Evaluación del conocimiento en dolor orofacial de los docentes de la Facultad de Odontología de la Universidad Finis Terrae / Evaluation of the orofacial pain knowledge of the Dental School professors of the University Finis Terrae

Introducción: El Dolor Orofacial (DOF) es una forma frecuente de dolor percibido en la cara y/o cavidad bucal. Puede ser causado por enfermedades o trastornos de las estructuras regionales, disfunción del sistema nervioso o por derivación de fuentes distantes." (International Association for the Study of Pain, s. f.) Esta condición presenta una alta prevalencia, y la literatura internacional demuestra una deficiencia en el conocimiento de los profesionales en DOF. Objetivo General: Determinar el conocimiento en Dolor Orofacial en los docentes de la Facultad de Odontología de la Universidad Finis Terrae en el año 2021. Material y Método: Se llevó a cabo un estudio descriptivo de corte transversal con componente analítico, utilizando un muestreo no probabilístico por conveniencia de voluntarios, a quienes se les realizó una encuesta validada de la literatura científica que fue adaptada a la lengua española, evaluando parámetros sociodemográficos, percepción y conocimiento respecto al diagnóstico, signos y síntomas clínicos de afecciones de DOF. Resultados: Se pudo observar un conocimiento aceptable de los participantes, en donde el 60% respondió al menos cinco enunciados de forma correcta. Se concluyó que el conocimiento de los docentes de la Facultad de Odontología de la Universidad Finis Terrae fue superior a los registros encontrados en la literatura científica. Si bien este estudio cuenta con algunas limitaciones, permite entregar una base para próximas investigaciones, fomentando la instauración de cursos actualizados en DOF, otorgando un nuevo enfoque a la odontología, en donde se desarrollen profesionales integrales y capaces de diagnosticar, tratar o manejar estas condiciones.

Introduction: Orofacial pain (OFP) is a common form of perceived pain in the face and/or oral cavity. It may be caused by disease or disorders of regional structures, dysfunction of the nervous system, or by referral from distant sources."(International Association for the Study of Pain, s. f.) This condition presents a high prevalence, and the international literature demonstrates a deficiency in the knowledge of OFP professionals. General Objective: To determine the knowledge of Orofacial Pain in the teachers of the Faculty of Dentistry of the Finis Terrae University in the year 2021. Material and Method: A descriptive cross-sectional study with an analytical component was carried out, using a non- probabilistic convenience sampling of volunteers, who were given a validated survey from the scientific literature that was adapted to the Spanish language, evaluating sociodemographic parameters, perception and knowledge regarding diagnosis, clinical signs and symptoms of OFP conditions. Results: It was possible to observe an acceptable knowledge of the participants, where 60% of them answered at least five statements correctly. It was concluded that the knowledge of the teachers of the Faculty of Dentistry of the Universidad Finis Terrae was superior to the records found in the scientific literature. Although this study has some limitations, it provides a basis for future research, encouraging the establishment of updated courses in OFP, providing a new approach to dentistry, in which comprehensive professionals capable of diagnosing, treating or managing these conditions are developed

Beneficios de la evaluación integral en adultos mayores con dolores crónicos de columna en un centro periférico del conurbano bonaerense / Benefits of the comprehensive evaluation in older adults with chronic back pain, in a peripheral medical center of the Buenos Aires suburbs

