Syfte: Beskriva förberedande faktorer vilket kan ha betydelse vid smärtsamma procedurer på barn. Vidare var syftet att granska vilket urval de inkluderade artiklarna använt sig av. Metod: Beskrivande litteraturstudie. Litteraturstudien grundar sig på tjugotvå inkluderade artiklar. Tre stycken artiklar med kvalitativ ansats, sjutton stycken med kvantitativ ansats, samt två med både kvalitativ och kvantitativ ansats. Resultat: Fyra områden vilka kan ha betydelse vid smärtsamma procedurer på barn framkom. Distraktion: ett effektivt verktyg mot oro och ångest. Distraktionen hindrade inte sjuksköterskan vid den smärtsamma proceduren och var kostnadseffektiv. Föräldraroll och coping: Föräldrars stöd var viktigt för uppbyggnad av coping strategier inför och under den smärtsamma proceduren. Sjuksköterskans roll: Förberedelse och hantering av material inför den smärtsamma proceduren har betydelse för att hindra uppkomst av oro hos barnet. Sjuksköterskan ska kunna bemöta barnet utifrån dess kunskapsnivå och ålder. Farmakologisk omvårdnad: Läkemedel visar positiva resultat på smärta. Detta är ett komplement till omvårdnaden. Metodologisk aspekt: Deltagarna till de inkluderade studierna rekryterades via fyra olika urvalsmetoder. Slutsats: Förberedelser av barn inför smärtsamma procedurer inkluderar flera områden. Sjuksköterskans betydande roll inkluderar att ge information till barnet och hjälpa barnet att utveckla coping strategier. Distraktion kan vara ett bra hjälpmedel, lika så farmakologisk omvårdnad. Sjuksköterskan bör kunna se helheten i mötet med barn. / Objective: Describe preparatory factors which can be of importance during painful procedures on children. A further aim was to examine which method of selection the included articles had chosen. Method: Descriptive literature study. The literature study is based on twenty-two included articles. Three articles feature a qualitative design, seventeen a quantitative design, and two were based on a both a qualitative and quantitative design. Results: Four areas of importance which can be of importance during painful procedures on children were established. Distraction: An effective tool to combat worry and anxiety. Distraction did not hinder the nurse during the painful procedure and was cost effective. Parent influence and coping: Parental support was an invaluable tool to developing coping mechanisms while preparing for and undergoing the painful procedure. The role of the nurse: Preparation of the necessary equipment for the painful procedure is of importance to prevent the development of anxiety in the child. The nurse must be able to relate to the child based on the child´s level of understanding and age. Pharmacological nursing: Pharmaceuticals show positive results on pain. This is a complement to the care. Methodological aspect: Participants of the included case studies were chosen by four different methods of selection. Conclusion: Preparation of children for painful procedures includes several areas. The nurse has an important role which includes giving information to the child and helping the child develop coping strategies. Distraction can be a helpful tool as can pharmacological nursing. The nurse must be able to consider all aspects in the treatment of children.

No description available.

The accurate assessment of human diabetic somatic polyneuropathy (DSPN) is important to define at risk patients, predict deterioration, and assess the efficacy of pathogenetic treatments. Corneal confocal microscopy (CCM) has been proposed as a surrogate endpoint for DSPN. Approximately 50% of patients with DSPN experience neuropathic pain or symptoms and the underlying reasons are not clearly elucidated. Vitamin D deficiency has been associated with diabetic complications including DSPN and diabetic retinopathy (DR). However there is a paucity of data regarding the interaction of vitamin D status with diabetic complications. This thesis shows that CCM can readily detect small fibre neuropathy prior to large fibre involvement and assess rapidly progressive nerve fibre loss prior to conventional thermal threshold testing. CCM has a superior diagnostic capabilities compared to intra-epidermal nerve fibres and correlates better with nerve conduction studies. Patients with LADA have a greater prevalence of small fibre neuropathy compared to matched patients with type 2 diabetes. Vitamin D deficiency is highly prevalent in patients with diabetes and despite relatively aggressive replacement regimens are inadequate in raising vitamin D levels in a significant proportion of patients. Vitamin D deficiency is not associated with DR but there is a strong association between painful DSPN and vitamin D insufficiency and more so with overt deficiency.

