Evaluation of Procedural Pain in Neonates in Cameroon

Introduction: Acute pain associated with caregiving is a major cause of pain among neonates. Left untreated, it can lead to long-term neurosensory and psychoaffective consequences. In Cameroon, this subject has been scarcely explored, thus constituting an impediment to the management of care-induced pain. Objective: Assess procedural pain in neonates in Yaoundé. Material and Methods: We conducted a cross sectional study with prospective data collection over a period of eight months (October 2022 to May 2023) in three hospitals. We included neonates who were being cared for and were not crying prior to the onset of healthcare, whose parents consented to the study. Assessments were done using the DAN scale, which is specific to care-induced pain. Data was entered and analyzed using SPSS 23.0 software. Results: A total of 161 newborns were included. The hospital prevalence of care-induced pain in neonates was 85%. Neonatal sepsis was the main cause for admission (96.6%). The most common procedures were venous blood sampling (94.4%) and insertion of peripheral venous lines (93.8%). The pain intensity for these procedures was severe (83.9%). The most painful procedure was lumbar tap, followed by venous access procedures. Conclusion: Neonates in hospitals are subjected to many painful procedures. The pain experienced during these procedures is severe. The most nociceptive procedure is a lumbar puncture.

Procedural Transition in the Principle of the Best Interests of the Child in the Eyes of the European Court of Human Rights

The principle of the best interests of the child,as a criterion for substantive review,is conceptually ambiguous and uncertain in its application.To mitigate this dilemma in the application of the principle of the best interests of the child,the European Court of Human Rights(ECHR)has made a procedural transition in the interpretation and application of this principle,shifting from conducting specific proportionality analysis or interests balancing in cases related to children to examining whether States Parties have applied the principle of the best interests of the child in their judicial procedures.Moreover,ECHR has developed three procedural review schemes:holistic reviews,key factors-based reviews and factor list-based reviews.Compared with substantive reviews,procedural reviews adhere to the ECHR doctrine of margin of appreciation,restrict the free discretion of the court,give play to the effect of procedural autonomy,and pursue the value of subjective procedural justice,which has its own unique theoretical value and practical significance,and provides a feasible reference for China to interpret and apply the principle of the best interests of the child.

Effects of white noise on procedural pain-related cortical response and pain score in neonates:A randomized controlled trial

Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.

Management of procedural pain in the intensive care unit

Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,the management of persistent pain in ICU patients has attracted considerable attention,and there are many related clinical studies and guidelines.However,the management of transient pain caused by certain ICU procedures has not received sufficient attention.We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion.Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation,painrelated training of all relevant personnel,effective relief of all kinds of pain,and improvement of patients'quality of life.In clinical work,which involves complex and diverse patients,we should pay attention to the following points for procedural pain:(1)Consider not only the patient's persistent pain but also his or her procedural pain;(2)Conduct multimodal pain management;(3)Provide combined sedation on the basis of pain management;and(4)Perform individualized pain management.Until now,the pain management of procedural pain in the ICU has not attracted extensive attention.Therefore,we expect additional studies to solve the existing problems of procedural pain management in the ICU.

Emergency department procedural sedation for primary electrical cardioversion — a comparison with procedural sedations for other reasons

BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation(EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital.METHODS: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression.RESULTS: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male(58.5% vs. 47.1%), older(59.5 years vs. 48.1 years), and less likely to be ASA I(46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy(11.5% vs. 78.2%). PEC patients were more likely to experience hypotension(27.6% vs. 16.5%) but respiratory AEs(apnea, hypoxia and airway intervention) were not different.CONCLUSION: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.

Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands

BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

Remote nursing training model combined with proceduralization in the intensive care unit dealing with patients with COVID-19

The shortage of personal protective equipment and lack of proper nursing training have been endangering health care workers dealing with coronavirus disease 2019(COVID-19).In our treatment center,the implementation of a holistic care model of time-sharing management for severe and critical COVID-19 patients has further aggravated the shortage of intensive care unit(ICU)professional nurses.Therefore,we developed a short-term specialized and targeted nursing training program to help ICU nurses to cope with stress and become more efficient,thus reducing the number of nurses required in the ICU.In order to avoid possible human-to-human spread,small teaching classes and remote training were applied.The procedural training mode included four steps:preparation,plan,implementation,and evaluation.An evaluation was conducted throughout the process of nursing training.In this study,we documented and shared experiences in transitioning from traditional face-to-face programs to remote combined with proceduralization nursing training mode from our daily work experiences during the COVID-19 pandemic,which has shown to be helpful for nurses working in the ICU.

Procedural learning changes in patients with Wilson's disease

In the present study, we compared explicit memory performance, using the Wechsler Memory Scale and implicit memory performance, using the Nissen software version of the serial reaction time task, in patients with Wilson＇s disease to normal controls. The Wilson＇s disease patients exhibited deficits in explicit memory tasks, such as figure recall and understanding memory. Moreover, the Wilson＇s disease patients exhibited deficits in implicit memory tasks, including significantly prolonged response times. These findings indicate that Wilson＇s disease patients have explicit and implicit partial memory impairments.

Impact of the United States propofol ban on emergency providers' procedural sedation agent choice and patient length of stay

In the recent past, propofol was temporarily removed from the emergency department （ED） for use in procedural sedation. We sought to determine which agents replaced it in clinical practice and the impact this change had on turnaround times （TAT） for sedated patients. This study is a retrospective chart review at a level one trauma center. Patients receiving sedative agents （propofol, ketamine, midazolam, and etomidate） were identified by pharmacy codes, and their charts were then reviewed for demographics and TAT. Propofol was unavailable in the emergency department （ED） between May 2010 and February 2011. The study period extended from May 2009 until May 2011. Patients receiving sedation by non-emergency medicine physicians and those receiving sedation related to intubation were excluded. In total 2466 charts were reviewed and 209 met inclusion criteria. When propofol was available, the most commonly used sedative agent was etomidate （40%）, followed by propofol （28%）, ketamine （20%）, and midazolam （6%）. When propofol was unavailable, etomidate remained the most commonly used agent （43%）, followed by ketamine （41%）, and midazolam （11%）. When propofol was available, the median TAT for sedated patients was 163 minutes compared to 178 minutes when propofol was unavailable （P=0.83）. When propofol was the primary sedative agent used, the median TAT was 166 minutes as compared with a median TAT of 172 minutes for all other sedative agents combined （P=0.87）. When propofol was unavailable, ketamine became a preferred ED sedation agent. Removal of propofol from the sedation armamentarium did not affect ED TAT.

Jailing polymer jacketed guide-wires during bifurcation coronary interventions is associated with procedural myocardial infarction

AIM To study the relationship of jailed polymer jacketed guide wires(PGW) with procedural myocardial infarction(PMI) after bifurcation coronary interventions.METHODS Consecutive bifurcation interventions performed from January 2010 to October 2014 were included in the study. Chart review was performed to obtain demographic, clinical and procedural data. PMI was defined as Creatine Kinase MB > 3 × upper reference limit of normal. Multivariate logistic regression was used to ascertain relationship of PGW use with PMI.RESULTS Two hundred and ninety-three patients(age 63.5 ± 12.3 years; 33.8% diabetic) were included in the study. Eighty point two percent(n = 235) were true bifurcation lesions use of PGW was associated with PMI on univariate analysis(OR = 4.1; P = 0.002). This association remained significant after adjusting for other possible risk factors(OR = 3.5; P = 0.02).CONCLUSION Our results suggest that PGW use for side branch protection may be associated with PMI. Randomized studies are needed to validate these findings.

