The Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF): validation of a rating scale for children's and adults' behaviors during painful medical procedures.

This study evaluated the concurrent and construct validity of the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF), a behavior rating scale of children's acute procedural distress and coping, and the coping promoting behaviors and distress promoting behaviors of their parents and the medical personnel who were present in the medical treatment room. Sixty preschool children undergoing immunizations at a county health department served as subjects. Videotapes of the procedures were scored using three observational measures in addition to the CAMPIS-SF. Also, parent, nurse, and child report measures of child distress, fear, pain, and cooperation were obtained. Results indicated that the validity of the CAMPIS-SF codes of Child Coping, Child Distress, Parent Coping Promoting, Parent Distress Promoting, Nurse Coping Promoting, and Nurse Distress Promoting behaviors was supported by multiple significant correlations with the other measures. The interrater reliability of the 5-point CAMPIS-SF scales was good to excellent. The results emphasize that the CAMPIS-SF scales can be used to monitor not only children's acute procedural distress, but also their coping and the various adults' behaviors that significantly influence children's distress. Further, because of the CAMPIS-SF's ease of use, it is likely that the study of the effects of the social environment on children's distress and coping will be facilitated.

Acute non-Q-wave myocardial infarction: a distinct clinical entity of increasing importance.

Despite the increasing incidence of acute non-Q-wave myocardial infarction, controversy remains regarding its validity as a distinct pathophysiologic physiologic and clinical entity. Review of the data indicates that the controversy is more apparent than real. The pathophysiologic factor discriminating best between non-Q-wave and Q-wave infarction is the incidence rate of total occlusion of the infarct-related artery, approximately 30% in non-Q-wave infarction and 80% in Q-wave infarction. Patients with non-Q-wave infarction have a higher incidence of pre-existing angina than patients with Q-wave infarction; they also have lower peak creatine kinase levels, higher ejection fractions and lower wall-motion abnormality scores, which suggests a smaller area of acute infarction damage. However, patients with non-Q-wave infarction have a significantly shorter time to peak creatine kinase level and more heterogeneous ventriculographic and electrocardiographic infarct patterns. The in-hospital death rate is lower in non-Q-wave than in Q-wave infarction (approximately 12% v. 19%). The long-term death rates are similar for the two groups (27% and 23%), but the incidence of subsequent coronary events is higher among patients with non-Q-wave infarction; in particular, reinfarction is an important predictor of risk of death. Most of the differences in biologic and clinical variables between the two types of acute infarction can be related to a lower incidence of total occlusion, earlier reperfusion or better collateral supply in non-Q-wave infarction. Further study is needed to better characterize the long-term risk and to define the most appropriate therapies.