This thesis consists of 3 studies: 1. Determination of the minimal important difference (MID) of the visual analogue scale for dyspnoea (VASD): Determining the MID of the VASD is essential to interpret the results of trials in patients with malignant pleural effusions (MPEs). Patients undergoing a pleural procedure assessed the change in their VASD and the degree of change in their symptoms on a Likert scale. The mean VASD in patients experiencing a ‘small but just worthwhile’ decrease in their symptoms is the MID for the VASD and was found to be 22mm (95% CI 16 - 27mm). 2. Development of a thoracic ultrasound septation score (TUSS): A TUSS is important for objectively assessing the degree of septation within a pleural effusion. An iterative process was used to demonstrate that degree of septation predicts clinical outcome, to identify candidate factors for inclusion in a TUSS and to determine which factors predicted the degree of septation. The final TUSS consisted of an assessment of the degree of homogeneity of septation distribution and number of septations at the most septated area. 3. Effect of an indwelling pleural catheter (IPC) versus standard care for relieving dyspnoea in patients with MPEs: the TIME2 randomised controlled trial (RCT). The objective of this unblinded RCT was to determine whether IPCs are more effective than chest drains and talc pleurodesis at relieving dyspnoea in patients with MPEs. 106 patients were randomised to either IPC or standard care in a 1:1 ratio. The primary outcome was daily VASD over 42 days post intervention. Dyspnoea improved in both groups with no significant difference in mean dyspnoea in the first 42 days (mean score: IPC 25mm (95% CI 19 – 30), standard care 24mm (95% CI 19 – 29)).

Thesis advisor: Michael Russell / For more than a half century surveys and questionnaires with Likert-scaled items have been used extensively by researchers in schools to draw inferences about students; however, to date there has not been a single study that has examined whether alternative item response types on a survey might lead to different results than those obtained with Likert scales in a K-12 setting. This lack of direct comparisons leaves the best method of framing response options in educational survey research unclear. In this study, 4th through 12th grade public school students were administered two versions of the same survey online: one with Likert-scaled response options and the other with visual analogue-scaled response options. A randomized, fixed-effect, between-subjects experimental design was implemented to investigate whether the survey with visual analogue-scaled items yielded results comparable to the survey with Likert-scaled items based on the following four methods and indices: 1) factor structure; 2) internal consistency and test-retest reliability; 3) survey summated scores; and 4) main, interaction, and simple effects. Results of the first three indices suggested that both the Likert scale and visual analogue scale produced similar factor structures, were equally reliable, and yielded summated scores that were not significantly different across all three school levels (elementary, middle, and high school). Results of the factorial ANOVA suggested that only the main effect of school level was statistically significant but that there was no significant interaction between item response type and school level. Results of the post-survey questionnaires suggested that students at all school levels preferred answering questions on the survey with the VAS compared to the LS nearly three to one. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Research, Measurement, and Evaluation.

The purpose of this quantitative study was to investigate which bullying rating scale, between the Likert Scale (LS) and the Visual Analogue Scale (VAS), is more appropriate for Grade 4 learners. Although literature verifies the reliability of these two rating scales used to measure bullying in young children, the validity and the suitability of these instruments for young learners has not been extensively explored in the South African context. The concern with bullying in this study has to do with the need for the accurate assessment/measurement of bullying, since a proper understanding of bullying depends on the accuracy of the instrument used. Against this backdrop, this study employed a survey design, rooted in a post-positivist conceptualisation of bullying, using a bullying questionnaire. The study’s questionnaire consisted of both LS and VAS response options, and was used to measure both the bully and the victims’ response option preferences (LS versus VAS), in addition to assessing the reliability and validity of both response options. A class of Grade 4 learners from one Model C school formed part of the survey and those who were willing to participate completed the Learner Bullying Questionnaire (LBQ). The school was selected using a purposive, non-probability sampling method based on the geographical area, the in addition to the incidence of bullying and diversity of the school population. The quantitative data obtained from the survey design questionnaires were analysed statistically using descriptive statistics as well as the Spearman correlation coefficient to determine the correlation between the VAS and LS responses for each question presented. Using the Wilcoxon tes, the differences between the two response options were determined (i.e. the variances in the preference scores and difficulty scores of the Grade 4 learners for the two response options). The results of the LBQ show no significant difference of scale preference for the Grade 4 learners. However, the learners - in the six scale preference questions included near the end of the LBQ - indicated that they preferred the VAS over the LS. / Dissertation (MEd)--University of Pretoria, 2017. / Educational Psychology / MEd / Unrestricted