Preliminary Investigation of Sex Differences in Procedural Skill Learning in Veterans with Co-Morbidities

Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for returning Veterans that have a range of co-morbid conditions (traumatic brain injury, posttraumatic stress disorder, and depression) and possess impairments in multiple domains. Sixty-five (55 males, 10 females) Veterans completed two procedural learning tasks and answered self-report questionnaires. Participants’ performance and total learning slope were analyzed to determine sex differences in learning. Our results revealed sex differences in both tasks demonstrating females tend to perform better than males with a large effect size for these mean differences. While females performed better on the procedural learning tasks compared to males, their rate of learning was equivalent. Skill learning is an important requisite for rehabilitation, as skill learning is necessary to perform daily activities in new settings. Ultimately, these results provide insight into skill learning in Veterans with a range of co-morbid conditions and provide support for further investigation of sex differences in procedural learning.

How to duplicate the procedural success of coronary interventions by the radial approach:tips and tricks in the selection and manipulations of guides

In this issue of the Journal of Geriatric Cardiology;Jing et al. showed off their near perfect results of percutaneous coronary interventions (PCI) through transfemoral approach (TFA) and transradial approach (TRA) in the elderly Chinese patients. All patients were older.than 60years of age, with an average of 67.……

Procedural Sedation and Analgesia in Children in Emergency Department—Role of Adjunct Therapies

Objective: To compare sedation efficacy and parent/consultant satisfaction between standard sedation, sedation with music listening, and sedation with Certified Child life Specialists (CCLS) in children undergoing procedural sedation in the Pediatric Emergency Department (PED). Methods: Eligible children, aged 3 - 18 years, were randomly allocated to one of 3 groups: 1) standard sedation;2) sedation with music listening;3) sedation with CCLS intervention. All 3 groups received intravenous ketamine. The child life group received age appropriate comforting measures, while the music group listened to music of their choice during the procedure. The primary outcome was sedation efficacy, measured by Ramsay Sedation scale, FACES-P scale and need for re-dosing. The secondary outcome was parent/consultant satisfaction. Results: Fifty nine patients were analyzed (standard sedation: 20;sedation with music listening: 20;and sedation with CCLS: 19). There was no significant difference in mean initial ketamine dosing (1.58 ± 0.44 vs. 1.68 ± 0.36 vs. 1.42 ± 0.47, p = 0.26). There was no significant difference in median Ramsay Sedation scores [6(IQR:4,6) vs. 6 (IQR:4,6) vs. 6 (IQR:5,6)], FACES-R pain score [0 (IQR:0.0) vs. 0 (IQR:0.0) vs. 0 (IQR:0.0)] and need for re-dosing [9/20 (45%) vs. 4/20 (20%) vs. 8/19 (42.1%)] amongst the 3 groups. Parent and consultant satisfaction was high in all 3 groups. Conclusion: Our pilot study did not demonstrate a difference in sedation efficacy or parent/consultant satisfaction when adjunct therapies were used during PSA. Further studies with a large sample size are needed to define the role for such adjunct therapies during procedural sedation in PED.

End-tidal capnometry during emergency department procedural sedation and analgesia： a randomized, controlled study

BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

Dermatology Procedural and Surgical Skills Workshop for Medical and Physician Assistant Students

Background: Evidence indicating the limited amount of hands-on experience in the current era of medical training has raised concern regarding students’ development and potential deficiencies in the performance of basic procedural skills. Studies have demonstrated the value of surgical workshops for medical students;however evaluation of improved student performance during future clerkships or residencies has yet to be assessed. We initiated and evaluated a resident-led surgical skills workshop for students through the Department of Dermatology. Methods: Participants received instructions on surgical tools/techniques followed by hands-on practice. Anonymous surveys administered to 24 medical and physician assistant students assessed their skill level, confidence level, and likelihood of using surgical skills in future practice preand post-workshop using a 1 - 5 Likert scale. Overall experience was also assessed. Non-parametric bivariate tests were used for analysis to account for non-normal distribution of the data. Results: There was a statistically significant change in skill (p = 0.0001) and confidence (p = 0.0001) level post workshop. There was no significant difference in utility. There were also no statistically significant differences based on the year of medical student training, medical student versus physician assistant student responses, or number of procedures performed prior to the workshop. Estimated cost per participant was $5.65. Conclusions: Research supports our finding that workshop learning experiences increase students’ ability to perform common procedural skills, their confidence, and desire to practice such skills. Further studies are necessary to determine the impact of these skills workshops on long-term clinical performance in future clerkships and residencies.

