GE promoveu um aumento na CVF nas 48 horas em relação ao PO (P<0,001). A PImáx e PEmáx diminuíram em todos os grupos comparando o pré com o PO e 48 horas (P<0,001). Não houve diferença entre os grupos em relação as medicações analgésicas, porém o GC apresentou maior consumo de morfina (p=0,037) e o GP maior consumo de paracetamol (p=0,035) 24 vs 48 horas, o que não foi alterado no GE. Conclusão: Não foi observado diferença entre os grupos em relação aos desfechos avaliados no pós-operatório de cirurgia torácica, porém, a TENS 13 promoveu redução da dor e aumento mais precoce da CVF, além disso, não promoveu aumento no consumo de medicação. / Objective: To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and control group on pain, pulmonary function, respiratory muscle strength and analgesic medications in the postoperative period of thoracic surgery in an Intensive Care Unit (ICU). Methods: Patients between 31 and 76 years submitted to postero-lateral thoracotomy, were included and randomly allocated into three groups: TENS (GE), TENS placebo (GP) and control (GC). The GE received TENS (frequency = 100 Hz, pulse duration = 100 μs, intensity at the sensory level for 30 minutes, three times a day during ICU stay), associated with conventional physiotherapy (respiratory and motor). In GP, TENS was performed in addition to conventional physiotherapy; And GC received only conventional physiotherapy. The outcomes were evaluated in the preoperative, postoperative (PO) or 24 hours, and 48 hours after ICU admission: Pain through Visual Analog Scale, pulmonary function through spirometry (FEV 1 and FVC), respiratory muscle strength Through manovacuometry (MIP and MEP), and medications through the analysis of medical records. Results: 45 patients were included, 15 in each group. Regarding pain perception, there was no difference between the groups (P = 0.172), but there was a reduction in pain after the end of the first treatment in the GE (4.7 ± 3.2 vs. 3.3 ± 2.6; P <0.05). Regarding pulmonary function and respiratory force, there was no significant difference between the groups at the moments evaluated. However, in the intragroup evaluations, improvement in FVC, all the groups had a reduction at the time PO and 48 hours compared to the pre (P <0.001), and only the GE promoted an increase in FVC at 48 hours in relation to PO (P <0.001). The MIP and MEP decreased in all groups comparing the pre with PO and 48 hours (P <0.001).There was no difference between the groups in relation to analgesic medications, however, the CG had higher morphine consumption (p = 0.037) and the GP had a higher paracetamol consumption (p = 0.035) 24 vs 48 hours, which was not altered in the GE. Conclusion: No differences were observed between the groups in relation to the outcomes evaluated in the postoperative period of thoracic surgery, however, TENS promoted pain reduction and earlier increase in FVC, in addition, did not promote increase in medication consumption.

