Introdução: A dor é o principal motivo de procura ao atendimento médico. Organizações internacionais de saúde indicam o alívio da dor como um direito humano básico. A literatura indica subutilização de opioides devido ao conhecimento insuficiente, o receio quanto ao potencial de adição, efeitos adversos e mitos persistentes sobre estes analgésicos por parte dos profissionais de saúde. Objetivo: Avaliar grau de conhecimento de profissionais de saúde no manejo da dor e no uso de opioides em três unidades pediátricas (Pediatria, UTI e Oncologia). Metodologia: Estudo transversal realizado em um hospital universitário do Sul do Brasil. Um questionário autoaplicável foi entregue para 182 profissionais (médicos, enfermeiros, farmacêuticos, técnicos e auxiliares de enfermagem), entre dezembro de 2011 e março de 2012. Resultados: A taxa de retorno foi de 67% (122). O percentual médio de acertos foi de 63,2 ± 1,4%. Os erros mais frequentes foram: um opioide não deve ser utilizado sem se saber a causa da dor (47%; 54/115); pacientes desenvolvem depressão respiratória frequentemente (42,3%; 22/52) e confusão entre os sintomas da síndrome de abstinência, tolerância e dependência (81,9%; 95/116). Apenas 8,8% (10/114) relataram o uso de escalas de dor para reconhecer a dor em crianças. A barreira para o controle da dor mais citada foi a dificuldade de medir e localizar a dor em pacientes pediátricos. Finalmente, 50,8% (62/122) não receberam nenhum treinamento sobre dor. Conclusões: Foram identificados problemas nos processos de identificação, mensuração e tratamento da dor. Os resultados sugerem a necessidade de investimento na formação continuada dos profissionais e no desenvolvimento de protocolos que busquem aperfeiçoar a terapia analgésica, impedindo um aumento desnecessário do sofrimento da criança. / Introduction: Pain is the main reason to seek medical care. Health international organizations indicate pain relief as a basic human right. The literature indicates underuse of opioids due to insufficient knowledge, fears about the potential for addiction, side effects and persistent myths about these analgesics by health professionals. Objective: To assess degree of knowledge and attitudes of health professionals about management of pain in three pediatric units (Pediatric, ICU and Oncology). Methods: Cross-sectional study in a teaching hospital in southern Brazil. A self-administered questionnaire was delivered to 182 professionals (doctors, nurses, pharmacists, technicians and nursing assistants), between December 2011 and March 2012. Results: The rate of return was 67% (122). The average percentage of correct responses was 63.2 ± 1.4%. The most frequent errors were: an opioid should not be used without knowing the cause of pain (47%, 54/115); patients often develop respiratory depression (42.3%, 22/52); and confusion between symptoms of the syndrome withdrawal, tolerance and dependence (81.9%, 95/116). Only 8.8% (10/114) reported using pain scales to recognize pain in children. The barrier to pain control most cited was the difficulty to measure and locate the pain in pediatric patients. Finally, 50.8% (62/122) received no training on pain. Conclusions: The study identified problems in the process of recognizing, measuring and treating pain. The results suggest the need for investment in training to health care team and development of protocols that seek to optimize analgesic therapy, preventing an unnecessary increase the suffering of the child.

