ABSTRACT
Este estudio fue diseñado para validar en 54 niños españoles, de 1 mes a 6 años de edad, una nueva escala de valoración de dolor agudo, la escala LLANTO, comparando sus puntuaciones con las obtenidas con la escala CHEOPS. LLANTO es el acrónimo de cinco parámetros conductuales o fisiológicos que previamente han sido relacionadas con el dolor agudo en niños (llanto, actitud, normorrespiración, tono postural y observación facial). La escala LLANTO fue estudiada en su validez y su reproducibilidad. Se estudió el comportamiento de los niños en la Unidad de Recuperación Post Anestésica (URPA) inmediatamente antes y después de la administración del pertinente tratamiento analgésico. Tres observadores (un médico experimentado, un residente en formación y una enfermera) valoraron con las dos escalas la conducta de los niños simultáneamente pero de modo independiente uno del otro. La escala LLANTO presentó una correlación aceptable entre los distintos observadores (0,809, 0,686 y 0,908; p<0,0001). La escala LLANTO presentó una adecuada validez discriminante (p<0,002) diferenciando las dos situaciones de pre y postadministración de analgesia. Ambas escalas mostraron un alto nivel de correlación (0,804; p<0,0001) evidenciando la adecuada validez convergente de la escala LLANTO. El análisis k de concordancia demostró un nivel perfecto de coincidencia entre la escala LLANTO y la escala CHEOPS que se correspondió con unas adecuadas sensibilidad (96%) y especificidad (87%). En base a estos hallazgos, podemos recomendar la escala LLANTO como un instrumento válido, reproducible y práctico de medición del dolor agudo en los niños preescolares en entorno hispanoparlante (AU)
This study was designed to validate a new paediatric acute pain scale, LLANTO, comparing its scores with those obtained from the CHEOPS scale in 54 Spanish children aged 1 month-6 years. LLANTO is an acronym of five behavioural or physiological variables previously shown to be associated with pain in children (crying, attitude, respiratory pattern, muscle tone and facial expression). The LLANTO pain scale was tested for validity and inter-rater reliability. The children's behaviour was observed after surgery, before and after analgesics administration in the post-anaesthesia care unit (PACU). Three observers (an experienced physician, a resident in training and a nurse) then simultaneously rated pain behaviour in a blinded way with both scales. LLANTO scale had an acceptable inter-rater correlation (0.809, 0.686 and 0.908, P<0.0001). Construct validity was determined by the ability to differentiate the group with a high pain level before analgesia and after analgesia (P<0.002). The positive correlation between both scales (r=0.804, P<0.0001) supported concurrent validity. Use of the ê statistic indicated that LLANTO scale yielded a perfect agreement with the CHEOPS scale, with an appropriate sensitivity and specificity (96% and 87% respectively). On the basis of data from this study, we recommend LLANTO as a valid, reliable and practical tool for Spanish speakers (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Pain/diagnosis , /methods , Pain Threshold , Severity of Illness Index , Sensitivity and SpecificityABSTRACT
This study was designed to validate a new paediatric acute pain scale, LLANTO, comparing its scores with those obtained from the CHEOPS scale in 54 Spanish children aged 1 month-6 years. LLANTO is an acronym of five behavioural or physiological variables previously shown to be associated with pain in children (crying, attitude, respiratory pattern, muscle tone and facial expression). The LLANTO pain scale was tested for validity and inter-rater reliability. The children's behaviour was observed after surgery, before and after analgesics administration in the post-anaesthesia care unit (PACU). Three observers (an experienced physician, a resident in training and a nurse) then simultaneously rated pain behaviour in a blinded way with both scales. LLANTO scale had an acceptable inter-rater correlation (0.809, 0.686 and 0.908, P<0.0001). Construct validity was determined by the ability to differentiate the group with a high pain level before analgesia and after analgesia (P<0.002). The positive correlation between both scales (r=0.804, P<0.0001) supported concurrent validity. Use of the κ statistic indicated that LLANTO scale yielded a perfect agreement with the CHEOPS scale, with an appropriate sensitivity and specificity (96% and 87% respectively). On the basis of data from this study, we recommend LLANTO as a valid, reliable and practical tool for Spanish speakers.
Subject(s)
Pain Measurement , Pain/diagnosis , Acute Disease , Child , Child, Preschool , Female , Humans , Infant , Male , SpainABSTRACT
This experimental study was designed and carried out in order to investigate the participation of the collagen and muscular tissues on the viscoelastic properties of the bladder wall. Sixty-five adult male mongrel dogs were utilized. These animals were divided into 5 groups: control group (n = 10); dogs (n = 10) receiving 2.5 mg/kg atropine (cholinergic antagonist); dogs (n = 10) receiving 0.7 mg/kg verapamil (calcium extracellular inflow blocker); dogs (n = 10) receiving 0.1 mg/kg/min nitroprusside (intracellular calcium blocker), and dogs (n = 25) receiving EGTA (a calcium-chelating agent) at increasing doses from 90 to 450 mg/kg. Based on a mathematical model, we have demonstrated that: (1) the collagen component is responsible for the elastic properties; (2) the muscle component is responsible for the viscoelastic properties; (3) the viscoelastic properties have an active element which is affected by calcium total depletion, and (4) such viscoelastic properties are not dependent on cholinergic stimulation.
Subject(s)
Elastic Tissue/physiology , Muscle, Smooth/physiology , Urinary Bladder/physiology , Animals , Atropine/pharmacology , Biomechanical Phenomena , Dogs , Egtazic Acid/administration & dosage , Elastic Tissue/drug effects , Male , Models, Biological , Muscle, Smooth/drug effects , Nitroprusside/administration & dosage , Random Allocation , Urinary Bladder/drug effects , Verapamil/pharmacologyABSTRACT
An appropriate experimental study was designed and carried out in mongrel dogs, in order to evaluate the active muscle and cholinergic participation on bladder compliance. The filling bladder pressure was measured at 100 ml of bladder volume, in 50 dogs distributed into five groups of 10 dogs each: (1) control group, (2) group which received atropine (cholinergic antagonist), (3) group which received verapamil (extracellular Ca2+ blocker), (4) group which received nitroprusside (intracellular Ca2+ antagonist), and (5) group which received EGTA (Ca(2+)-chelating agent). Furthermore, the following was demonstrated. (1) The greatest decrease of the bladder filling pressure was observed in the group which was treated with EGTA. (2) A significant decrease of the bladder filling pressure was also seen in the group which was given nitroprusside. (3) The decrease of bladder filling pressure in the verapamil group tended towards statistical significance. (4) There was no decrease in the atropine group. Thus, it was concluded that the active muscle component has an important role in the bladder compliance (through the intracellular calcium fraction), and the cholinergic component does not participate in the bladder compliance.