Sammanfattning Bakgrund: Smärtsamma procedurer i barnsjukvården kan vara en orsak till att barn blir rädda och utvecklar fobier. Flera metoder finns för att minska barns upplevda smärta vid smärtsamma procedurer, en metod är lustgas. Syftet med lustgasen är att blockera receptorer så att känslan av smärta minskar.    Syfte: Syftet med studien var att undersöka barns självskattade smärta under smärtsamma procedurer och jämföra skillnader mellan ålder och kön då lustgas som smärtlindrande metod användes. Vidare undersöktes om barn som använt lustgasen skulle vilja använda den igen vid smärtsamma procedurer. Metod: Med en kvantitativ och jämförande kohortdesign, undersöktes tidigare ifyllda protokoll som användes vid lustgasbehandlingar på Gävle sjukhus. Från protokollen extraherades data om barns smärtskattning under lustgasbehandling vid smärtsamma procedurer. Skattningen beskrivs med en ordinalskala från 0 till 10. T-test användes för att undersöka skillnader mellan åldersgrupperna 7 till 11 år och 12 till 18 år samt mellan pojkar och flickor. Vidare samlades data in om barns önskan att använda lustgas igen från protokollen och beskrevs sedan med procentfördelning mellan ja och nej. Resultat: 149 protokoll i båda åldersgrupperna analyserades. Det var ingen skillnad mellan deras smärtskattning under lustgasbehandling. Totalt jämfördes 152 protokoll från flickor och 146 från pojkar som visade en signifikant skillnad mellan könen (p=0.02). Medelvärdet (standardavvikelse) för flickornas självskattade smärta var 2.3 (2.7) och pojkarnas var 1.6 (2.2). Resultatet visade att 97 % av barnen svarade att de ville använda sig av lustgas vid en annan smärtsam procedur. Slutsats: Lustgasbehandling tolkas som en bra metod för att lindra smärta vid smärtsamma procedurer och metoden verkar uppskattas av de barn som använd sig av den. Skillnaden mellan flickor och pojkars smärtskattning under lustgasbehandling indikerar på att vidare forskning kan behövas. / Abstract   Background: Painful procedures in the care of children may cause fear and phobia later in life. Several methods exist to reduce children's perceived pain during painful procedures and one method is nitrous oxide. Nitrous oxide blocks receptors to reduce the pain experience.   Aim: The purpose was to investigate children's self-assessed pain during painful procedures and compare ratings between age-groups (7-11 vs 12-18 years) and gender. Furthermore, the study explored wheatear children who had used nitrous oxide would like to use it again during another painful procedure.   Method: A quantitative and comparative cohort design was used. Protocols from Gävle Hospital regarding children’s pain assessments during nitrous oxide treatments during procedures were reviewed. From the protocols, the children's pain estimations were extracted when nitrous oxide treatment was used during painful procedures. The pain estimation was described on an ordinal scale, ranging from 0 to 10. Independent t-tests were used to investigate differences between age-groups 7 to 11 year’s vs 12 to 18 years and between genders. Furthermore, data were collected (yes/no) to explore if the children had a desire to use nitrous oxide again if they were to undergo another painful procedure.   Results: 149 protocols in each of the two age-groups was analyzed and no significant difference between children’s pain estimation during nitrous oxide treatment was found. In comparison of 152 protocols representing girls and 146 boys a significant difference between the genders was found regarding their pain estimation. Mean (standardeviation) for girls estimated pain were 2.3 (2.7) and for boys 1.6 (2.2). The result showed that 97 % of the children had a desire to use nitrous oxide again if they had to undergo another painful procedure. Conclusion: Nitrous oxide as a pain relief treatment shown to have a positive effect to reduce the pain experience during painful procedures   and the method seems to be appreciated by the children who have used it. The difference between girls’ and boys’ pain estimation during nitrous oxide treatment indicates that further research is needed.