Lau Suk-chu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 85-94). / Abstracts in English and Chinese. / Abstract --- p.i / 論文摘要 --- p.iii / Acknowledgements --- p.v / Table of Contents --- p.vi / List of Tables --- p.ix / List of Figures --- p.x / Table of Abbreviations --- p.xi / CHAPTERS / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Literature Review --- p.3 / Chapter 2.1 --- The Importance of Postoperative Pain Management --- p.3 / Chapter 2.1.1 --- Humanitarian --- p.3 / Chapter 2.1.2 --- Under-management of Postoperative Pain Relief --- p.3 / Chapter 2.1.3 --- Pain Relief- A Key Strategy for Better Surgical Outcomes --- p.5 / Chapter 2.2 --- Postoperative Pain Relief and Clinical Outcomes --- p.7 / Chapter 2.3 --- Postoperative Pain Relief and QoR --- p.8 / Chapter 2.4 --- A New Concept of Service Expected for Better Surgical Pain Relief --- p.9 / Chapter 2.4.1 --- Recognition of the New Concept of Service - APS --- p.10 / Chapter 2.4.2 --- Role of an APS --- p.11 / Chapter 2.4.3 --- Organization of APS --- p.12 / Chapter 2.4.3.1 --- The Anesthesiologist-based APS --- p.12 / Chapter 2.4.3.2 --- The Nurse-based APS --- p.13 / Chapter 2.4.3.3 --- The Multidisciplinary APS --- p.14 / Chapter 2.4.4 --- Postoperative Pain Management Service in Hong Kong --- p.15 / Chapter 2.4.4.1 --- Review of postoperative pain management service in Hong Kong --- p.15 / Chapter 2.4.4.2 --- Recommending APS in Hong Kong --- p.15 / Chapter 2.4.4.3 --- The recognition of APS in Hong Kong --- p.15 / Chapter 2.4.4.4 --- The development of APS in Hong Kong --- p.16 / Chapter 2.4.4.5 --- The compliance of APS teams in Hong Kong with the recommendations made by Hospital Authority --- p.17 / Chapter 2.4.5 --- Summary of Background of APS --- p.19 / Chapter 3. --- Economic Evaluation of Acute Pain Service Programs: A Systematic Review --- p.20 / Chapter 3.1 --- Abstract --- p.20 / Chapter 3.2 --- Introduction --- p.21 / Chapter 3.3 --- Methods --- p.22 / Chapter 3.3.1 --- Study Selection Criteria --- p.22 / Chapter 3.3.2 --- Search Strategy --- p.23 / Chapter 3.3.3 --- Data Analysis --- p.23 / Chapter 3.4 --- Results --- p.24 / Chapter 3.5 --- Discussion --- p.27 / Chapter 3.6 --- Conclusion --- p.30 / Chapter 4. --- Methodology of the RCT Study --- p.41 / Chapter 4.1 --- Setting --- p.41 / Chapter 4.2 --- Eligibility Criteria for Participants --- p.42 / Chapter 4.3 --- Obtaining Informed Consent --- p.42 / Chapter 4.4 --- Study Intervention --- p.43 / Chapter 4.4.1 --- Randomization --- p.43 / Chapter 4.4.1.1 --- Randomization: Generation and Concealment --- p.43 / Chapter 4.4.1.2 --- Randomization: Implementation --- p.43 / Chapter 4.4.1.3 --- Study Intervention: APS (Intervention group) and CWPS (Control) --- p.44 / Chapter 4.5 --- Data Collection and Outcome Measures --- p.44 / Chapter 4.5.1 --- Primary Outcomes --- p.44 / Chapter 4.5.1.1 --- Data Obtained at 72 hours After Surgery --- p.44 / Chapter 4.5.1.2 --- "Data Obtained at 24, 48 and 72 hours After Surgery" --- p.46 / Chapter 4.5.2 --- Secondary Outcomes --- p.47 / Chapter 4.6 --- Sample Size --- p.47 / Chapter 4.7 --- Data Analysis --- p.48 / Chapter 4.7.1 --- Comparability Between APS and CWPS Groups --- p.48 / Chapter 4.7.2 --- Comparing Costs and Effects of Interventions --- p.48 / Chapter 5. --- Results and Analysis --- p.51 / Chapter 5.1 --- Flow of Participation --- p.51 / Chapter 5.1.1 --- Enrollment of Participation --- p.51 / Chapter 5.1.2 --- Allocation of Treatment --- p.51 / Chapter 5.1.3 --- Follow-up --- p.53 / Chapter 5.2 --- Results of Data Analysis --- p.53 / Chapter 5.2.1 --- Patient Demographics --- p.53 / Chapter 5.2.2 --- Costs of Interventions --- p.55 / Chapter 5.2.3 --- Patient Satisfaction --- p.55 / Chapter 5.2.4 --- QoR --- p.61 / Chapter 5.2.5 --- Average Pain Severity Ratings --- p.62 / Chapter 5.2.6 --- Pain at Rest Severity --- p.63 / Chapter 5.2.7 --- Pain on Movement --- p.64 / Chapter 5.2.8 --- Average Pain Interference with Daily Activities --- p.65 / Chapter 5.2.9 --- Effectiveness of Pain Relief --- p.66 / Chapter 5.2.9.1 --- Side Effects of Pain Medications --- p.66 / Chapter 5.2.9.2 --- Summary of results --- p.67 / Chapter 6. --- Discussion and Conclusion --- p.68 / Appendix A: Data Collection Form --- p.71 / Appendix B: Conference Abstract --- p.81 / Appendix C: Conference Abstract --- p.83 / REFERENCES --- p.85