Introducción. Desde hace varios años, el abordaje de los pacientes adultos mayores que consultan por dolor crónico en un centro periférico del Hospital Italiano del conurbano bonaerense se realiza de manera integral, mediante la evaluación conjunta de una kinesióloga y un médico de familia, lo que facilita la indicación terapéutica individualizada, con la aplicación de estrategias cognitivo-conductuales. Objetivo. Documentar los resultados clínicos luego de una evaluación integral de pacientes mayores de 60 años que consultaron por dolor crónico de columna refractarios a tratamientos monodisciplinarios. Métodos. Estudio observacional, analítico tipo antes-después, prospectivo. Recolectamos variables descriptivas de los participantes al momento de la evaluación integral (demográficas, antropométricas, contextuales y clínicas) y de desenlace: dolor, calidad de vida y actividad física a los tres y seis meses, consultas no programadas y a servicio de traumatología durante ese periodo. Estimamos necesaria una muestra de 30 pacientes, pero debido a la pandemia por SARS-CoV-2finalizamos precozmente el estudio con los pacientes reclutados hasta ese momento. Resultados. Incluimos nueve participantes (edad media 66,5 años, desviación estándar 4,9; 67 % sexo femenino). Todos completaron el seguimiento a seis meses. Observamos reducción del dolor y mejoría de la calidad de vida a los seis meses (cambio en la escala visual analógica [EVA] -3, intervalo de confianza [IC] 95 % -5,1 a -0,94; cambio en el puntaje del EQ-5D-3L 0,17, IC 95 % 0,08 a 0,26, respectivamente). Conclusión. En los pacientes adultos mayores de 60 años con dolor crónico de columna no oncológico evaluados de manera integral por un médico de familia y un kinesiólogo se observó una mejoría del dolor y la calidad de vida a los seis meses de seguimiento. Debido a que el diseño no incluyó un grupo control estas diferencias no pueden atribuirse de manera fehaciente a la intervención, aunque estos hallazgos son concordantes con los de ensayos previos. (AU)

Introduction. For several years, the approach of elderly patients who consult for chronic pain in a peripheral center ofthe Hospital Italiano de Buenos Aires has been carried out in a comprehensive way, through the joint evaluation of akinesiologist and a family doctor, which facilitates individualized therapeutic indication, with the application of cognitive-behavioral strategies.Objective. To document the clinical results after the comprehensive evaluation of patients over 60 years of age whoconsulted for chronic back pain refractory to monodisciplinary treatments. Methods. Observational, analytical, before-after, prospective study. We collected descriptive variables from the participantsat the time of the comprehensive evaluation (demographic, anthropometric, contextual and clinical) and outcome variables:pain, quality of life and physical activity at three and six months, unscheduled consultations and trauma service during thatperiod. We estimate that a sample of 30 patients is necessary, but due to the SARS-CoV-2 pandemic we ended the studyearly with the patients recruited up to that time. Results. We included nine participants (mean age 66.5 years, standard deviation 4.9; 67 % female). All completed the six-month follow-up. We observed reduction in pain and improvement in quality of life at six months (change in visual analogscale [VAS] -3, 95 % confidence interval [CI] -5.1 to -0.94; change in score of the EQ-5D-3L 0.17, 95 % CI 0.08 to 0.26,respectively). Conclusion. In adult patients over 60 years of age with chronic non-cancer back pain who were comprehensively evaluatedby a family doctor and a kinesiologist, an improvement in pain and quality of life was observed at six months of follow-up. Since the design did not include a control group, these differences cannot be reliably attributed to the intervention, althoughthese findings are consistent with those of previous trials. (AU)

Complexity of pediatric chronic disease: cross-sectional study with 16,237 patients followed by multiple medical specialties / Complexidade da doença crônica pediátrica: estudo tranversal com 16.237 pacientes seguidos por múltiplas especialidades médicas