Este trabalho teve por objetivo avaliar os efeitos da acupuntura em dois diferentes grupos de pacientes portadores de Disfunções Temporomandibulares (DTM), um deles com DTM de característica apenas muscular (MUSC), e o outro com DTM muscular associada a desordem articular (ART). Participaram dessa pesquisa 68 pacientes, 32 no grupo MUSC e 36 no grupo ART. Os pacientes de cada grupo foram aleatoriamente subdivididos em dois grupos, que receberam diferentes tratamentos por acupuntura. Um grupo foi tratado com pontos próximos ao local da dor (VG20, VB20, TA21, E6 e E7), e o outro, com pontos à distância (IG4 e YinTang). Foram 6 sessões semanais, cada uma com duração de 20 minutos. Os pacientes foram avaliados por meio de escala visual analógica (VAS), limiar de dor à pressão por algômetro, sensibilidade dolorosa à palpação digital, extensão de movimentos mandibulares, questionário para medir o impacto da dor na qualidade de vida (OHIP-14), questionário de qualidade do sono (SAQ) e questionário para avaliar a percepção dos sinais e sintomas pelo paciente (ProDTMmulti). As avaliações foram feitas em 4 momentos diferentes, o inicial, no primeiro contato com o paciente após o período de triagem, o controle, após 4 semanas sem qualquer intervenção terapêutica, o final, após 6 sessões semanais de acupuntura, e o de acompanhamento, 4 semana após o fim do tratamento, sem que nenhum intervenção fosse feita. Os resultados demonstraram que as melhorias estatisticamente significativas para os grupos experimentais foram observadas de maneira generalizada para a avaliação subjetiva da dor, em que todos os grupos de comportaram de maneira semelhante, apesar de os melhores resultados terem sido observados em ART-PD. Em todos os outros parâmetros de avaliação foi possível observar aspectos de melhoria dos grupos com significância estatística (p<0,05), mas não de maneira generalizada como na VAS. Parâmetros objetivos, como extensão de movimentos mandibulares e algometria, mostraram uma tendência para melhoria, embora sem significância estatística para todos os grupos. A acupuntura foi um tratamento considerado eficiente no controle da dor e dos outros aspectos avaliados em pacientes com DTM muscular associada ou não a alterações articulares. / This study aimed to evaluate the effect of acupuncture treatment in two diferent types of temporo-mandibular disorder (TMD) pacients: muscular TMD (MUSC) and a muscular plus articular TMD (ART). Out of 68 patientes, 32 were classified to the MUSC group and the other 36 ones for the ART group. Patientes of each group were randomly assigned into two subgroups according to type of practiced acupuncture. One subgroup were treated with local acupuncture, next (PL) to the pain location (VG20, VB20, TA21, E6 e E7), and the other one were treated with needles inserted distant (PD) to the pain location (IG4 e YinTang). Six weekly 20min treatment sections were performed. The patients were evaluated according to Visual Analogic Scale (VAS), pressure pain thresold by algometer, digital pressure pain sensation, mandibular movements extension, quality of life questionaire (OHIP-14), sleep quality questionaire (SAQ), and signals and simptoms questionaire (ProDTMmulti). Evaluations were performed at for different moments: initially, at the first meeting; control, four weeks after the initial meeting; end, after six acupunture meetings; and follow-up, four weeks after treatment end, without any additional intervention. Results showed that statistical significant better observations for subjective pain evaluation were noted for all groups, in spite of the best results were noted in ART-PD. According to all evaluation methods it was possible to note better results for all groups (p<0,05), but this was not so noticiable as on VAS evaluation. Direct objective parameters, i.e., mandibular movements extension or algomenter measurements, showed a tendecy for better results, but no statistical significant results were found. Acupuncture could be considered an effective treament option for pain relief and also for the other evaluated aspects for patients with muscular TMD with or without articular association.