Learning Objectives: Describe the rationale for the belief that opioids have no maximum dose Describe the data supporting the rationale that high doses of opioids increase toxicity Describe the data supporting the rationale that high doses of opioids do not improve outcomes Identify potential safety concerns with patients taking high doses of opioids

Learning Objectives: Describe the concept of patient ‐centered care from the pharmacist’s perspective. Summarize the science of patient ‐centered communication in pain management. Describe pharmacogenetic tests that are available to guide the use of opioids in pain management. Discuss research opportunities related to patient ‐centered care and genetic testing in pain management. Describe strategies used by pharmacists to implement genetic testing in clinical pharmacy practice.

No description available.

The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices in healthcare settings may improve patient conditions such as pain and decrease the cost of healthcare. A wealth of literature can be found describing barriers and facilitators of evidence-based practice (EBP), and a movement in research has begun to focus on what influences the use of EBP. This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPP) using an existing data set of nurses and providers caring for children in the Emergency Department. Initial analysis found several significant correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and Magnet Status and EBNPP for nurse or providers. Nurse regression analyses showed knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the nurse and provider models. A pooled regression analysis with Registered Nurses and Providers found nurses had a significant increased use of EBNPP when compared to providers. Regression analyses found that while overall context is a significant predictor of EBNPP, no single element was significant when all three were added to the model. The effect of context on EBNPP did not differ by profession in this sample. Results of this study indicate that while context is important in the uptake of EBNPP, one area does not have more influence than another. The variables explored in this study account for 13% of the variance in EBNPP. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.

<p><strong>Introduktion:</strong> Smärta, smärtskattning samt smärtbehandling är centrala begrepp inom hematologin. Intresset att genomföra en studie huruvida kvalitetsmål för smärtbehandling som finns utarbetade på Akademiska sjukhuset (AS) i Uppsala följs, väcktes med anledning av detta. <strong>Syfte:</strong> Författarna valde i denna uppsats att undersöka om gällande kvalitetsmål för smärtbehandling uppnås på hematologen på AS för patienter med maligna blodsjukdomar. De mål som undersöks är dokumentation, kunskap hos behandlande personal på avdelningen, smärtskattning samt smärtbehandling.<strong>Metod:</strong> Studien är en journal- och enkätstudie med deskriptiv design. 30 journalers dokumentation på inneliggande patienter från november 2008 har granskats under en period med fokus på smärta. Utöver journalgranskning har en enkätstudie med smärtrelaterade frågor gjorts bland läkare och sjuksköterskor på avdelningen. <strong>Resultat:</strong> Resultatet från studien påvisar en del brister i smärtskattning, i dokumentation samt kännedom av sjukhusets kvalitetsmål för smärtbehandling. Dock tror sig både sjuksköterskor och läkare att de har den kunskap som krävs för en god vård.<strong>Slutsats: </strong>Om sjukhusövergripande kvalitetsmål för smärtbehandling implementeras på rätt sätt är de till hjälp i vården. Väl utförd smärtskattning, bra dokumentation och tydlig utvärdering hjälper vårdpersonalen att få inblick i patientens smärtstatus.</p> / <p><strong>Introduction:</strong> Pain, pain estimation and pain treatment is central concepts within hematology. The interest to conduct a study whether quality of Pain Medicine, which is prepared in the Academic hospital (AS) in Uppsala are followed, brought with it. <strong>Aim:</strong> The authors chose in this paper to examine whether the existing quality of Pain Medicine achieved in the Department of Hematology at AS in patients with malignant blood diseases. The targets under investigation are the documentation, knowledge of the treating staff, pain estimation and Pain Medicine.<strong>Methods:</strong> The study is a record and a survey-study with descriptive design. 30 journals documentation of indwelling patients from November 2008 have been reviewed in a period with a focus on pain. In addition to record review, a survey of pain-related issues among doctors and nurses in the department has also been done.<strong>Results:</strong> Showing some weaknesses in the painfully estimation, in documentation and knowledge of hospital quality of Pain Medicine. However, both nurses and doctors believe they have the knowledge required for good health care.<strong>Conclusion:</strong> If the hospital overall quality objectives for Pain Medicine is implemented correctly, they are helpful in care. Well done pain estimation, good documentation and clear evaluation helps the nursing staff to gain insight into the patient's pain status.</p>