ABSTRACT Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

RESUMO Objetivo: Avaliar dados demográficos e características de crianças e adolescentes com doenças crônicas pediátricas, de acordo com o número de especialidades/paciente. Métodos: Realizou-se um estudo transversal com 16.237 pacientes com doenças crônicas pediátricas durante um ano. A análise foi feita em um sistema eletrônico, de acordo com número de consultas médicas para doenças crônicas pediátricas. Este estudo avaliou dados demográficos, características do seguimento, tipos de especialidades médicas, diagnóstico (10ª Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde - CID-10), número de visitas e complicações agudas. Resultados: Os pacientes acompanhados por três ou mais especialidades simultaneamente tiveram seguimento de maior duração comparados com aqueles seguidos por ≤2 especialidades [2,1 (0,4-16,4) vs. 1,4 (0,1-16,2) anos; p<0,001], bem como maior número de consultas em todas as especialidades. As áreas médicas mais comuns em pacientes acompanhados por ≥3 especialidades foram: psiquiatria (Odds Ratio - OR=8,0; intervalo de confiança de 95% - IC95% 6-10,7; p<0,001); dor/cuidados paliativos (OR=7,4; IC95% 5,7-9,7; p<0,001); doenças infecciosas (OR=7,0; IC95% 6,4-7,8; p<0,001); nutrologia (OR=6,9; IC95% 5,6-8,4; p<0,001). As regressões logísticas mostraram que os pacientes com doenças crônicas pediátricas seguidos por ≥3 especialidades tinham alto risco para: maior número de consultas/paciente (OR=9,2; IC95% 8,0-10,5; p<0,001); atendimentos em hospital-dia (OR=4,8; 95%IC3,8-5,9; p<0,001); atendimentos em pronto-socorro (OR=3,2; IC95% 2,9-3,5; p<0,001); hospitalizações (OR=3,0; IC95%2,7-3,3; p<0,001); internação em terapia intensiva (OR=2,5; IC95% 2,1-3,0; p<0,001); óbitos (OR=2,8; IC95%1,9-4,0; p<0,001). Os diagnósticos de asma, obesidade, dor crônica, transplante e infecção do trato urinário foram mais frequentes nos pacientes seguidos por três ou mais especialidades. Conclusões: O presente estudo mostrou que pacientes com doenças crônicas pediátricas que necessitaram de múltiplas especialidades médicas simultaneamente apresentavam doenças complexas e graves, com diagnósticos específicos.

Validación Delphi de un cuestionario sobre el manejo del dolor en pediatría / Delphi´s validation of a questionnaire about handling of pain in Pediatrics

Introducción: Existen numerosos factores que influyen en la prescripción de analgésicos en pediatría, algunos relacionados con el prescriptor y otros no relacionados directamente. Para determinar los factores de mayor impacto en este problema, se construyó un cuestionario que se sometió a una validación por un grupo de expertos y a test estadísticos. Objetivos: Evaluar la fiabilidad del instrumento construido. Métodos: Se utilizó el método Delphi, con una circulación en tres rondas de un cuestionario remitido a un grupo de expertos de la provincia La Habana, durante los meses de mayo a octubre de 2016. Resultados: Participaron 23 expertos, en las dos primeras rondas se determinaron los ítems a incluir y en la tercera las preguntas. En esta última se logró un consenso de 89,3 por ciento. Las 43 preguntas aceptadas se condensaron en 19 con múltiples incisos y se obtuvo el cuestionario final. Para los factores no dependientes del prescriptor, el alfa de Cronbach fue de 0,179 y el coeficiente de Spearman-Brown de 0,231, mientras que para los factores que sí dependieron del prescriptor los valores fueron de 0,506 y 0,717, respectivamente. Conclusiones: El alto nivel de consenso obtenido y los resultados de los test estadísticos referentes a los factores que sí dependen del prescriptor, indican que las preguntas incluidas en el cuestionario son marcadores válidos para evaluar de forma confiable el manejo del dolor en el área de pediatría(AU)

Introduction: There are numerous factors that influence the prescription of analgesics in Pediatrics, some of them are related to prescriptors and other are not directly related to them. In order to determine the factors of bigger impact in this problem, a questionnaire was developed and submitted later to a group of experts in order to be validated. Objectives: To determine the contents to include in the questionnaire and to evaluate its reliability. Method: The Delphi method was used, with a circulation in 3 rounds of a questionnaire remitted to a group of experts of Havana province from May to October of 2016. Results: 23 experts participated in the study; in the two first rounds they determined the items to include and in the third round the questions. In this last round the consensus was of 89.3 percent, so, it was decided to finish the circulation of the questionnaire. They condensed the 43 accepted questions into 19 with multiple clauses and the final questionnaire was obtained. For the factors not dependents of the prescriptor, Cronbach's alpha value was 0.179 and Spearman-Brown coefficient´s value was 0.231; while for the factors that depended on the prescriptor, the values were 0.506 and 0.717, respectively. Conclusions: The high level of consent obtained and the results of statistics test referred to factors depending on the prescriptor are indicators that the questions included in the questionnaire are valid markers to evaluate in a reliable way the handling of pain in Pediatric areas(AU)