Com o desenvolvimento tecnológico, cada vez mais, os neonatos têm sido expostos a procedimentos dolorosos. Atualmente, existem várias intervenções farmacológicas e não farmacológicas para o alívio da dor. Há escassez de estudos sobre a a exposição à dor dos recém-nascidos e as práticas para o seu manejo nas unidades neonatais brasileiras. Este estudo descritivo exploratório teve como objetivo dimensionar a exposição a procedimentos dolorosos de recém-nascidos pré-termo e as intervenções farmacológicas e não farmacológicas utilizadas para o alívio da dor, durante os primeiros 14 dias de vida em unidades neonatais de um hospital universitário de Ribeirão Preto - SP. Participaram do estudo 89 prematuros, após obtenção do consentimento livre e esclarecido dos responsáveis. Foi adicionado um questionário no prontuário dos neonatos para registro dos procedimentos dolorosos, intervenção analgésica, número de tentativas e profissional que realizou o procedimento. A coleta de dados foi realizada no período de outubro de 2012 a outubro de 2013. Também foi realizada busca nos prontuários dos prematuros para minimizar falha de registro e completar questionários que se encontravam incompletos. Realizada dupla digitação dos dados no Excel e para análise estatística foi utilizado o SPSS. Na análise quantitativa dos dados utilizou-se a estatística descritiva e para comparação das médias de distribuição dos procedimentos dolorosos foi testada a normalidade por meio do teste Kolmogorov-Smirnov (?=0,05), e uso de estatística paramétrica para amostras independentes e estatística paramétrica para amostras dependentes, comparando as médias de procedimentos dolorosos segundo os grupos das variáveis peso ao nascer e idade gestacional com uso do teste ANOVA oneway (?=0,05); para as variáveis sexo e uso de ventilação invasiva utilizou-se o teste t-student não pareado (?=0,05) e para a variável período de internação utilizou-se o teste t-student para duas amostras em par (?=0,05). Obtiveram-se seguintes resultados: média de peso de 1384,1 ± 615,7g; média de idade gestacional de 30,6 ± 3,1 semanas; escore de risco SNAPPE II de 25,8 ± 20,2; parto cesáreo mais frequente (65,2%); média de tempo do uso de ventilação invasiva de 5,9 ± 5,5 dias; média total do tempo de internação 56,1 ± 50,4 dias. Foram realizados 6.687 procedimentos dolorosos, 65,5% registrados no questionário e 34,5% inseridos a partir do levantamento dos prontuários. A média diária foi de 5,37 procedimentos dolorosos por prematuro; na primeira e segunda semanas de internação as médias foram de 6,56 e 4,18 procedimentos dolorosos diários por prematuro (p<0,0001). Os procedimentos mais frequentes foram as aspirações nasal ou oral (35,85%) e traqueal (17,17%). Os prematuros que ficaram em ventilação invasiva foram os mais expostos a procedimentos dolorosos (71,2%). Apenas 44,9% dos procedimentos dolorosos tiveram alguma intervenção para o alívio da dor, sendo mais utilizada a sacarose (78,21%) e analgesia contínua (19,82%). Constata-se o subtratamento da dor aguda nessas unidades neonatais, recomendando-se maior sensibilização da equipe para o uso efetivo do protocolo existente e a implantação de outros para o manejo adequado e alívio da dor dos recém-nascidos / Due to technological development, neonates are increasingly exposed to painful procedures. Currently, there are many pharmacological and non-pharmacological interventions to relieve pain. Few studies address the exposure of newborns to pain and practices used to manage pain in Brazilian neonatal units. This exploratory descriptive study aimed to verify exposure of preterm newborns to painful procedures and pharmacological and non-pharmacological interventions used to relieve pain in the first 14 days of life in neonatal units of a university hospital in Ribeirão Preto, SP, Brazil. A total of 89 preterm infants participated in the study after their legal guardians signed free and informed consent forms. A questionnaire was added to the neonates\' medical files to record painful procedures, analgesic interventions, number of attempts, and the professional who performed the procedure. Data were collected from October 2012 to October 2013. The infants\' medical files were checked to minimize missing information and incomplete questionnaires. Data were double entered in Excel and SPSS was used for the statistical analysis. Descriptive statistics was used for the quantitative analysis and the Kolmogorov-Smirnov test (?=0.05) was employed to verify normality in order to compare the means of distribution of painful procedures. Parametric statistics was used for both independent and dependent samples. The means of painful procedures were compared according to groups of variables: for birth weight and gestational age one-way ANOVA (?