Guy C. Petroz

Construct validity of a multidimensional electronic pain diary for adolescents with arthritis.

&NA; The aim of this study was to evaluate the construct validity and feasibility of a multidimensional electronic pain diary (e‐Ouch©) in adolescents with juvenile idiopathic arthritis (JIA). Two descriptive studies with repeated measures were conducted between January and December 2005. Participants were drawn from a large metropolitan rheumatology clinic in a university affiliated pediatric tertiary care centre. In Study 1, 76 adolescents with active arthritis recorded their pain three times a day for 2 weeks using the e‐Ouch©. In Study 2, 36 adolescents recorded their pain three times a day for 1 week before and 2 weeks after joint injections. Adolescents in both studies completed multiple measures to determine the construct validity and feasibility of the e‐Ouch©. Adolescents reported mild levels of pain intensity, unpleasantness, and interference as well as stiffness, and mild to moderate levels of fatigue. e‐Ouch© average weekly pain unpleasantness and interference scores were higher in adolescents with higher pain intensity scores. Correlations between average weekly pain ratings on the e‐Ouch© and scores from: (a) recalled least, average and worst weekly pain, (b) health‐related quality of life and pain coping, and (c) disease activity were as predicted. Pain ratings were significantly lower following joint injections with effect sizes in the low to moderate and moderate to high ranges at the first and second week post‐injection, respectively. These findings provide evidence of the construct validity and feasibility of the e‐Ouch© electronic diary in adolescents with JIA. Use of real‐time data capture approaches should be considered in future studies of chronic arthritis.

Working out the kinks: testing the feasibility of an electronic pain diary for adolescents with arthritis.

BACKGROUND Current approaches to evaluating pain in children with chronic arthritis suffer from methodological problems. A real-time data capture approach using electronic diaries has been proposed as a new standard for pain measurement. However, there is limited information available regarding the development and feasibility of this approach in children. OBJECTIVES The aim of the present study was to pilot test the e-Ouch electronic pain diary in terms of compliance and acceptability in adolescents with arthritis to further refine the prototype. METHODS A descriptive study design -- with two iterative phases of testing, modifying the prototype and retesting -- was used. A purposive sample of 13 adolescents with mild to severe pain and disability was drawn from a large rheumatology clinic in a university-affiliated pediatric tertiary care centre in Canada over a four-week period in December 2004. Participants were signalled with an alarm to use the diary three times per day for a two-week period. Adolescents completed an electronic diary acceptability questionnaire. RESULTS Overall mean compliance rates for phases 1 and 2 were 72.9% and 70.5%, respectively. Compliance was affected by the timing of data collection and technical difficulties. Children rated the diary as highly acceptable and easy to use. Phase 1 testing revealed aspects of the software program that affected compliance, which were subsequently altered and tested in phase 2. No further technical difficulties arose in phase 2 testing. CONCLUSIONS Feasibility testing is a crucial first step in the development of electronic pain measures before use in clinical and research practice.

Preparation of the Dräger Primus anesthetic machine for malignant hyperthermia-susceptible patients.