Dolor en niños y adolescentes hospitalizados en un centro de referencia / Pain in children and adolescents hospitalized in a center of reference

Resumen: Introducción: La evaluación y tratamiento del dolor en niños hospitalizados, continúa siendo un importante problema de salud. Objetivo: Conocer la prevalencia, características y prácticas de abor daje del dolor en niños y adolescentes hospitalizados en salas de cuidados moderados del Hospital Pediátrico, Centro Hospitalario Pereira Rossell (HP-CHPR), centro de referencia en Uruguay. Pa cientes y Método: Estudio transversal, mediante encuesta y revisión de historias clínicas el 13/09/16. Se incluyeron todos los menores de 19 años hospitalizados. Variables: edad, sexo, motivo de ingreso, presencia de trastorno cognitivo, prevalencia de dolor en algún momento de la hospitalización, en las últimas 24 h y durante la entrevista, causa de máximo dolor, intensidad, tratamiento farmacológico y no farmacológico. Resultados: se incluyó 97,4% (152/156) de los niños hospitalizados. Prevalencia de dolor en algún momento de la hospitalización: 51,3% (78/152; IC 95%: 43,2-59,3); en las 24 h previas: 39,5% (60/152; IC 95%: 31,7- 47,2); durante la entrevista: 15,8% (24/152; IC 95%: 10 - 21,5). Intensidad: leve 13/24, moderado-severo 11/24. Máximo dolor referido en internación: punciones con agujas 48,5% (38/78). Tenían alguna indicación analgésica 47,3%. Inadecuado intervalo inter dosis: 45,8% de las prescripciones; dosis adecuada 98,9%; vía de administración intravenosa: 43,7%; tenía contraindicación a la vía oral: 40,5%. Conclusiones: de los niños y adolescentes hospitalizados, 39,5% reportó dolor en las 24 h previas a la entrevista y 15,8% durante la misma. El máximo dolor referido durante la hospitalización se debió a punciones con agujas. Se continúa detectando niños con dolor con prescripciones analgésicas inadecuadas.

Abstract: Introduction: The evaluation and treatment of pain in hospitalized is still an important health pro blem. Objective: To know the prevalence, characteristics and approaches to pain management in children and adolescents hospitalized in the Pediatric Hospital of the Pereira Rossell Center (HP-CH- PR), a pediatric reference center in Uruguay. Patients and Method: Cross-sectional study, through survey and review of clinical records on 09/13/16. All hospitalized children under the age of 19 were included. Variables: age, gender, reason for admission, presence of cognitive disorder, the prevalen ce of pain at some time during hospitalization, in the last 24 hours and during the interview, cause of maximum pain, intensity, pharmacological and non-pharmacological treatment. Results: 97.4% (152/156) hospitalized children were included. Pain prevalence at some point during hospitalization: 51.3% (78/152, 95% CI: 43.2-59.3); in the previous 24 hours: 39.5% (60/152, 95% CI: 31.7-47.2); during the interview: 15.8% (24/152, 95% CI: 10-21.5). Intensity: mild 13/24, moderate-severe 11/24. Maximum pain referred during hospitalization: needle punctures 48.5% (38/78). They had some analgesic prescription 47.3% of them had some analgesic prescription. Inadequate interdose inter val: 45.8%; adequate dose 98.9%; intravenous administration: 43.7%; contraindication to oral route: 40.5%. Conclusions: Regarding children and adolescents hospitalized, 39.5% reported pain 24 hours before being the interviewed and 15.8% reported pain during the interview. The maximum pain reported during hospitalization was due to needle punctures. Children in pain with inappropriate analgesic prescriptions are still detected.