Introduktion: Smärta, smärtskattning samt smärtbehandling är centrala begrepp inom hematologin. Intresset att genomföra en studie huruvida kvalitetsmål för smärtbehandling som finns utarbetade på Akademiska sjukhuset (AS) i Uppsala följs, väcktes med anledning av detta. Syfte: Författarna valde i denna uppsats att undersöka om gällande kvalitetsmål för smärtbehandling uppnås på hematologen på AS för patienter med maligna blodsjukdomar. De mål som undersöks är dokumentation, kunskap hos behandlande personal på avdelningen, smärtskattning samt smärtbehandling.Metod: Studien är en journal- och enkätstudie med deskriptiv design. 30 journalers dokumentation på inneliggande patienter från november 2008 har granskats under en period med fokus på smärta. Utöver journalgranskning har en enkätstudie med smärtrelaterade frågor gjorts bland läkare och sjuksköterskor på avdelningen. Resultat: Resultatet från studien påvisar en del brister i smärtskattning, i dokumentation samt kännedom av sjukhusets kvalitetsmål för smärtbehandling. Dock tror sig både sjuksköterskor och läkare att de har den kunskap som krävs för en god vård.Slutsats: Om sjukhusövergripande kvalitetsmål för smärtbehandling implementeras på rätt sätt är de till hjälp i vården. Väl utförd smärtskattning, bra dokumentation och tydlig utvärdering hjälper vårdpersonalen att få inblick i patientens smärtstatus. / Introduction: Pain, pain estimation and pain treatment is central concepts within hematology. The interest to conduct a study whether quality of Pain Medicine, which is prepared in the Academic hospital (AS) in Uppsala are followed, brought with it. Aim: The authors chose in this paper to examine whether the existing quality of Pain Medicine achieved in the Department of Hematology at AS in patients with malignant blood diseases. The targets under investigation are the documentation, knowledge of the treating staff, pain estimation and Pain Medicine.Methods: The study is a record and a survey-study with descriptive design. 30 journals documentation of indwelling patients from November 2008 have been reviewed in a period with a focus on pain. In addition to record review, a survey of pain-related issues among doctors and nurses in the department has also been done.Results: Showing some weaknesses in the painfully estimation, in documentation and knowledge of hospital quality of Pain Medicine. However, both nurses and doctors believe they have the knowledge required for good health care.Conclusion: If the hospital overall quality objectives for Pain Medicine is implemented correctly, they are helpful in care. Well done pain estimation, good documentation and clear evaluation helps the nursing staff to gain insight into the patient's pain status.

Vaccinations provide protection against deadly diseases and children are scheduled to receive many immunization injections before the age of six. However, painful procedures, such as immunizations cause negative short- and long-term consequences for children. The Gate Control Theory of Pain suggests that physical interventions may be helpful, but they have not yet been validated as an effective intervention to manage children’s acute pain. This randomized trial examined the effectiveness of the ShotBlocker®, a physical intervention designed to decrease children’s injection pain, in a sample of 89 4- to 12- year-old children receiving immunizations at a pediatric practice. An ANOVA revealed no significant effect of treatment group (Typical Care Control, Placebo, and ShotBlocker®) on any measure of child distress. Clinical and theoretical implications are discussed.

Distraction is an effective pain management intervention and children’s coping styles are important to consider when designing interventions. The purpose of this study was to examine two movie distractions in children 3 to 11 years old receiving venipunctures and to evaluate the relations between the effectiveness of the interventions and coping styles. Results revealed no interaction and no main effects of condition or coping style. However, coping on caregiver-report of child pain approached significance. T-tests revealed significant differences between approach and avoidance coping styles, with children with an approach coping style experiencing significantly less pain compared to children with an avoidance coping style. Descriptive statistics revealed the presence of a mixed coping style, suggesting that children’s coping styles may be continuous. This study highlights the importance of examining coping styles in the context of pediatric painful medical procedures and the need to further examine the effectiveness of distraction interventions.