=0.05) was used; t- student test (?=0.05) was used for sex and use of invasive ventilation; and finally, two sample matched t-student (?=0.05) was used for the variable period of hospitalization. The results indicated average weight of 1,384.1 ± 615.7g; average gestational age of 30.6 ± 3.1 weeks; SNAPPE II risk score of 25.8 ± 20.2; C-sections were more frequent (65.2%); average time invasive ventilation was used was 5.9 ± 5.5 days; and total average of length of hospitalization of 56.1 ± 50.4 days. A total of 6,687 painful procedures were verified: 65.5% was recorded in the questionnaire and 34.5% was included after checking the medical files. The daily average of painful procedures per infant was 5.37; the averages of daily painful procedures per infant in the first and second weeks of hospitalization were 6.56 and 4.18 (p<0.0001) respectively. The most frequent procedures were nasal or oral (35.85%) and tracheal (17.17%) aspirations. The infants receiving invasive ventilations were the ones most exposed to painful procedures (71.2%). Only 44.9% of the painful procedures included some pain relief intervention and the most used were sucrose (78.21%) and continuous analgesia (19.82%). Under treatment of acute pain was observed in the neonatal units and greater sensitization of the staff for effectively using the existent protocol and implementing other measures to appropriately manage and relieve pain among newborns is recommended

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

Background. Pain is the most commonly reported symptom in primary care and is estimated to affect over 110 million people in the United States. Increased pain severity and occurrence and inadequate treatment of pain is linked to being a minority, healthcare access, socioeconomic status, age and gender. Outcomes of pain include costs, healthcare utilization, functional changes, and quality of life. Gaps in knowledge exist regarding the American Indian (AI) chronic non-malignant pain experience, management and outcomes. Objective. The purpose of this research is to describe Northern New Mexico (NNM) AIs chronic pain experience, intervention strategies, and outcomes. Methods. This study utilized a qualitative descriptive (QD) design, with in-depth, one-on-one interviews with semi-structured interview questions. A sample of 14 Native Americans were interviewed for this study. A questionnaire was used to collect demographic data. Domain, taxonomic and content analyses were utilized to gain a highly nuanced description of the research topic. Results. The participants provided rich qualitative data regarding chronic pain experience, management strategies and outcomes. Frequent pain experiences included the body as a confining entity, body awareness, unpredictability of pain, and psychological outcomes. AIs in the study utilize a variety of biomedical, professional and self-care interventions. Outcomes discussed were functional status, costs, healthcare utilization, and quality of life. Outcomes. The goal of this research is increased understanding of the chronic pain experience through the perspective of those experiencing it. Findings will be submitted to the University of Arizona dissertation library, disseminated across relevant peer-reviewed journals focused on pain and pain management, and presented to appropriate groups and organizations.

Det är känt att ambulanspersonalens omhändertagande av barns smärta kan bli bättre. Akut smärta hos barn är en vanlig orsak till att barn söker ambulanssjukvård. Barn i för- skoleålder utgör en utmaning på grund av bristerna i den språkliga och kognitiva ut- vecklingen, som gör det svårt för dem att kommunicera kring sin egen smärta. Att ge- nomföra en adekvat smärtskattning hos barn är ett sätt att mäta deras smärta och därige- nom utföra en lämplig behandling, samt kunna utvärdera effekten av genomförd be- handling. Idag är VAS det vanligaste smärtskattningsinstrument som används i ambu- lansen, det är endast validerat från barn &gt; 8 år. Syfte: Att undersöka hur smärtskattning av barn i åldrarna tre till sex år inom prehospital akutsjukvård genomförs och vilka för- utsättningar som finns för att genomföra smärtskattning. Studien är en integrativ littera- turstudie. Tio artiklar ingår i studien, åtta kvantitativa och två kvalitativa. Sökning