Uso da rede social FacebookTM na coleta de dados e disseminação de evidências / Use of the FacebookTM social network in data collection and dissemination of evidence

Aim: The aim of this study was to evaluate the use of the FacebookTM platform as a means of disseminating a video in Portuguese demonstrating the use of three interventions of pain management (breastfeeding, skin-to-skin contact, and sweet solutions) during minor procedures, and to evaluate prior knowledge, the range, dissemination and intent to use the strategies in the future. Method: This is a cross-sectional survey, which used the "virtual snowball" sampling method, aimed at parents and health professionals caring for neonates. The study was conducted in Brazil, through a FacebookTM page (https://www.facebook.com/sejadocecomosbebes), in which the video and a brief questionnaire were posted. Results: After three months the page reached 28,364 "views", in 45 municipalities across Brazil, 1531 people accessed the page, 709 responses to the questionnaires, 1126 "likes", and multiple positive comments. Almost all viewers (99.71%) answered they would use one of the pain reducing strategies. Conclusion: Our results indicate that using FacebookTM to deliver and evaluate an intervention is feasible, rapid in obtaining responses at a low cost, and it is promising for data collection and knowledge dissemination.

Objective: Evaluar el uso de la plataforma FacebookTM para diseminar un vídeo em portugués, demostrando las intervenciones de manejo del dolor neonatal (amamantamiento, contacto piel a piel y soluciones dulces) durante procedimientos dolorosos menores, y evaluar conocimiento previo, alcance, diseminación e intención de uso de lasestrategiasenel futuro. Metodo: El estudio transversal del tipo survey, con método de muestreo virtual "snowball", dirigido a padres y profesionales de salud, aplicado en Brasil, a través de una página creada en FacebookTM, em la cual un vídeo fue publicado, asociado a unc uestionario corto. Resultados: Tres meses de recolección em línea mostraronun alcance de 28.364 visitas en 45 municipios del país, acceso a la página por parte de 1531 personas, 709 respuestas al cuestionario. El 99,71% respondieron que recomendarían el uso de una de las estrategias. Conclusión: La utilización de FacebookTM para presentar y evaluar una intervención es viable, rápida em la obtención de respuestas, de bajo costo y prometedora para la recolección de datos y la diseminación del conocimiento.

Objetivo: Avaliar o uso do FacebookTM, como plataforma de mídia social, para disseminar um vídeo em português, demonstrando as três intervenções de manejo da dor (amamentação, contato pele a pele e soluções adocicadas) durante procedimentos dolorosos menores, e avaliar conhecimento prévio, alcance, disseminação e intenção de uso das estratégias no futuro. Método: Estudo transversal do tipo survey, com método de amostragem virtual "snowball", direcionado a pais e profissionais de saúde, aplicado no Brasil, em uma página no FacebookTM na qual um vídeo associado a um breve questionário foi postado. Resultados: Três meses de coleta online mostraram alcance de 28.364 visualizações em 45 municípios brasileiros, acesso à página por parte de 1531 pessoas, 709 respostas ao questionário. 99,71% recomendariam o uso de uma das estratégias. Conclusão: A utilização do FacebookTM para apresentar e avaliar uma intervenção é viável, rápida na obtenção das respostas, de baixo custo e promissora para coleta de dados e disseminação do conhecimento.

Conocimientos relativos al abordaje del dolor en niños: Encuesta a posgrados y residentes / Knowledge related to pain management in children: Survey to postgraduate students and residents

