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Pain Squad+ smartphone application screenshots of the application landing screen (A), a visual analogue slider scale for pain assessment (B) and a portion of the library of pain self-management advice. Photos used in this figure are stock photos and are under license from the copyright owners.
Source publication
Introduction
Pain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decisio...
Citations
... Jib et al. dynamically assessed pain in adolescents with cancer and provided real-time pain treatment to decrease the intensity of pain [10]. A recent study evaluated the pain scores of women using ibuprofen and oxycodone/acetaminophen for medical abortion pain relief at regular intervals, showing more pain relief and lower use of analgesic agents [11]. ...
Purpose
Combined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia.
Methods
This was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed.
Results
Overall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m ² , and those with a primary or secondary education level.
Conclusion
Appropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia.
Clinical trial number and registry
Clinicaltrials.gov (ChiCTR2100051809).
... 11 12 17-20 Mobile devices, particularly smartphones and current health applications ('apps'), have enabled nurses to provide remote pain management counselling to adolescent patients with cancer. [21][22][23] The utilisation ...
Introduction
Digital competencies are essential for nurses to actively participate in the digitisation of healthcare systems. Therefore, it is important to assess their skill levels to identify strengths and areas for improvement.
Method and analysis
This study aims to investigate nurses’ knowledge, attitudes, behaviours, subjective norms and behavioural control regarding digital health. A knowledge-attitude-practice model guided the development of a structured questionnaire divided into six sections. A sample of 480 registered nurses of Naples will be involved in the study. After conducting a pretest, an invitation will be publicised through the institutional communication channels of Nurses Provincial Order of Naples. Nurses will respond via a unique link or quick response code sent through a PEC email system (a legally valid email system, which guarantees delivery and receipt). They will have 30 days to complete the survey, scheduled between May and July 2024 .
Ethics and dissemination
No ethics committee approval was required, as the study does not involve minors, direct or indirect physical or physiological harm to participants, or clinical trials. Anonymity will be guaranteed at all data collection and processing levels. The results will be broadly distributed through conference presentations and peer-reviewed publications. The effective use of digital technologies by healthcare professionals can bring significant improvements to healthcare services and help improve the health of individuals and community health. The study’s findings will serve as a foundation for developing and implementing educational programmes related to eHealth and telemedicine, promoting the harmonisation of such programmes.
... For this purpose, they prioritize the use of telemonitoring, as an element within telemedicine [29]. Some elements that may positively influence patient experience are the ongoing expansion of digital culture and the use of IoT, including wearables, which facilitate new nursing approaches to manage chronic pain [30]. Benefits from m-health and telemonitoring have been observed in diabetes control, thanks to the inclusion of wearables in the service portfolio of the National Health Service of Spain. ...
... Use of gamification has been shown to increase adherence to treatment and selfmanagement. 16 Gamification has been successfully used in other health apps, such as one developed for pediatric cancer patients 17 and an intervention for parents of children with behavioral issues. 18 To our knowledge, this is the first time gamification has been used in a pain management application with hospice caregivers. ...
e-PainSupport is a digital pain management application (app) designed to facilitate better pain management in hospice. Early testing revealed caregivers found it was easy to use and successful in communicating patient pain and caregiver administration of analgesics to hospice nurses. However, caregiver knowledge of analgesic management remained low. The purpose of this study was to enhance e-PainSupport by (a) adapting and integrating an evidence-based pain educational intervention; (b) increasing ease of accessing and navigating the app; and (c) facilitating app communication with agency electronic health records (EHRs). An advisory board method, including two key stakeholder groups (an expert panel and a caregiver advisory board), guided the adaptation of an evidence-based pain educational intervention. Further, stakeholders recommended format changes to increase app usability. Study staff worked with four hospice agencies to facilitate app communication with EHRs. While modification to the e-PainSupport app to integrate a pain educational intervention and facilitate usability was successful, EHR integration was challenging. Future evaluation is needed to evaluate the effects of e-PainSupport on pain intensity among home hospice patients.
... 11 With the development and refinement of digital tools, real-time appraisal of pain will increase, 6 which may empower children to engage in pain management in all of their natural environments. 12 The child's perception of pain assessment may differ between the digital format and an analog assessment tool. Therefore, it is very challenging to translate analog tools unequivocally into a digital tool. ...