Based on Coopey's critical review of the terms 'Utopian sunshine' and 'Foucauldian gloom' with regard to the earning organization (Coopey, 1998), this article explores the learning organization from two opposing perspectives. While researchers agree that the learning organization concept is an important one for organization science, two seemingly irreconcilable research communities are arguing about whether the learning organization is a dream or a nightmare for its members, particularly with regard to three critical dimensions: control, ideology and potentially painful employee experiences. The purpose of this article is to review and critically examine both the optimistic view of the learning organization as positive ideal and the more critical view of the learning organization as negative ideology. Based on this examination, the article aims to synthesize a new middle-ground perspective on the learning organization, referred to as the 'fluorescent light' view, incorporating elements from both optimistic and critical views in hopes of generating a dialog between them that will provide new research questions on control, ideology and potential pain in learning organizations.

Syfte: Syftet med föreliggande studie var att beskriva förberedelser och distraktionsmetoder som sjuksköterskor använder sig av i samband med smärtsamma omvårdnadsprocedurer för att hjälpa barn i åldern 4-6 år samt vilka fördelar detta hade. Metod: En deskriptiv design användes till den kvalitativa studien. Materialet inhämtades genom semistrukturerade intervjuer med nio sjuksköterskor som arbetade på barnkliniker. Det insamlade materialet analyserades genom kvalitativ innehållsanalys. Huvudresultat: Resultatet av berättelserna kunde kategoriseras i ”Sociala och praktiska förberedelser”, ”Ickefarmakologiska distraktionsmetoder”, ”Farmakologiska distraktionsmetoder” samt ”Distraktionen kan hjälpa barnet att främja dess självkänsla”. Att verbalt och praktiskt förbereda barn inför smärtsamma omvårdnadsprocedurer ansågs underlätta barnets besök på kliniken. Både farmakologiska och ickefarmakologiska distraktionsmetoder användes med gott resultat för att distrahera barnets uppmärksamhet från den smärtsamma omvårdnadsproceduren. Distraktionen ansågs även hindra utvecklingen av en långvarig stick- och sjukhusrädsla genom att barnet fick ett positivt minne och en stärkt självkänsla. Slutsats: Verbal och praktisk information till barn och föräldrar var viktiga aspekter i förberedelsen inför den smärtsamma omvårdnadsproceduren. Såväl farmakologiska som ickefarmakologiska distraktionsmetoder användes i stor utsträckning med gott resultat vilket kunde ha många fördelar på både kort och lång sikt. / Aim: The aim of this study was to describe preparations and distraction techniques that nurses use when dealing with painful care procedures to help children aged 4-6 years, and the benefits they have. Methods: A descriptive design was used for the qualitative study. The materials have been collected by semi-structured interviews with nine nurses working in paediatric clinics. The collected data was analyzed through a qualitative content analysis. Results: The results of the interviews were categorized in “Social and practical preparations”, “Non-pharmacological distraction techniques”, “Pharmacological distraction techniques” and “Distractions can help the child promote their self esteem”. To verbally and practically prepare the child for painful procedures was considered to facilitate the child’s visit to the clinic. Both pharmacological and non pharmacological distraction techniques were used successfully to distract the child’s attention from the painful procedure. Distraction could also prevent the development of a long term fear of hospitals and needle related procedures if the child received a positive memory and there by an enhanced self esteem. Conclusion: Verbal and practical information to children and parents were important aspects in the preparation for the painful procedure. Both pharmacological and non pharmacological distraction techniques were used extensively with good results, which could have many benefits, in both short and long term.

Interstitial Cystitis / Painful Bladder Syndrome (IC/PBS) is a persistent and refractory medical condition that is characterized by chronic pelvic pain along with abnormal urinary frequency and urgency. There is no widely accepted etiology or efficacious cure for IC/PBS, thus treatment often relies on pain and symptom management. IC/PBS is associated with strong functional disability but theoretical models of disability have yet to be tested with these patients. As well, psychosocial factors associated with various IC/PBS outcomes (i.e., depression, catastrophizing, social support) are also associated with disability in a variety of chronic painful medical conditions but remain untested in disability models for IC/PBS. Thus, this research evaluated psychosocial factors as potential mediators of disability within the Disablement Process Model. Female patients diagnosed with IC/PBS by a urologist in a tertiary care hospitals were recruited (n=196; females). In using structural equation modeling of a final IC/PBS disability model, negative affect and catastrophizing were found to be partial mediators on the relationship between impairments and functional disability and social support was not a significant mediator of disability. Negative affect and catastrophizing may be key psychosocial factors in IC/PBS disability. Research implications for the Disablement Process Model and potential clinical interventions are discussed in light of the current findings. / Thesis (Master, Psychology) -- Queen's University, 2011-08-29 14:18:29.478

