[Empathy deficit in adolescents : how to characterize and evaluate it clinically ? A litterature review]. / Le déficit d'empathie chez l'adolescent : comment le caractériser et l'évaluer cliniquement ? Revue de la littérature.

Introduction : empathy has been considered since a long time under the angle of human sciences. Today, certain neuro-scientific postulates complement this knowledge. Context : observation of adolescents presenting psychiatric disorders, accompagnied by conduct disorders and/or psychopathic traits, frequently describe empathy deficits ; nurses should evaluate the nature and the degree of empathy of these adolescents. Aims : this litterature review aims to expose the clinical characteristics of empathy deficit from its definition and to describe the clinical evaluation tools. Method : target population of this review is children and adolescents from twelve to eighteen years old. The review was carried out with PubMed, CINAHL and PsycINFO, from 2002 to 2012. Results : twenty-two articles were retained. Empathy is defined as a mechanism combining several components of neuronal activity. Empathy includes a cognitive component, an affective component which are based on a neurofunctional dysfunctional substrate when there is a deficit of empathy. Three evaluation scales are distinguished : the Basic empathy scale, the Interpersonal reactivity index and the Griffith empathy measure. Discussion : three evaluation tools present the validity and reliability criteria for clinical use. Conclusion : the development of evidence based practices should confirm the interest of these tools for nurses.

Reducing pain in patients undergoing cardiac surgery after implementation of a quality improvement postoperative pain treatment program.

PURPOSE: The aim of this study was to test the effectiveness of a quality improvement postoperative pain treatment program after cardiac surgery. MATERIALS AND METHODS: This was a prospective, quasiexperimental study using nonequivalent groups comprising 3 periods: baseline (group baseline), implementation of the algorithm for acute pain management, and reassessment (group reassessment). Inclusion of 133 patients after elective cardiac surgery at an 18-bed surgical intensive care unit (SICU) at a Swiss university hospital. The algorithm was implemented by training, pocket guidelines, regular audits, and feedback. The implementation period was completed when the adherence to 2 of 3 process indicators attained at least 70% over 2 months. Visual analog scales (VAS) for pain, morphine consumption, pain perception, and sleep quality were assessed during stay in SICU and after 1 month and 6 months. RESULTS: The assessment included 79 patients at baseline and 54 in the reassessment periods. Pain intensity at rest decreased from 2.7 +/- 1.4 to 2.2 +/- 1.4 cm (VAS; P = .008). Retrospective perception of pain intensity at rest decreased from 3.8 +/- 2.2 to 2.6 +/- 1.8 (P = .004). The proportion of patients with no pain or often without pain increased from 11% to 37% (P = .005). The number of patients with sleep disturbances decreased from 68% to 35% (P = .012). No differences were observed at 1 and 6 months postoperatively. CONCLUSIONS: After algorithm implementation in the SICU, pain intensity at rest decreased and quality of sleep improved.

Harmonization of practice among different groups of caregivers: a guideline on arterial blood gas utilization.

Quality improvement programs based on guidelines should change practice and reduce intraindividual and interindividual variations as well as variations between groups of caregivers. We analyzed a quality improvement program in 3 groups of caregivers. The groups modified differently their practice. Less experienced caregivers modified their practice the most, joining the more experienced professionals. This harmonization was achieved only during the last consolidation period. The analysis of practice could identify the quality of the implementation process and the group on which attention should be focused when such a quality improvement program is undertaken.

Percutaneous vertebroplasty in octogenarians: results and follow-up.

OBJECTIVES: To determine pain relief, performance status, morbidity, and mortality associated with percutaneous vertebroplasty for spinal pain in patients aged 80 years and older. DESIGN: Prospective, descriptive, third-party independent interview, clinical audit. SETTING: University Hospital, Geneva, Switzerland. PARTICIPANTS: Patients aged 80 years and older who underwent vertebroplasty between August 1997 and August 2004 because of vertebral fractures from osteoporotic or malignant etiologies. METHODS: Primary outcome measures were verbal rating scale (VRS) (0--no pain, 5--intolerable) and Eastern Cooperative Oncology Group (ECOG) performance status scale (0--normal activity, 4--unable to get out of bed) before and after procedure. Patients were interviewed 8 to 35 months post treatment (mean 25), independently assessed for pain relief, analgesic consumption, and overall satisfaction by using the American Society of Anesthesiologists (ASA) Outcome Measures questionnaire. RESULTS: Mean VRS scores significantly decreased from 4.86 +/- 0.64 to 2.39 +/- 1.14 (P < 0.05), and mean ECOG performance scores improved from 1.87 +/- 0.97 to 1.29 +/- 1.06 (P < 0.05) after treatment. When patients were analyzed by etiology (group 1--cancer; group 2--osteoporosis), both groups significantly reduced their VRS (P < 0.05); however, only group I significantly improved their performance (P < 0.05; P = 0.334, respectively). Nine patients answered the ASA questionnaire (18 deceased, 1 demented, 1 lost to follow-up) and reported an improvement in their ability to perform daily tasks. No early or late complications were observed; none of the deaths were procedure-related. CONCLUSIONS: Percutaneous vertebroplasty is a safe, minimally invasive, well-tolerated analgesic procedure among octogenarians suffering from spinal pain, permitting increased activities of daily living. Pain reduction is significant regardless of the etiology; performance scores are significantly improved in cancer pain.