It is often a challenge for a child to communicate their pain, and their possibilities to do so should be strengthened in healthcare settings. Digital self-assessment provides a potential solution for person-centered care in pain management and promotes child participation when a child is ill. A child's perception of pain assessment differs when it is assessed using digital or analog formats. As we move into the digital era, there is an urgent need to validate digital pain assessment tools, including the newly developed electronic Faces Thermometer Scale (eFTS). This study protocol describes three studies with the overall aim to evaluate psychometric properties of the eFTS for assessing pain in children 8–17 years of age. A multi-site project design combining quantitative and qualitative methods will be used for three observational studies. Study 1: 100 Swedish-speaking children will report the level of anticipated pain from vignettes describing painful situations in four levels of pain and a think-aloud method will be used for data collection. Data will be analyzed with phenomenography as well as descriptive and comparative statistics. Study 2: 600 children aged 8–17 years at pediatric and dental settings in Sweden, Denmark, Iceland, and USA will be included. Children will assess their pain intensity due to medical or dental procedures, surgery, or acute pain using three different pain Scales for each time point; the eFTS, the Faces Pain Scale Revised, and the Coloured Analogue Scale. Descriptive and comparative statistics will be used, with subanalysis taking cultural context into consideration. Study 3: A subgroup of 20 children out of these 600 children will be purposely included in an interview to describe experiences of grading their own pain using the eFTS. Qualitative data will be analyzed with content analysis. Our pilot studies showed high level of adherence to the study procedure and rendered only a small revision of background questionnaires. Preliminary analysis indicated that the instruments are adequate to be used by children and that the analysis plan is feasible. A digital pain assessment tool contributes to an increase in pain assessment in pediatric care. The Medical Research Council framework for complex interventions in healthcare supports a thorough development of a new scale. By evaluating psychometric properties in several settings by both qualitative and quantitative methods, the eFTS will become a well-validated tool to strengthen the child's voice within healthcare.
... Contoh penggunaan teknologi menunjukkan bagaimana teknologi digital telah membawa manfaat bagi praktik dan pendidikan keperawatan (Krick et al., 2019) Misalnya, program telehealth di mana perawat menyediakan pemantauan harian, pembinaan, dan triase pasien dengan beberapa penyakit kronis telah membantu mengurangi penerimaan unit gawat darurat perangkat seluler, khususnya smartphone dan aplikasi kesehatan, memungkinkan perawat untuk menawarkan saran jarak jauh tentang manajemen nyeri kepada pasien remaja penderita kanker (L. Jibb et al., 2020;L. A. Jibb et al., 2017) dan melengkapi aspek pendidikan keperawatan dengan memberikan solusi pedagogis inovatif untuk penyampaian konten dan peluang pembelajaran jarak jauh (Buchanan et al., 2020;Chuang et al., 2018). ...
Optimizing health services during the pandemic is something that hospitals must do in order to keep improving service quality. This community service aims to educate nurses on how to use digital technology-based nursing services in the pandemic. Health education is provided through webinars, as a method of implementing this community service program. The majority of webinar participants (60%) had sufficient knowledge based on the results of the pretest. Following the presentation of the material, it can be concluded that there has been an increase in knowledge, with 182 participants (90%) having excellent knowledge. Nursing services are benefiting from digital innovation not only in terms of workforce management, but also in terms of changing the way care is delivered. Nurses are crucial in the adoption of digital tools and information technology to improve patient care. This is due to the fact that the quality of digital care delivery has risen to the forefront of healthcare and is being scrutinized more than ever before.
... Interventions for the home setting are warranted. Some efforts have already been made to address this using mHealth, such as the Pain Squad + smartphone app [22], the tablet-based Pain Buddy program [23], and the Color me Healthy app [24], which were all developed to improve pain management in children with cancer. The KLIK Pain Monitor app, named after the existing KLIK PROM (patientreported outcome measures) portal [25], was developed to reduce pain in children aged 0-18 years old at home during cancer treatment with the aim to (1) monitor pain in the home setting, enabling healthcare professionals (HCP's) to follow-up with families and offer help more quickly, and (2) provide families with psycho-educational information about pain. ...
Purpose
This study assessed adherence to, feasibility of, and barriers and facilitators of implementation of an app developed to monitor and follow-up with pain in children with cancer at home.
Methods
Children (8–18 years) receiving cancer treatment (all diagnoses) or their parents (of children aged 0–7 years) used the KLIK Pain Monitor app for 3 weeks. Pain was assessed twice daily using an 11-point numeric rating scale (NRS-11) (ranging from 0 to 10). Healthcare professionals (HCP’s) from the hospital’s Pediatric Pain Service were instructed to follow-up with clinically significant pain scores (≥ 4) within 120 min (scores 4–6) or 30 min (scores 7–10). Adherence, feasibility, and implementation outcomes were assessed using questionnaires, app log data, and interviews.