Introducción: el dolor es un problema de salud pública en todas las edades. Los niños tienen más riesgo de ser insuficientemente tratados. Una encuesta a médicos residentes del Hospital Maciel reportaba que 75% no conocía la escalera analgésica de la Organización Mundial de la Salud (OMS) y 67% no prescribía morfina habitualmente cuando estaba indicada. Objetivo: describir el grado de conocimiento de médicos posgrados y residentes que asisten niños respecto a los principios de la OMS para tratamiento del dolor y sus prácticas enunciadas de prescripción analgésica. Metodología: estudio descriptivo, transversal, encuesta anónima. Resultados: respondieron 131 médicos. Refirieron asistir niños con dolor: 98%; frecuentemente: 43%. Relataron conocer la escalera analgésica de la OMS: 70%. Identificaron correctamente fármacos del primer escalón: 76%, del segundo: 4%. Respecto a morfina: nunca la prescribió: 61%; la razón más frecuente para no hacerlo: 'no necesitar usarlo' 49%; refirieron correctamente: que no tiene dosis máxima: 48%, y el intervalo de administración correcto: 44%. Reportaron: 2 fármacos coadyuvantes: 28%, y haber leído 1 artículo relativo a dolor en los últimos 3 años: 39%. Conclusiones: se detectaron deficiencias en: el reconocimiento de fármacos para el tratamiento de dolor severo; fármacos coadyuvantes; propiedades farmacológicas y farmacocinéticas de morfina. Más de la mitad de los médicos encuestados nunca prescribió morfina. Se constató escasa lectura referente a este frecuente problema de salud.

Introduction: pain is a public health problem at all ages. Children are at particular risk of receiving insufficient treatment. A survey to resident doctors at Maciel Hospital showed that 75% of them did not know the analgesic ladder from the World Health Organization (WHO) and 67% did not prescribe morphine when indicated. Objective: to describe the level of knowledge of postgraduate and resident doctors who care for children, considering the WHO principles for pain treatment and their expressed analgesic prescription practice. Methodology: A descriptive, transversal and anonymous survey was performed. Results: 131 doctors answered the survey; 98% declared they treat children in pain, 43% do it frequently; 70% stated that they knew the WHO analgesic ladder; 76% correctly identified drugs belonging to the first step and 4% the ones of the second. Regarding morphine: 61% never prescribed it, the most frequent reason for not doing it was: 'it was not necessary': 49%; correctly reported not having a maximum dose: 48%; expressed correct interval dose: 44%; reported 2 adjuvant drugs: 28%; having read one article related to pain in the last 3 years: 39%. Conclusions: deficits in the following areas were found: lack of knowledge of drugs to treat severe pain; adjuvant drugs; morphine pharmacological and pharmacokinetic properties, more than half of the interviewees never prescribed morphine. Limited reading regarding this frequent health problem was found.

Perfil epidemiológico de los pacientes ingresados a la Unidad de Dolor Músculo-esquelético del Servicio de Medicina Física y Rehabilitación del Hospital Clínico Universidad de Chile / Epidemiological profile of patients admitted to the Pain Unit Musculoskeletal Service Physical Medicine and Rehabilitation Hospital Clínico Universidad de Chile

Pain is an individual and subjective experience, recognized as an important public health issue. Further, pain is a complex phenomenon which needs a transdisciplinary approach. Objective: To describe the epidemiological characteristics of patients admitted in a Pain Unit. Methods: We performed an observational prospective study that analyzed the medical records of patients who attend the Pain Clinic, at the Rehabilitation Unit in the University of Chile Clinical Hospital, between April 2012 and April 2013. Results: Women are more frequently affected by pain (78.50 percent), with a mean age of 54 years old. The mean duration of pain was 1.76 years and the most common presentation was low-backache (54.21 percent) with moderate intensity. Most of the patients were taking painkillers (75.70 percent), preferably aracetamol and NSAIDs. 47.66 percent suffered from mixed pain and a 92.52 percent manifested chronic pain. Myofascial pain and osteoarthritis were the more frequent causes. After admission, a more appropriated treatment was prescribed in all of the patients, most of them consisting in opioids and antiepileptic drugs, associated with interventional techniques (60.75 percent). As a consequence, 67.09 percent of the patients had a significant decrease in pain intensity. Conclusion: It is necessary to generate epidemiological research lines that support health policies and allows a transdisciplinary pain management...

