[show abstract][hide abstract] ABSTRACT: Assessment of pain in children is an important aspect of pain management and can be performed by observational methods or by self-assessment. The Faces Pain Scale-Revised (FPS-R) is a self-report tool which has strong positive correlations with other well established self-report pain intensity measures. It has been recommended for measuring pain intensity in school-aged children (4 years and older). The objective of this study is to compare the concordance and the preference for two versions, electronic and paper, of the FPS-R, and to determine whether an electronic version of the FPS-R can be used by children aged 4 and older.
The study is an observational, multicenter, randomized, cross-over, controlled, open trial. Medical and surgical patients in two pediatric hospitals (N=202, age 4-12 years, mean age 8.3 years, 58% male) provided self-reports of their present pain using the FPS-R on a personal digital assistant (PDA) and on a paper version. Paper and electronic versions of the FPS-R were administered by a nurse in a randomized order: half the patients were given the PDA version first and the other half the paper version first. The time between the administrations was planned to be less than 30 minutes but not simultaneous. Two hundred and thirty-seven patients were enrolled; 35 were excluded from analysis because of misunderstanding of instructions or abnormal time between the two assessments.
Final population for analysis comprised 202 children. The overall weighted Kappa was 0.846 (95%CI: 0.795; 0.896) and the Spearman correlation between scores on the two versions was rs=0.911 (p<0.0001). The mean difference of pain scores was less than 0.1 out of 10, which was neither statistically nor clinically significant; 83.2% of children chose the same face on both versions of the FPS-R. Preference was not modified by order, sex, age, hospitalization unit (medical or surgical units), or previous analgesics. The PDA was preferred by 87.4% of the children who expressed a preference.
The electronic version of the FPS-R can be recommended for use with children aged 4 to 12, either in clinical trials or in hospitals to monitor pain intensity.
[show abstract][hide abstract] ABSTRACT: There is no recent publication based on either literature review or experts’ group opinions concerning sedation during end of life or terminal phase in paediatrics. The aim of this review is to describe some indications of sedation during terminal phase or end of life in childhood, based on literature and expert's opinion confrontation. Paediatric palliative care specificities and some complex or singular situations are described and discussed in various paediatrics fields such as neonatology, neuropaediatry, with brief focus on some specific situations in paediatric or neonatal intensive care. Indications of sedation which are proposed do not pretend to exhaustiveness. The decision-making must be done with responsibility and with the most possible objectivity. The singular emotional context of paediatrics must be considered and taken into account. Indication of sedation must always stand in legacy and be supported by a specific ethical preoccupation. The ethical questioning is omnipresent during all the reflexive time needed to identify an indication of sedation in paediatrics. This work proves the necessity of research and the necessity to validate clinical practice in this field.
Médecine Palliative : Soins de Support - Accompagnement - Éthique. 04/2010; 9(2).
[show abstract][hide abstract] ABSTRACT: No work about the decision-making and implementation of sedation in final phase or at the end of the life in the child resting on a literature review and/or the opinion of a group of experts was recently published. This review of the literature with confrontation of experts’ opinion aims to propose methods of decision-making, implementation and monitoring of sedation in this context. Decision-making must be anticipated, collegial, shared with the child like his family and nursing team. The implementation suggested initially specifies the way of administration, the drugs usable, the methods of induction by a titration and monitoring of sedation. The whole of the recommendations suggested fall under a prospect called clinical ethical step. They all benefit from a strong agreement of the experts’ group having realized this work. Ethical questions raised by the practice of sedation, in this context, are tackled. This work proves the necessity of research and the necessity to validate clinical practice in this field. May be it will be interesting to share experience with colleagues all over the world to improve our practice and our reflexion in this field of medicine.
Médecine Palliative : Soins de Support - Accompagnement - Éthique. 04/2010; 9(2).
[show abstract][hide abstract] ABSTRACT: The Standards, Options and Recommendations (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
To establish the Standards, Options and Recommendations clinical practice guidelines for the management of procedure related pain (lumbar puncture, bone marrow aspiration or biopsy, blood sampling) in children oncology patients. To define, on the basis of the critical appraisal of the best available evidence and expert agreement, the clinical situations in which a pain preventive strategy should be implemented.
MEDLINE was searched using specific search strategies from January 1966 to August 2004. Literature monitoring was performed to identify controlled clinical trials published in 2005.
A total of 57 references were identified. Clinical guidelines have been defined for each invasive procedure.
Bulletin du cancer 09/2006; 93(8):805-11. · 0.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the French Federation of Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients.
To update clinical practice guidelines for the assessment of pain in adult or children with cancer in collaboration with the French society for pain study and treatment.
The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guideline has been defined, the document is submitted for review by independent reviewers.
This article is a summary version of the full document presenting the clinical practice guidelines with algorithms. The main recommendations concern the means used to evaluate pain and its consequences and their use in specific cases (acute or chronic pain, patients able to communicate or not, children under or over 6 years old). Others recommendations were also established concerning the evaluation ofpsychological, social and family context, the evaluation of pain in hospital or at home, in terminal phase patients and for the establishment of a therapeutic strategy and follow-up of patient with pain.
Bulletin du cancer 06/2004; 91(5):419-30. · 0.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: To augment available validation data for the Faces Pain Scale - Revised (FPS-R) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale (CAS) in pediatric acute pain.
The present prospective, multicentre study included 131 inpatients five to 15 years of age (mean age 8.8 years; 56% male) seen in postoperative recovery. They provided CAS and FPS-R pain scores before and after administration of analgesic medication. Nurses and physicians used the same tools as observational scales. Children and health care providers indicated which scale they preferred.
FPS-R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups (0.66 <or= r <or= 0.88). There were no significant mean differences in any age group between the scales. Scores on the two scales differed by 210 or less in 81% to 91% of children, depending on age. Both scales demonstrated expected changes in postoperative pain following administration of an analgesic. Scores at the upper end point were given by approximately 20% of children five to six years of age on both scales, compared with 2% to 9% in the older age groups. Health care providers' observational ratings were significantly lower than self-ratings. The FPS-R was preferred over the CAS by most children in all age groups and both sexes. Global satisfaction of the health care providers was similar for both tools.
These results support the use of the FPS-R for most children five years of age or older in the postoperative period. Further research is needed to identify young children, particularly those younger than seven years of age, who have difficulty with self-report tools, and to establish methods for training them in the reliable use of these measures.
Pain research & management: the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur 15(3):163-8. · 1.04 Impact Factor