Results
Twenty-seven children ( M age = 7.3 years, 51.8% male) and six HCP’s participated. Sixty-three percent ( N = 17) of families used the app on a daily basis during three weeks, and 18.5% ( N = 5) reported pain scores twice daily during that time ( family adherence ). Twelve out of 27 children (44.4%) reported a clinically significant pain score at least once. In 70% (14/20) of clinically significant pain scores, HCP’s followed-up with families within the set timeframe ( HCP adherence ). Outcomes reveal feasibility for the majority of app functions (i.e., positive evaluation by ≥ 70% families/HCP’s), and non-feasible aspects could be resolved. Identified barriers and facilitators were used to improve future implementation efforts.
Conclusion
Use of the KLIK Pain Monitor app seems feasible. Future research will determine its effectiveness in reducing pain in children with cancer at home.
... There are many pain management applications available based on patients' subjective pain levels [10,[47][48][49]. They provide personalized pain treatment and assessment strategies by asking several questions, including pain location, pain symptoms, pain levels, or demographic information. ...
The subjectiveness of pain can lead to inaccurate prescribing of pain medication, which can exacerbate drug addiction and overdose. Given that pain is often experienced in patients’ homes, there is an urgent need for ambulatory devices that can quantify pain in real-time. We implemented three time- and frequency-domain electrodermal activity (EDA) indices in our smartphone application that collects EDA signals using a wrist-worn device. We then evaluated our computational algorithms using thermal grill data from ten subjects. The thermal grill delivered a level of pain that was calibrated for each subject to be 8 out of 10 on a visual analog scale (VAS). Furthermore, we simulated the real-time processing of the smartphone application using a dataset pre-collected from another group of fifteen subjects who underwent pain stimulation using electrical pulses, which elicited a VAS pain score level 7 out of 10. All EDA features showed significant difference between painless and pain segments, termed for the 5-s segments before and after each pain stimulus. Random forest showed the highest accuracy in detecting pain, 81.5%, with 78.9% sensitivity and 84.2% specificity with leave-one-subject-out cross-validation approach. Our results show the potential of a smartphone application to provide near real-time objective pain detection.
... There are many pain management applications available based on patients' subjective pain levels [10,[47][48][49]. They provide personalized pain treatment and assessment strategies by asking several questions, including pain location, pain symptoms, pain levels, or demographic information. ...
BACKGROUND
The subjectiveness of pain leads to inaccurate pain management, which can exacerbate drug addiction and overdose. The consequence is tremendous cost to society and individuals as the opioid crisis grows. Given that pain is often experienced in patients’ homes, there is an urgent need for ambulatory devices that can quantify pain in real time.
OBJECTIVE
We developed a smartphone-based system for real-time objective pain measurement and assessment using a wrist-worn electrodermal activity (EDA) device.
METHODS
Our smartphone application collects EDA signals from a wrist-worn device and evaluates pain based on the computation of three pain-sensitive EDA indices: the time-varying index of EDA (TVSymp); modified TVSymp (MTVSymp), and the derivative of phasic EDA (dPhEDA). For testing of our computational algorithms that were embedded in a smartphone application, ten subjects underwent heat pain using a thermal grill, which delivered a level of pain that was calibrated for each subject to be 8 out of 10 on a visual analog scale (VAS). The thermal grill induces heat pain perception without tissue injury using the temperature difference between warm and cold water. All of the wearable-collected EDA signal processing was performed using a smartphone application. Furthermore, another group of fifteen subjects underwent pain stimulation using electrical pulses (EP), which elicited a VAS pain score level 7 out of 10. For EP data collection, EDA signals were collected using a non-wearable device but the same smartphone application was used to calculate the EDA-derived pain indices. We set 5-second segments before and after each pain stimulus to be painless and pain segments, respectively, and trained eight machine-learning classifiers to test the feasibility of our smartphone and EDA-based system to detect pain in real-time. Parameters of the classifiers were optimized using the grid search cross-validation technique. We trained and tested the classifiers on both datasets with leave-one-subject-out cross-validation approach to prevent over-fitting of the models.
RESULTS
We obtained up to 82.1% accuracy in detecting pain. We also trained using only one dataset at a time and tested with other datasets (and vice versa) and achieved up to 83.1% accuracy.
CONCLUSIONS
Our results show the potential of a smartphone application to provide near real-time objective pain detection. This approach can potentially enable pain quantification for both acute and chronic pain and it is especially suited for subjects with communication disorders as well as infants.
