E. Ista

The COMFORT-behavior scale is useful to assess pain and distress in 0- to 3-year-old children with Down syndrome.

Summary Psychometric properties of the COMFORT‐Behavior scale were comparable between 0‐ to 3‐year‐old children with and without Down syndrome. ABSTRACT Many pediatric intensive care units use the COMFORT‐Behavior scale (COMFORT‐B) to assess pain in 0‐ to 3‐year‐old children. The objective of this study was to determine whether this scale is also valid for the assessment of pain in 0‐ to 3‐year‐old children with Down syndrome. These children often undergo cardiac or intestinal surgery early in life and therefore admission to a pediatric intensive care unit. Seventy‐six patients with Down syndrome were included and 466 without Down syndrome. Pain was regularly assessed with the COMFORT‐B scale and the pain Numeric Rating Scale (NRS). For either group, confirmatory factor analyses revealed a 1‐factor model. Internal consistency between COMFORT‐B items was good (Cronbach’s α = 0.84–0.87). Cutoff values for the COMFORT‐B set at 17 or higher discriminated between pain (NRS pain of 4 or higher) and no pain (NRS pain below 4) in both groups. We concluded that the COMFORT‐B scale is also valid for 0‐ to 3‐year‐old children with Down syndrome. This makes it even more useful in the pediatric intensive care unit setting, doing away with the need to apply another instrument for those children younger than 3.

Evaluating outpatient transition clinics: a mixed-methods study protocol

Introduction To support young people in their transition to adulthood and transfer to adult care, a number of interventions have been developed. One particularly important intervention is the transition clinic (TC), where paediatric and adult providers collaborate. TCs are often advocated as best practices in transition care for young people with chronic conditions, but little is known about TC models and effects. The proposed study aims to gain insight into the added value of a TC compared with usual care (without a TC). Methods and analysis We propose a mixed-methods study with a retrospective controlled design consisting of semistructured interviews among healthcare professionals, observations of consultations with young people, chart reviews of young people transferred 2–4u2005years prior to data collection and questionnaires among the young people included in the chart reviews. Qualitative data will be analysed through thematic analysis and results will provide insights into structures and daily routines of TCs, and experienced barriers and facilitators in transitional care. Quantitatively, within-group differences on clinical outcomes and healthcare use will be studied over the four measurement moments. Subsequently, comparisons will be made between intervention and control groups on all outcomes at all measurement moments. Primary outcomes are ‘no-show after transfer’ (process outcome) and ‘experiences and satisfaction with the transfer’ (patient-reported outcome). Secondary outcomes consider clinical outcomes, healthcare usage, self-management outcomes and perceived quality of care. Ethics The Medical Ethical Committee of the Erasmus Medical Centre approved the study protocol (MEC-2014-246). Dissemination Study results will be disseminated through peer-reviewed journals and conferences. The study started in September 2014 and will continue until December 2016. The same study design will be used in a national study in 20 diabetes settings (2016–2018).

Verpleegkundige ondersteuning bij zelfmanagement en eigen regie

Onder redactie van AnneLoes van Staa, Ada ter Maten-Speksnijder en Lausanne Mies. Dit boek helpt verpleegkundigen, studenten verpleegkunde en verpleegkundig specialisten het zelfmanagement van mensen met chronische aandoeningen te ondersteunen. Dat behoort tot de kerntaak van elke verpleegkundige. Het boek geeft daarvoor de kennis, traint de vaardigheden en bespreekt de gewenste attitude, zoals een open houding, goede gespreksvoering en samenwerking met de patient en andere (mantel)zorgverleners.