Evaluación y mejoría del dolor en niños atendidos por enfermeras acreditadas: estudio descriptivo / Pain assessment and improvement in children treated by accredited nurses: descriptive study

Antecedentes: la evaluación del dolor es una tarea compleja que requiere de un esfuerzo considerable dada su naturaleza multidimensional. Esta evaluación es, si cabe, más compleja en el caso de los niños debido a las dificultades de comunicación y dominio del lenguaje. Objetivos: analizar la reducción del dolor logrado por enfermeras acreditadas, en función de la edad de los niños atendidos. Metodología: se utilizaron 161 evaluaciones del dolor percibido en niños de entre 0 y 15 años, realizadas por 93 enfermeras acreditadas entre septiembre de 2006 y julio de 2011. Para la elaboración de los análisis descriptivos se utilizó el test estadístico Chi-cuadrado. Se calcularon las Odds ratio para la probabilidad de reducir el dolor a 0 en los niños según su edad. Resultados: los resultados evidenciaron que las enfermeras presentan un mayor nivel de competencias en la reducción del dolor en niños de edades comprendidas entre 2 y 3 años, observándose hasta los 10 años una leve tendencia negativa en la capacidad de reducir el dolor a cero por parte de las enfermeras, a medida que aumenta la edad del niño. Conclusiones: este trabajo aborda la evaluación del dolor, realizada por el conjunto de enfermeras de cuidados infantiles, que trabajan en los servicios de salud públicos de Andalucía, y que han sido acreditadas por la Agencia de Calidad Sanitaria de Andalucía, España. Las enfermeras utilizaron distintos tipos de escalas de medición del dolor, en función del desarrollo cognitivo de los niños atendidos.

Background. Pain assessment is a complex task that requires considerable effort due to its multidimensional nature. This assessment is, if anything, more complex in the case of children due to the difficulties of communication and language proficiency. Aim. To analyse pain reduction achieved by accredited nurses depending on the age of the children treated. Method. 161 assessments of perceived pain in children aged 0 to 15 years conducted by 93 accredited nurses between September 2006 and July 2011 were used. Chi-square tests were applied for descriptive analysis. Odds ratio for probabilities of reducing pain to 0 was calculated according the age of the children. Results. The results show that nurses have a higher level of competency in reducing pain in children aged between 2 and 3 years, showing a mild negative trend in the ability to reduce pain to zero, with increasing child's age. Conclusions. This paper addresses the assessment of pain, held by all child-care nurses who work in Public Health Services of Andalusia (Spain), which have been accredited by the Andalusian Agency for Healthcare Quality. Nurses have used different types of pain measurement scales, depending on the cognitive development of children treated.

Evaluación de un programa de dolor agudo: eficiencia, seguridad y percepción de la atención por parte de los pacientes, experiencia Clínica Alemana, Santiago-Chile / Evaluation of a program of acute pain: efficiency, safety and perception of care by patients, experience Clínica Alemana, Santiago-Chile

La falta de alivio adecuado del dolor postoperatorio tiene efectos negativos en los resultados de la cirugía y en la satisfacción de los pacientes. Hoy en día el dolor continúa siendo sub tratado en muchos lugares del mundo La incidencia de dolor moderado a severo está entre 30 a 80 por ciento de los postoperados. Un programa de dolor agudo (PDA) es muy recomendable en las instituciones y debe basarse en guías clínicas con la mejor evidencia disponible. Objetivos: Evaluación del PDA de Clínica Alemana de Santiago con respecto a la eficacia y seguridad del tratamiento del dolor y a las opiniones del paciente sobre su experiencia de dolor y la atención recibida por el equipo de dolor (EDA) y enfermeras. Material y Métodos: Revisamos los datos electrónicos de todos los pacientes manejados por el PDA entre diciembre de 2010 y septiembre de 2011 (993 pacientes). También se realizó una encuesta con 9 preguntas a una muestra de 163 pacientes por investigadores ciegos. Resultados: El promedio de edad fue 51,4 +/- 18 años con un 51 por ciento de mujeres y 49 por ciento hombres. Los pacientes tenían dolor agudo postoperatorio (93 por ciento) y dolor agudo no quirúrgico (7 por ciento).El promedio de control por el PDA fue de 2,6 +/- 1,19 días. Las técnicas analgésicas fueron multimodales en todos los casos. La frecuencia de las técnicas utilizadas fue: PCA IV 46 por ciento, catéteres peridurales 35 por ciento y catéteres perineurales 18 por ciento. La morfina fue el opioide más usado (63,8 por ciento). Todos los pacientes recibieron de 1 a 3 analgésicos no opioides. En 11 por ciento se usó medicación coadyuvante. El promedio de intensidad del dolor registrado el primer día fue de 1,4 en reposo y 3,3 dinámico (escala 0 a 10) y estos valores disminuyeron a 0,86 y 2,5 respectivamente el día del alta del programa. Casi todos los valores estuvieron en el rango de dolor leve (0 a 3). No se presentaron complicaciones en relación a los métodos de analgesia...