Research on the Higher Vocational Student Status Management under the Perspective of Procedural Justice

In this paper, we conduct research on the higher vocational student status management under the perspective of procedural justice. The main task of higher vocational education is to develop production, construction, management and service of fi rst-line high-skilled applied talents. Higher vocational colleges must according to the talent market demand to set up the professional, training target, teaching content, to the talent market for applied talents’ with high skill specific requirements embodied in the culture type, specification, and the teaching content. One’s status as a student, it is to point to upon passing the entrance examination, offi cial admission the admission formalities in basic accordance with the relevant provisions, report to qualified students after registration. Management refers to the school in accordance with relevant state policies, laws and regulations for students from entrance to graduation during the management of the implementation of the training process. Our research proposes the new perspective on the issues that will be necessary.

Advances and challenges in peroral endoscopic myotomy:Safety,precision,and post-procedure management

Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events.The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration,especially regar-ding anesthetic considerations.Despite significant advances,challenges remain in standardizing safety protocols and managing complications.As POEM appli-cations expand,precision endoscopy continues to enhance therapeutic outcomes,promising a transformative impact on gastrointestinal motility disorder manage-ment.

Neoproceduralism and Its Discontents in China

Neoproceduralism,a legal paradigm proposed by Weidong Ji,has stirred a debate on the emphasis of the due process of law and the limits of its implications for the programmes of legal reform in contemporary China.This article aims to introduce the debate around Neoproceduralism and some of its major theoretical criticisms in Chinese legal scholarship,as commentators have criticised this paradigm on its newness,a utilitarian reading of legal processes,Westcentrism in its theoretical orientation,and the conflict between its stress on legal processes and Chinese legal-cultural traditions.

Effect of acupressure on procedural pain before heel lancing in neonates

OBJECTIVE:To investigate the effect of acupressure applied to UB60 and K3 acupuncture points in order to relieve the procedural pain caused by heel lancing blood sampling process in the term newborns.METHODS:The data were collected by using the Information Form and the Neonatal Infant Pain Scale.Acupressure applied for 3 min before heel lancing blood sampling in the newborns in the experimental group(n=31).No intervention was applied to newborns in the control group(n=32).RESULTS:A significant difference was found between mean scores of the newborns in the control and acupressure group in favor of the acupressure group in terms of heart rate during and after the procedure,oxygen saturation before,during and after the procedure,duration of crying during and after the procedure(P<0.05).It was found that there was a significant difference between groups in terms of Neonatal Infant Pain Scale mean scores during(P=0.001)and after the procedure(P<0.05),and the difference was found to be in favor of the acupressure group.CONCLUSION:As a result,acupressure was found to be an effective method in relieving pain caused by heel lancing blood sampling in newborns.

Procedural simulation method for aggregating charging load model of private electric vehicle cluster

The usage of each private electric vehicle(PrEV)is a repeating behavior process composed by driving,parking,discharging and charging,in which PrEV shows obvious procedural characteristics.To analyze the procedural characteristics,this paper proposes a procedural simulation method.The method aggregates the behavior process regularity of the PrEV cluster to model the cluster’s charging load.Firstly,the basic behavior process of each PrEV is constructed by referring the statistical datasets of the traditional private non-electric vehicles.Secondly,all the basic processes are set as a simulation starting point,and they are dynamically reconstructed by several constraints.The simulation continues until the steady state of charge(SOC)distribution and behavior regularity of the PrEV cluster are obtained.Lastly,based on the obtained SOC and behavior regularity information,the PrEV cluster’s behavior processes are simulated again to make the aggregating charging load model available.Examples for several scenarios show that the proposed method can improve the reliability of modeling by grasping the PrEV cluster’s procedural characteristics.