O-159 A Preliminary Validation Of A Screening Tool For Paediatric Delirium

Introduction Paediatric delirium (PD) in critically ill children has an estimated prevalence of 5 to 20%. The aim of this study was to determine the preliminary psychometric properties of the Sophia Observation withdrawal Symptoms-Paediatric Delirium Scale (SOS-PD). Methods This prospective study included patients aged 3 months or older and admitted for more than 48 h. These patients were assessed three times a day with the SOS-PD. If the SOS-PD total score was 4 or higher the child psychiatrist was consulted to confirm the diagnosis of PD using the Diagnostic and Statistical Manual-IV criteria. The child psychiatrist was blinded for outcomes of the SOS-PD. The interrater reliability was independently tested in paired observations between the care-giving nurse and a researcher and calculated by using the Intra Class Correlation coefficient (ICC). Results A total of 2088 SOS-PD assessments were obtained in 150 children (median age 54 months; IQR 14–146). Most frequent symptoms in PD patients (n = 13) were anxiety (13%), motor disturbance (13%), sleeplessness (16%) and less eye contact (19%) We compared 63-paired observations of the child psychiatrist versus SOS-PD assessments in 14 patients. The sensitivity was 90.1% (95% CI 75.6–97.9%) and positive predictive value 96.8% (95% CI 90.5–100). The specificity was 96.7% (95% CI 82.7–99.4) and the negative predictive value 90.6% (95% CI 80.5–100). The ICC of 16-paired observations was 0.90 (95% CI 82.7–99.4) for the SOS-PD scale. Conclusions The SOS-PD scale shows promising validity for screening PD. Future research is aimed to establish the psychometric properties in a multicenter study.

How often do we perform painful and stressful procedures in the paediatric intensive care unit? A prospective observational study

BACKGROUNDnAdequate analgesia and sedation is crucial in critical care. There is little knowledge on the extent of painful and stressful procedures on children admitted to a paediatric intensive care unit (PICU) and its analgesic and/or sedative management.nnnOBJECTIVEnThe primary objective was to determine the number of painful and stressful procedures per patient per day in our PICU patients, including the numbers of attempts. A secondary objective was to map PICU nurses perceptions of the painfulness of the included procedures.nnnMETHODSnA prospective, single-centrexa0observational cohort study in a tertiary PICU. All patients admitted to the PICU over a 3-month period were eligible. Readmissions, polysomnography patients, and patients without any data have been excluded. The number of painful and stressful procedures was collected daily, and use of analgesics and sedatives was assessed and recorded daily. Twenty-five randomly assigned nurses rated the painfulness of procedures based on their personal experience using a numeric rating scale from 0 to 10.nnnRESULTSnIn a 3-month period, a total of 229 patients were included, accounting for 855 patient days. The median number of painful and stressful procedures per patient per day was 11 (interquartile range=5-23). Endotracheal suctioning was the most frequent procedure (45%), followed by oral and nasal suctioning. Arterial and lumbar puncture, peripheral IV cannula insertion, and venipuncture were scored as most painful ranging from 3 to 10. Procedural analgesia or sedation was often not used during these most painful procedures.nnnCONCLUSIONSnMechanically ventilated patients undergo more than twice as many painful procedures than non-ventilated patients, as endotracheal suctioning accounts for almost half of all. Nurses regarded skin-breaking procedures most painful; however, these were rarely treated by procedural analgosedation and only covered in the minority of cases by adequate background analgosedation.

O-163 Does Early Screening Lead To Higher Prevalence Of Paediatric Delirium?

Introduction Early screening of paediatric delirium (PD) allows for early intervention if necessary. The aim of this study was to determine if early screening with the SOS-PD scale led to higher prevalence of PD in ICU patients. Methods A prospective before-after study design was applied in a population of children aged >3 months and admitted for ≥48 h to the PICU. In the before-period the prevalence of PD was estimated in terms of the number of children with PD confirmed by the consulting psychiatrist. During the after-period nurses systematically assessed the children with the SOS-PD scale three times a day in addition to the psychiatric consultation (SOS-PD score ≥4). Results 148 and 150 children were included in the before and after period, respectively. The prevalence of PD was 6.1% and 8.7% for the before and after period respectively (see Table). The relative risk of PD with early screening was 1:43 (95% CI 0.63 to 3.23). In 33 patients (22%) the SOS-PD score was ≥4 on one or more occasions. In 14 of these patients, the child psychiatrist was consulted. In the remaining patients the child psychiatrist was not consulted for the following reasons: only once a high score (n = 9), adverse effects of sedatives (n = 4), and underlying disease/motor restlessness (n = 6). Abstract O-163 Table 1 Patient characteristics and prevalence of PD Conclusions Systematic early screening of PD resulted in a higher incidence of PD and could contribute to timely start of treatment.