Este trabalho teve por objetivo avaliar os efeitos da acupuntura em dois diferentes grupos de pacientes portadores de Disfunções Temporomandibulares (DTM), um deles com DTM de característica apenas muscular (MUSC), e o outro com DTM muscular associada a desordem articular (ART). Participaram dessa pesquisa 68 pacientes, 32 no grupo MUSC e 36 no grupo ART. Os pacientes de cada grupo foram aleatoriamente subdivididos em dois grupos, que receberam diferentes tratamentos por acupuntura. Um grupo foi tratado com pontos próximos ao local da dor (VG20, VB20, TA21, E6 e E7), e o outro, com pontos à distância (IG4 e YinTang). Foram 6 sessões semanais, cada uma com duração de 20 minutos. Os pacientes foram avaliados por meio de escala visual analógica (VAS), limiar de dor à pressão por algômetro, sensibilidade dolorosa à palpação digital, extensão de movimentos mandibulares, questionário para medir o impacto da dor na qualidade de vida (OHIP-14), questionário de qualidade do sono (SAQ) e questionário para avaliar a percepção dos sinais e sintomas pelo paciente (ProDTMmulti). As avaliações foram feitas em 4 momentos diferentes, o inicial, no primeiro contato com o paciente após o período de triagem, o controle, após 4 semanas sem qualquer intervenção terapêutica, o final, após 6 sessões semanais de acupuntura, e o de acompanhamento, 4 semana após o fim do tratamento, sem que nenhum intervenção fosse feita. Os resultados demonstraram que as melhorias estatisticamente significativas para os grupos experimentais foram observadas de maneira generalizada para a avaliação subjetiva da dor, em que todos os grupos de comportaram de maneira semelhante, apesar de os melhores resultados terem sido observados em ART-PD. Em todos os outros parâmetros de avaliação foi possível observar aspectos de melhoria dos grupos com significância estatística (p<0,05), mas não de maneira generalizada como na VAS. Parâmetros objetivos, como extensão de movimentos mandibulares e algometria, mostraram uma tendência para melhoria, embora sem significância estatística para todos os grupos. A acupuntura foi um tratamento considerado eficiente no controle da dor e dos outros aspectos avaliados em pacientes com DTM muscular associada ou não a alterações articulares. / This study aimed to evaluate the effect of acupuncture treatment in two diferent types of temporo-mandibular disorder (TMD) pacients: muscular TMD (MUSC) and a muscular plus articular TMD (ART). Out of 68 patientes, 32 were classified to the MUSC group and the other 36 ones for the ART group. Patientes of each group were randomly assigned into two subgroups according to type of practiced acupuncture. One subgroup were treated with local acupuncture, next (PL) to the pain location (VG20, VB20, TA21, E6 e E7), and the other one were treated with needles inserted distant (PD) to the pain location (IG4 e YinTang). Six weekly 20min treatment sections were performed. The patients were evaluated according to Visual Analogic Scale (VAS), pressure pain thresold by algometer, digital pressure pain sensation, mandibular movements extension, quality of life questionaire (OHIP-14), sleep quality questionaire (SAQ), and signals and simptoms questionaire (ProDTMmulti). Evaluations were performed at for different moments: initially, at the first meeting; control, four weeks after the initial meeting; end, after six acupunture meetings; and follow-up, four weeks after treatment end, without any additional intervention. Results showed that statistical significant better observations for subjective pain evaluation were noted for all groups, in spite of the best results were noted in ART-PD. According to all evaluation methods it was possible to note better results for all groups (p<0,05), but this was not so noticiable as on VAS evaluation. Direct objective parameters, i.e., mandibular movements extension or algomenter measurements, showed a tendecy for better results, but no statistical significant results were found. Acupuncture could be considered an effective treament option for pain relief and also for the other evaluated aspects for patients with muscular TMD with or without articular association.

Les risques psychosociaux prennent une part de plus en plus prégnante en matière de santé au travail. Le médecin du travail doit pouvoir disposer d'outil permettant d'évaluer l'état de santé des salariés. L'évaluation du stress, conséquence et facteur de risque à la fois est un marqueur particulièrement intéressant pour le médecin du travail. Ce travail vise à éclairer l'utilisateur sur les qualités psychométriques de l'échelle visuelle analogique (EVA) dans l'évaluation du stress, dans le cadre de la médecine du travail. Nous avons étudié la stabilité, la fidélité interjuge, la validité concourante, la sensibilité discriminative, mais aussi les facteurs cognitifs pouvant influencer la réponse à l'EVA tels que la présentation de Soi, la revendication, ou la représentation sociale du stress. Nous proposons aussi des modalités d'utilisation et d'interprétation de l'EVA. / Psychosocial risk factors are more and more important in the field of occupational health. Occupational physicians must have some useful tools to assess the mental health. Stress assessment may be an interesting marker for the occupational physicians. One way to assess the stress is the visual analogue scale, well known in pain assessment. But what about its psychometric properties? What about the stability, inter judge reliability, fiability, agreement between visual analogue scale and perceived stress scale, discriminative sensitivity? What is the influence of cognitive factors, such as the presentation of self, the claimings, and the social representation of stress? This manuscript is a guideline of stress assessment using a visual analogue scale too.

