Postoperative pain: a comparison of adolescent inpatient and day patient experiences.

This three-year study investigated the experience of postoperative pain and its management following elective surgery in an adolescent population aged 12-18 years (n=351) in 5 NHS trusts. In addition to the adolescents, one parent of each adolescent and a range of health professionals including surgeons, anaesthetists and registered nurses were interviewed concerning their views on acute pain in adolescent patients. The results presented in this paper are those related to the management of day and inpatient surgery in this adolescent population. Data were collected pre-operatively and postoperatively (days 1 and 3) using semi-structured interviews, telephone interviews, self-completion questionnaires and standardised tools to measure pain intensity (Adolescent Pediatric Pain Tool), psychological adjustment to adolescence (Offer Self-Image Questionnaire-Revised) and emotional state (Hospital Anxiety and Depression Scale). Day cases were discharged on the day of surgery while most inpatients were discharged on the first postoperative day.

Lack of mental well-being in 15-year-olds: an undisclosed iceberg?

BACKGROUND: Young people suffer from psychiatric symptoms and illness, and the frequency of both may be higher than currently is recognized. The frequency with which young people consult GPs with emotional problems is not established. OBJECTIVE: The purpose of this study was to identify the number of 15-year-olds who consult their GP directly or indirectly with psychiatric symptoms or illness. METHODS: A two part survey was carried out involving (i) general practice casenote review; and (ii) questionnaires self-report. The subjects comprised all adolescents aged 15 years from 34 randomly selected general practices and a randomly selected subsample of these adolescents. The main outcome measures were a purpose-designed data collection sheet, General Health Questionnaire (GHQ-12) and a purpose-designed self-report questionnaire. RESULTS: In phase 1, the general practice casenotes of 2359 adolescents were examined. Five per cent of subjects were identified as attending the GP with mental health problems; 1% had attempted suicide during the year. In phase 2, 99 subjects returned completed self-report questionnaires. Although over a quarter (26%) were rated as GHQ-12 'cases' and approximately half reported having felt 'sad, unhappy or low' or 'anxious or worried' in the previous year, only one subject reported attending his/her GP with any of these concerns. CONCLUSIONS: Fifteen-year-olds rarely consult their GP about their emotional well-being, yet, with the GHQ-12, the self-reported rate of psychiatric morbidity was nearly seven times greater than that suggested by these same subjects' medical records. Although the majority of adolescents consult their GP throughout the course of a year, those with mental health problems, including those who attempt suicide, are indistinguishable in the frequency of their GP consultations from adolescents without mental health problems.

Postoperative pain assessment and management in adolescents.

A 3-year study investigated the experience and management of postoperative pain following elective surgery in an adolescent sample, using a variety of valid, reliable instruments and semi-structured interviews. In addition to the adolescent subjects, the views of one parent of each adolescent were sought and a sample of health professionals comprising surgeons, anaesthetists and nurses were interviewed about acute pain in adolescent patients. This paper presents some of the main findings pertaining to pain assessment and management. Pain, experienced by most adolescents on the 1st and 3rd postoperative days, was influenced by the presence of anxiety and depression, in addition to the maturational stage; differences between in-patients and day cases are highlighted. Recommendations for practice include the need for more effective pain management and raising awareness of the importance of both psychological state and adjustment to adolescence in this age-group.

Infections with Eikenella corrodens in a general hospital: a report of 33 cases.

Of 33 cases of Eikenella corrodens infection occurring in a general hospital during an 18-month period, 18 were related to human bites or fist-fight injuries, and nine of these 18 cases were complicated by septic arthritis and/or osteomyelitis. Because E. corrodens grows slowly, requires an atmosphere containing 5%-10% CO2, and may be overgrown by other organisms, it may be missed on routine culture. The high rate of recovery of the organism in this study was attributable to the use of a selective medium. Because infections due to E. corrodens commonly mimic or occur in association with anaerobic infections, they are sometimes treated inappropriately. E. corrodens should be considered a possible pathogen in infections associated with oral contamination. Empiric antibiotic treatment of these infections with clindamycin or metronidazole alone is inappropriate since E. corrodens is generally resistant to these agents.