Bakgrund: Inom vården förekommer det ofta smärtsamma procedurer i form av behandlingar och undersökningar. Dessa procedurer kan vara obehagliga för barn vilket gör smärtlindring till en viktig del av pediatrisk vård. Lustgas är ett bra alternativ till barn på grund av att den har lugnande effekt, inte kräver någon ytterligare smärtsam procedur som nålstick och har snabb och kortvarig effekt. Lustgasens lämplighet inom pediatrisk vård kan motivera en ökad användning. Syfte: Det huvudsakliga syftet var att undersöka vad sjuksköterskor på Akademiska barnsjukhuset med utbildning i lustgasadministrering ser för möjligheter och hinder i att administrera lustgas till barn (0-18 år) vid smärtsamma procedurer. Ett andra syfte var att undersöka hur dessa uppfattningar skiljer sig mellan avdelningar samt i förhållande till erfarenhet och utbildning. Metod: Studiens design var kvantitativ metod med en enkät-tvärsnittsstudie bestående av 25 frågor. Enkäten besvarades av samtliga 24 tillfrågade sjuksköterskor på Akademiska barnsjukhuset med utbildning i lustgasadministrering. Resultat: Sjuksköterskorna som deltog i studien ansåg att lustgasadministrering är en bra smärtlindringsmetod vid de flesta smärtsamma procedurer och de ansåg att de hade goda förutsättningar att administrera lustgas. Sjuksköterskorna föreslår lustgas generellt cirka 3-4 gånger per månad och de sjuksköterskor med längre erfarenhet ser fler tillfällen till lustgas och föreslår det oftare som smärtlindringsmetod. De uppfattade låg ålder som ett hinder då de ansåg att små barn har svårt att samarbeta vid lustgasadministrering. Slutsats: Sjuksköterskorna upplever i stort att de har goda möjligheter att administrera lustgas till barn vid smärtsamma procedurer och att de har fått tillräcklig utbildning i ämnet. Sjuksköterskors inställning till lustgas är övervägande positiv och de anser att lustgas är lämpligt till barn över fyra år. / Background: In healthcare, treatments and examinations can often include some level of pain. For children, such painful procedures can be difficult to understand and accept, making pain management a key part of pediatric care. Nitrous oxide is a good option for children since it is inhaled and its effect is transient and rapid. Nurses trained in administration of nitrous oxide to children can safely administer it, allowing for a wider use. The suitability of nitrous oxide in pediatric care can justify an increased usage. Aim: The main purpose was to investigate how nurses at Akademiska Children's Hospital with training in nitrous oxide administration view their possibilities and obstacles in administering nitrous oxide in children (0-18 years) during painful procedures. A second objective was to investigate how these perceptions differ between departments and in relation to experience and training. Method: The study design was a quantitative method with a questionnaire-sectional study consisting of 25 questions. The questionnaire was answered by 24 nurses at Akademiska Children's Hospital with training in nitrous oxide administration. Main results: Nurses at Akademiska Children's Hospital consider nitrous oxide to be a good method of pain relief for most painful procedures and that they had good opportunities to administer nitrous oxide. The nurses suggested nitrous oxide on average about three to four times per month and the nurses with long experience saw more opportunities for nitrous oxide and suggested it more often. Conslusion: The nurses generally felt that they have good opportunities to administer nitrous oxide to children during painful procedures and that they have received adequate training for the task. The nurses have a predominantly positive attitude towards nitrous oxide and they consider nitrous oxide to be suitable for children over four years of age.