The aim of our study was to assess the changes of free radicals and other biochemical parameters after nociceptive stimulation in different experimental animal models. In patiens we detected whether preemptive analgesia had a positive effect on acute postoperative pain. Objective evaluation of pain intensity is a long-term problem because the objectification of using electrophysiological and imaging methods is currently difficult and expensive, and therefore in laboratories in the Czech Republic and many other places are used the evaluation by means biochemical methods. We implemented large experimental studies using mechanical, inflammatory and visceral nociception and we found out in particular that nitroxid and hydroxyl free radicals and singlet oxygen increased significantly after nociceptive stimulation. This increase can be suppressed by antioxidants. At the same time, we showed that some parameters of metabolism lipids, carbohydrates and proteins have also been changed. In particular, we measured the free hydroxyl radicals and singlet oxygen by EPR method in the tail of living and anesthetized rats. This method is absolutely a priority and has never been used before. Earlier experimental results were partially clinically verified using different types of acute and chronic pain in humans...

Background: There is a high incidence of moderate to severe postoperative pain in patients undergoing neurosurgery. Post-craniotomy headache (PCH) remains undertreated due to the cautious use of opioids in this surgical population. Various alternative analgesics such as acetaminophen and scalp blocks are widely utilized for the treatment of PCH, but this is often inadequate. Although a multimodal approach to the management of PCH may be effective in improved pain relief, only a limited number of randomized controlled trials have explored this. Aim: This study aims to investigate whether or not a multimodal analgesic regime, consisting of gabapentinoids and non-steroidal inflammatory drugs (NSAIDs) provides superior pain relief in patients undergoing elective craniotomy compared to the standard of care analgesia utilized at a local South African hospital. Methods: Twenty-seven patients, 18 years or older, scheduled for elective craniotomy for the management of their epilepsy were recruited into this clinical trial. Enrolled participants were randomized into one of two groups. The experimental group received oral 150mg pregabalin one hour before surgery, IV 40mg parecoxib at surgical closure, and oral 150mg pregabalin two hours after surgery. The control group received a matching placebo at these respective time points. Postoperatively, all patients received standard of care analgesia consisting of 24 hours IV paracetamol and additional analgesia as required (prn). Pain assessments using the numerical rating scale (NRS) and visual analogue scale (VAS) were performed at 1 hour, 8 hours, 24 hours, 48 hours and 72 hours postoperatively. Additional analgesia consumption, postoperative nausea and vomiting, as well as the incidence of any adverse events were captured. Results: Patients who received placebo showed an average trend of higher mean NRS pain scores compared to patients receiving pregabalin and parecoxib, although there was no significant difference (p = 0.218) in the maximum mean NRS pain scores between the experimental and control groups. However, patients who received pregabalin and parecoxib consumed significantly less dihydrocodeine than those who received placebo (p = 0.029). No significant differences were identified in use of other additional opioids and non-opioid analgesia during the first 24 postoperative hours. Conclusion: There is insufficient evidence to confirm that the perioperative use of pregabalin and parecoxib reduces PCH in patients undergoing elective craniotomy. The study medication did, however, result in a significant reduction in the use of postoperative dihydrocodeine, although it was also associated with higher rates of reported blurred vision and dizziness.