efter vetenskapliga artiklar skedde i databaserna Pubmed, Cinahl och Embase. Artiklarna granskades med SBU:s granskningsmall. Resultatet visar på olika sätt hur ambulansper- sonal försöker förstå barns smärta, men att det i dagsläget finns mer att önska. Smärt- skattning kan utföras oftare men kunskap och erfarenhet saknas om hur och varför man ska smärtskatta. Behandlingsriktlinjer räcker inte för att öka frekvensen samt förbättra utförandet av smärtskattning. I ambulansmiljö saknas det validerade instrument till barn i  förskoleåldern. Förutsättningar för att använda validerade smärtskattningsinstrument visade sig vara kunskap och erfarenhet. Både personalen och verksamheten har ett an- svar för att skapa förutsättningar till smärtskattnings. Det för att öka chansen till en hållbar vårdrelation.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Low back pain among high school children is perceived to be uncommon in the clinic setting. However, previous studies have suggested that it may be an important and increasing problem to be managed in this age group. The overall aim of this study was to determine the prevalence, the predisposing factors and management of low back pain among high school children in Nyamasheke district in Rwanda. A cross– sectional descriptive study was conducted using a combination of quantitative and qualitative research methods. The study included a population of 10 330 high school children aged 13- 21 years old registered in high schools of Nyamasheke district. In addition, 13 service providers involved in addressing low back pain were included in the study. The study was conducted in ten schools selected randomly, four schools from nine urban schools and six schools from 15 rural schools. The sample size included 1 000 participants selected by a simple random sampling method and six service providers selected by purposive sampling method. A self-administered questionnaire was given to high school learners. Semi-structured interviews amongst service providers were conducted to validate information given by high school learners. The software SPSS version 19.0 for windows and Microsoft Excel package 2010 were used to analyze the quantitative data. Descriptive statistics using frequencies, percentages, means, and standard deviations and inferential statistics using chi-square and correlation tests were calculated to examine the association between variables. For qualitative findings, audiotaped interviews were transcribed and translated from Kinyarwanda into English, and the expressed ideas were coded and reduced into themes and categories. Permission to conduct this study was obtained from the Senate Research Grants and Study Leave Committee at the University of the Western Cape, and the concerned authorities in Rwanda. Individual participants and their parents/guardians were informed of the study through an information sheet and written informed consent or assent was then obtained from the participants. The mean age of the quantitative study sample was 17 years, and 48.2% were females compared to 51.8% of males. The response rate was 96.2%. The low back pain prevalence was found to be 66.1%. The mean age of the first occurrence of low back pain was 14.5(SD = 2.28). One year prevalence was found to be 25.4% whereas the one month prevalence was 13.7%. Males were the most to report low back pain comparatively to females with 53.1% and 43.9% respectively. There was significant relationship between age group and low back pain (p = 0.000). High school children from the rural region were the most to report low back pain in comparison to those from urban region with 61.5% against 38.5% respectively. Regarding the predisposing factors to low back pain, a strong relationship was found between low back pain and posture (sitting and standing position) (p=0.000) with 83.2%. The findings of the interviews conducted among service providers showed that the main predisposing factors for low back pain could be posture/position in class and psychological factors. The study found that most of the participants do not attend medical services. The study highlighted that the impact of low back pain included medical costs, missing class when attending medical services and difficult to perform normal usual activities. It was found that the level of education in health promotion as preventive measures of low back pain is still at low level.

