Reliability and validity of preverbal pain assessment tools.

Pain assessments using three different observational pain assessment tools--the Post Operative Pain Score (POPS), the Nursing Assessment of Pain Intensity (NAPI), and the Pain Rating Scale (PRS)--were made on 98 preverbal children following surgery in an attempt to establish the reliability and validity of the three tools. Two observers (raters) scored pain intensity using each of the three instruments before and after administration of an analgesic. Interrater agreements were satisfactory on all three tools, with Interclass Correlations (ICC) ranging from .71 to .85. T tests supported the discriminant validity of all three tools at the p < .0001 level. The POPS and NAPI had internal consistency reliability alphas ranging from .79 to .88 for the POPS and .59 to .77 for the NAPI. Item analyses suggested specific revisions of the tools that might increase their reliability.

Gangrene of the fingers secondary to myeloproliferative disease.

The myeloproliferative disorders comprise a group of related diseases, including polycythemia vera, essential thrombocythemia, chronic myelogenous leukemia, myelofibrosis, and myeloid metaplasia. An increase in circulating platelets is associated with thrombotic phenomena affecting the arterial and venous circulation. In this article, the authors describe a case in which the initial manifestation of myeloproliferative disease was gangrene of the fingers.