Lack of adequate postoperative pain relief has negative effects on patient outcome and satisfaction. Nowadays pain continues being undertreated all over the world. Incidence of moderate to severe pain is between 30 to 80 percent of postoperative patients. An Acute Pain Program (APP) is strongly recommended in institutions and must be based on clinical guidelines with the best evidence available. Objectives: Evaluation of the APP of Clínica Alemana regarding the efficacy and safety of pain management and patients’ opinion about their pain experience and care provided by the pain team and nurses. Methods: We reviewed the electronic data of all patients treated by the APP between December 2010 and September 2011 (993 patients). Also a group of 163 patients was interviewed with a survey of nine questions by blind investigators. Results: Mean age was 51.4 +/- 18 years; 51 percent female and 49 percent male. Patients had acute postoperative pain (93 percent) and non-surgical acute pain (7 percent). The mean stay in APP control was 2.6 +/- 1.19days. Analgesic techniques were multimodal analgesia: iv PCA 46 percent, epidural catheters 35 percent and perineural catheters 18 percent. Morphine was the more used opioid (63.8 percent). All patients were treated with 1 to 3 non opioid analgesics. Adjuvant medication was used in 11 percent of the patients. The mean pain intensity registered the first day was 1.4 at rest and 3.3 dynamic (0-10 scale) and these values decreased to 0.86 and 2.5 respectively on the day of discharge. Almost all values were in range of mild pain (0-3). No complications occurred related to analgesia methods...

End of life in the neonatal intensive care unit

PURPOSE: Death at the beginning of life is tragic but not uncommon in neonatal intensive care units. In Portugal, few studies have examined the circumstances surrounding the final moments of neonates. We evaluated the care given to neonates and their families in terminal situations and the changes that had occurred one decade later. DESIGN AND METHODS: We analyzed 256 charts in a retrospective chart review of neonatal deaths between two periods (1992-1995 and 2002-2005) in a level III neonatal intensive care unit. RESULTS: Our results show differences in the care of dying infants between the two periods. The analysis of the 2002-2005 cohort four years revealed more withholding and withdrawing of therapeutic activities and more effective pain and distress relief; however, on the final day of life, 95.7 percent of the infants received invasive ventilatory support, 76.3 percent received antibiotics, 58.1 percent received inotropics, and 25.8 percent received no opioid or sedative administration. The 2002-2005 cohort had more spiritual advisor solicitation, a higher number of relatives with permission to freely visit and more clinical meetings with neonatologists. Interventions by parents, healthcare providers and ethics committees during decision-making were not documented in any of the charts. Only eight written orders regarding therapeutic limitations and the adoption of palliative care were documented; seven (87.5 percent) were from the 2002-2005 cohort. Parental presence during death was more frequent in the latter four years (2002-2005 cohort), but only 21.5 percent of the parents wanted to be present at that moment. CONCLUSION: Despite an increase in the withholding and withdrawing of therapeutic activities and improvements in pain management and family support, many neonates still receive curative and aggressive practices at the end of life.