Bakgrund: Nästan hälften av alla vuxna svenskar är överviktiga eller lider av fetma vilket tillsammans med dess följdsjukdomar kostar samhället flera miljarder kronor per år. Trots att behandlande överviktsoperationer (främst gastric bypass [GBP]) blir allt vanligare i Sverige, är patientens hälsotillstånd intra-, och postoperativt relativt outforskat vad gäller smärta, postoperativt illamående och kräkning [PONV], vårdtid samt det ökande lidandet detta medför.   Syfte och Metod: Syftet är att beskriva mängden analgetika och antiemetika som ges till patienter som genomgår GBP-operationer, från premedicinering till utskrivning på den postoperativa vårdavdelningen. Vidare undersöks om anestesisjuksköterskan positivt kan påverka den postoperativa vården med avseende på smärtlindring, PONV och vårdtid då detta kopplas till lidande. En kvantitativ deskriptiv retrospektiv journalgranskningsstudie gällande totalt 68 patienter genomfördes.   Resultat: Gavs lokalanestetika i operationssåret under operation minskade både behovet av analgetika postoperativt (p&lt;0,05) och den postoperativa vårdtiden (p&lt;0,05). Om antiemetika gavs intraoperativt minskade användningen av antiemetika postoperativt (p&lt;0,001). Ju större dos antiemetika/kg/min som gavs intraoperativt desto kortare tid på den postoperativa vårdavdelningen (p&lt;0,001). Detta gällde oavsett om patienten fått lokalanestetika (p&lt;0,01) eller inte (p&lt;0,05).   Slutsats: Anestesisjuksköterskan har stora möjligheter att på flera plan positivt påverka tiden direkt efter operation. Intraoperativ administrering av lokalanestetika och antiemetika har avgörande roller för den fortsatta vården hos patienter som genomgår GBP-operationer, både vad gäller smärta, PONV, vårdtid och det lidande som detta kan medföra. Antiemetika doseras till synes enligt rutin och inte i förhållande till vikt, men ger viktberoende effekter. Mer forskning inom området efterfrågas. / Objectives: Almost 50 % of Swedish adults are overweight or obese, which costs the society billions annually. Although surgical treatments of obesity (primarily gastric bypass [GBP]) are increasing in Sweden, the patient's perioperative health status are relatively unexplored in terms of pain, postoperative nausea and vomiting [PONV], length of postoperative observation ward [POW] stay and the increasing suffering this entails. The authors aim to describe the amount of perioperative analgesics and antiemetics that GBP patients receive, and investigate how the nurse anesthetist can affect the postoperative care. Method: A quantitative descriptive retrospective study with a total of 68 patients was conducted. Result: The need for postoperative analgesics (p&lt;.05) and the length of stay in the POW (p&lt;.05) were both reduced whenever local anesthetics were given during surgery. If antiemetics were given intraoperatively, the use of antiemetics postoperatively was reduced; (p&lt;.001). A greater intraoperative dose antiemetic/kg/minute reduced the length of stay in the POW (p&lt;.001) regardless whether the patients received local anesthetics (p&lt;.01) or not (p&lt;.05). Conclusion: The nurse anesthetist can positively impact the immediate time after surgery. Intraoperative administration of  antiemetics and local anesthetics have crucial roles for the continued care of the GBP patient in terms of suffering connected to pain, PONV and length of stay in the POW. Antiemetics are seemingly dosed based on a routine and not on the patient's weight. More research in this area are requested.

The present study explored whether use of Spanish language sayings, or dichos, improved group climate within multi-ethnic chronic pain groups. Use of this form of figurative language fits within psychological theory identifying use of metaphor as a means of promoting change and creating new meaning. Further, metaphor use is consistent with the broader aims of experiential therapy. Group climate was measured by group members' self reports using the Group Climate Questionnaire-Short Form. A pilot study involving Latino Americans in medical and non-medical contexts aided in categorizing dichos as high versus low-relevance. It was anticipated that clients would rate high-relevance sessions as involving greater engagement, and less conflict and avoidance than low-relevance groups. Participants were recruited from four multidisciplinary pain management clinics offering similar programs. Once every four to six weeks, group leaders were provided with a list of either high or low-relevance dichos, and were blind to the existence of dichos categories. Three hierarchical regression analyses were employed to determine whether dichos relevance, characterized as low, mixed or highly relevant, contributed to variance in group conflict, avoidance and engagement. Dichos familiarity was the last variable entered into the regression equation, with gender, ethnicity and acculturation score entered in sequential fashion. Consistent with predictions, low-relevance groups yielded higher conflict scores than all groups combined. Also, high-relevance groups predicted lower avoidance when compared to all groups. In contrast to hypotheses, high-relevance groups predicted lower ratings of group engagement when compared to all groups. Post-hoc analysis indicated the mixed-relevance groups yielded significantly higher engagement scores than the low and high-relevance groups. Implications of these findings are discussed in relation to impact on approaches to group therapy with Latino American clients, and within the chronic pain population. Limitations of the study and recommendations for future research are offered.