The thesis deals with comparing the postoperative analgesia with a focus on pacients after hip replacement surgery at the intensive care units. The quantitative study realized at the Fakultní nemocnice v Motole and Nemocnice Třebíč during November 2012 and February 2013. The main task of the theoretical part is to analyze the current trends in the field of post- operativeanalgesia by the patients undergoing hip joint surgery as well as the explanation the basicconcepts of this issue and overviewing the international postoperative pain treatments. The practical part is an objective comparison the postoperative analgesia byselected patients at the Fakultní nemocnice v Motole and Nemocnice Třebíč determined by questionnaire. The results of the questionnaire are processed into graphical representation and subsequently evaluated. The work serves to clarify the overall issue of post-operative analgesia. The focus is mainly on ensuring the quality of postoperative analgesia, the financial requirements administered analgesics and the possible complications associated with the use of analgesic therapy. Key words: Analgesia, pain, hip surgery, visual analogue scale, analgesics

A Visual Analogue Scale (VAS) e a escala Category-Ratio (CR10) foram aplicadas para mensurar a dor em pacientes com Disfunções Temporomandibulares (DTMs) em dois estudos. No primeiro estudo, em 35 pacientes (Grupo I) foram aplicadas uma versão modificada da escala CR10 em português e a VAS para mensurar a dor espontânea, durante função orofacial e durante palpação antes e após tratamento odontológico. A modificação na CR10 consistiu em um desmembramento das categorias verbais e da escala numérica apresentadas cada uma delas em única coluna em mesma folha. Os coeficientes de correlação de Pearson entre as pontuações da VAS e da CR10 foram 0,85 antes do tratamento odontológico e 0,9 após o tratamento, indicando alta validade de critério. A associação entre os valores numéricos e as categorias verbais da Escala CR10 Modificada mostrou diferenças em relação ao que é proposto na escala original. As categorias: “Moderado", “Forte" e “Muito Forte" foram associadas a valores superiores aos originais. O segundo estudo foi planejado para investigar se essas discrepâncias nas associações das categorias com os seus valores numéricos eram replicáveis e verificar se não dependiam da forma de apresentação da escala CR10 modificada. Para isso, as escalas foram aplicadas para medir dor em duas novas amostras de pacientes com DTMs antes do tratamento odontológico. A CR10 com nova modificação e a VAS foram aplicadas à primeira amostra (Grupo II , n=23 pacientes). A modificação na CR10 consistiu na apresentação primeiro da escala numérica em uma coluna seguida pela apresentação das categorias verbais em três colunas. A CR10 original e a VAS foram aplicadas à segunda amostra (Grupo III, n=17 pacientes). Os coeficientes de correlação de Pearson foram 0,9 para o Grupo II e 0,8 para o Grupo III, indicando também alta validade de critério. Assim como no primeiro estudo, na escala CR10, as categorias verbais: “Moderado", “Forte" e “Muito Forte" foram associadas na escala numérica a valores superiores aos propostos na escala original Em ambos estudos, a escala CR10 foi a mais bem avaliada pelos pacientes, segundo a facilidade de compreensão das instruções e a adequação para o registro da dor. Evidencia-se a necessidade de mais estudos para validar a escala CR10 para a língua portuguesa para determinar com precisão a associação das categorias verbais aos valores numéricos. / Visual Analogue Scale (VAS) and Category-Ratio Scale (CR10) were applied to measure pain in patients with Temporomandibular Disorders (TMDs). In the first study, a modified version of CR10 translated to Portuguese and VAS were applied to measure spontaneous pain, functional pain and pain by touch after and before dentistry treatment in 35 patients (Group I). The CR10 modification consisted of presenting the verbal categories and the numerical scale in separated columns in a sheet. Coefficients of Pearson’s correlation between VAS and CR10 scores were .85 and .90 respectively before and after treatment, indicating a high criterion validation. The association of numerical values and verbal categories of Modified CR10 scale were different from the original CR10. The verbal expressions “moderate", “strong" and “very strong" were attached to higher values. In the second study we investigated if these discrepancies in attaching the verbal categories to the numerical scale were replicable and if they were not an artifact of the way of presenting the modified CR10 scale. To check these topics, the scales were applied to measure pain in two new samples of patients with TMD before dentistry treatment. A new modified version of the CR10 scale and the VAS were applied to the first sample (Group II, n=23 patients). This modification in CR10 scale consisted of presenting first the numerical scale in separate column, and then the verbal categories distributed in three columns. The original CR10 and VAS were applied to the second sample (Group III, n=17 patients). Coefficients of Pearsons correlation between CR10 and VAS were .9 for Group II and .8 for Group III, indicating also high criterion validation. As indicated in the first study, some verbal categories were attached to the numerical scale at higher values than those ones in the original scale. In both studies,, most patients judged the CR10 easier to be understood and more adequate to measure pain than VAS. There is evidence of the necessity of more studies to validate CR10 to Portuguese to determine with precision the association of the verbal categories to the numeric values.