The thesis considers Joyce's short stories "Araby," "A Painful Case," and the "The Dead," illustrating how these works present three intellectually and emotionally similar protagonists, but at different stages of life, with the final tale "The Dead" suggesting a sort of limited solution to the conflicts that define the earlier works. Taken together, "Araby" and "A Painful Case," represent a sort of life cycle of alienation: the boy of "Araby" is an isolated, deeply introspective youth who lives primarily within his own idealized mental world before discovering, through a failed romantic quest at the story's end, the complete impracticality of his own highly abstracted desires. In contrast, Duffy of "A Painful Case" is an extremely rigid, middle-aged bachelor who lives in a self-imposed exile from Irish society in an ultimately unsuccessful attempt to escape the sort of mental and emotional pain that affects the boy, with his final epiphany being that such ideals still exist within him, but he now no longer has any hope of changing his life or taking part in society. The stories suggest that such idealized desires can neither be ignored nor fulfilled, and it is not until the chronologically final story "The Dead" that Joyce suggests any sort of limited solution to the dilemma. Gabriel of "The Dead" again displays the introversion, emotional fragility and extreme idealism of the earlier protagonists, but he, as a young, adult man, presents a break in the cycle and an alternate path. In contrast to the earlier protagonists, Gabriel refuses to exist within his own mental world alone, and instead takes part in and attempts to accommodate the desires of both society as a whole, and of specific individuals close to him, such as his aunts and his wife Gretta. Though Gabriel's attempts are not an unmitigated success, he earns a degree of satisfaction for his efforts, with his final revelation being of his connection to the rest of humanity, in contrast to the self-absorbed and hopeless reflections of the earlier protagonists.

During cancer treatment children are required to undergo many types of invasive procedures, including venipuncture, bone marrow aspirations, and lumbar punctures. These medical procedures invoke many negative symptoms including distress, pain, anxiety, and fear. The purpose of this thesis was to determine the most effective nursing interventions to decrease negative symptoms in pediatric oncology patients during invasive procedures. This integrated literature review examined evidence regarding the effects of distraction interventions used during procedures performed on children with cancer published between 1999 and 2009. Results showed that current research on distraction interventions included using virtual reality, electronic toys, nonessential touch, music therapy, and mixed distractors. Although all of the studies showed that distraction was effective at decreasing negative symptoms in children with cancer no single form of distraction stood out above the rest. Results indicated that distraction interventions were considered beneficial by the parents, and had a favorable impact on the quality of life of pediatric cancer patients. By using evidence based distraction interventions, nurses can improve the quality of life in children undergoing invasive procedures by decreasing the occurrence of experienced distress, pain, fear, and anxiety in this patient population. This review of literature will provide nurses with recommendations for nursing practice, allowing them to make informed decisions concerning the effectiveness and safety of their patients' care.

Neuropathic pain affects up to 50% of the 29 million diabetic patients in the United States. Neuropathic pain in diabetes manifests as a disease of the peripheral and central nervous systems. The prevalence of type 2 diabetes is far greater than type 1 (90%), yet the overwhelming focus on type 1 models this has left the mechanisms of pain in type 2 diabetes largely unknown. Therefore I aimed to improve the current mechanistic understanding of pain associated with type 2 diabetes using two preclinical rodent models: Zucker Diabetic Fatty rats and db/db mice. In addition, I highlight the translational importance of simultaneous measurement of evoked/sensory and non-evoked/affective pain-related behaviors in preclinical models. This work is the first to show a measure of motivational-affective pain in a model of type 2 diabetes. I used methodological approaches including: (1) immunohistochemical and calcium imaging to assess stimulus-evoked sensitization; (2) measurement nociceptive behaviors and evoked sensory thresholds as well as pain affect using novel mechanical conflict avoidance and conditioned place preference/aversion assays; (3) pharmacological and genetic manipulation of methylglyoxal, TRPA1, AC1, and PPARγ. I hypothesized that the thiazolidinedione class of peroxisome proliferator-activated receptor gamma (PPARγ) agonists would reduce neuropathic pain-like behavior and spinal neuron sensitization in traumatic nerve injury and type 2 diabetes. As PPARγ is a nuclear receptor, and already targeted clinically to promote cellular insulin sensitization to reduce hyperglycemia, sustained changes in gene expression are widely believed to be the mechanism of pain reduction. In two separate research aims, I challenged this view and tested whether the PPARγ agonist pioglitazone would (1) rapidly alleviate neuropathic pain through a non-genomic mechanism and (2) reduce painful sensitization in nociceptive and neuropathic pain models independent from lowering blood glucose. I aimed to investigate the contribution of the glucose metabolite methylglyoxal to painful type 2 diabetes. I tested the hypothesis that methylglyoxal produces nociceptive, evoked, and affective pain that is dependent on activation of the sensory neuron cation channel TRPA1 and the secondary messenger enzyme AC1. I also tested whether pioglitazone or the novel methylglyoxal scavenging peptide GERP10 could alleviate painful type 2 diabetes.