PurposePreparation of anesthesia machines for patients who are susceptible to malignant hyperthermia includes flushing the machine with vapour-free fresh gas to washout residual anesthetic agents. To establish guidelines for the preparation of the Dräger Primus machine, we compared the washout profiles for isoflurane and sevoflurane in the Dräger Primus and Ohmeda Excel 210 anesthesia machines.Technical featuresThe machines were primed with 1.5% isoflurane or 2.5% sevoflurane. Fresh gas flow (FGF) was set at 10 L·min-1 during the early washout phase, and subsequently reduced to 3 L·min-1 during the late washout phase. A Miran ambient air analyzer measured the anesthetic concentration every minute during washout until a concentration of 5 ppm was achieved in the inspiratory limb of the circle circuit. We found that at a FGF of 10 L·min-1, maximum washout times for isoflurane and sevoflurane in the Primus, 70 and 74 min, respectively, were approximately tenfold greater than for isoflurane in the Excel 210 (7.0 min). Increasing the FGF to 18 L·min-1 decreased the washout time for isoflurane in the Primus, only moderately, to 52 min. We observed a threefold increase in anesthetic concentration in the Primus during the late washout phase.ConclusionWe conclude that the Primus must be flushed for at least 70 min to decrease the anesthetic concentration to 5 ppm when using a FGF of 10 L·min-1. We recommend maintaining a FGF of 10 L·min-1 for the duration of anesthesia in order to prevent the rebound increase in anesthetic concentration in the FGF.ObjectifLa préparation des appareils à anesthésie pour les patients susceptibles d’hyperthermie maligne comprend la purge de l’appareil avec des gaz frais sans vapeur pour éliminer les anes-thésiques résiduels. Nous avons comparé les profils d’élimination de l’isoflurane et du sévoflurane des appareils à anesthésie Dräger Primus et Ohmeda Excel 210 pour établir des lignes directrices concernant la préparation de l’appareil Dräger Primus.Éléments techniquesUne purge des appareils a été faite avec de l’isoflurane à 1,5% ou du sévoflurane à 2,5 %. Le débit de gaz frais (DGF), fixé à 10 L·min-1 pour la première phase de purge, a été réduit à 3 L·min-1 pendant la dernière phase. Un analyseur d’air ambiant Miran donnait la concentration d’anesthésique à chaque minute pendant la purge jusqu’à l’obtention d’une concentration de 5 ppm dans la branche inspiratoire du circuit fermé. À un DGF de 10 L·min-1, le temps de purge maximal de 70 et de 74 min dans le Primus pour l’isoflurane et le sévoflurane respectivement était environ dix fois plus long que pour l’isoflurane dans le Excel 210 (7,0 min). L’augmentation du DGF à 18 L·min-1 a diminué le temps de purge pour l’isoflurane dans le Primus, mais modérément à 52 min. Une augmentation trois fois plus importante de la concentration anesthésique a été observée dans le Primus pendant la dernière phase de la purge.ConclusionLe Primus doit être purgé pendant au moins 70 min pour y faire baisser la concentration anesthésique à 5 ppm avec un DGF à 10 L·min-1. Nous recommandons de maintenir un DGF à 10 L·min-1 pour la durée de l’anesthésie afin de prévenir l’augmentation par rebond de la concentration d’anesthésique dans les gaz frais.

Accelerating the washout of inhalational anesthetics from the Dräger Primus anesthetic workstation: effect of exchangeable internal components.

Background:To establish guidelines for the preparation of the Primus anesthetic workstation (Dräger, Lübeck, Germany) for malignant hyperthermia–susceptible patients, the authors evaluated the effect of replacing the workstation’s exchangeable internal components on the washout of isoflurane. Methods:Primus workstations were exposed to isoflurane, and contaminated internal components were replaced as follows: group 1, no replacement; group 2, new ventilator diaphragm; group 3, autoclaved ventilator diaphragm; group 4, autoclaved integrated breathing system; group 5, flushed integrated breathing system; group 6, autoclaved ventilator diaphragm and integrated breathing system. The fresh gas flow was set at 10 l/min, and subsequently reduced to 3 l/min when a concentration of 5 ppm was achieved. Isoflurane concentration was measured in the inspiratory limb of the circle circuit every minute. Results:Washout times for isoflurane decreased in the following order: group 1 (67 ± 6.5 min) > groups 2 and 3 (50 ± 4.1 and 50 ± 5.7 min, respectively) > group 5 (43 ± 9.5 min) > group 4 (12 ± 1.5 min) > group 6 (3.2 ± 0.4 min). Isoflurane concentration increased approximately threefold when the fresh gas flow was reduced to 3 l/min. Conclusion:Washout of isoflurane increased 20-fold with the use of an autoclaved ventilator diaphragm and integrated breathing system. To prepare the Primus for malignant hyperthermia–susceptible patients, the authors recommend replacing the ventilator diaphragm and integrated breathing system with autoclaved components, flushing the workstation for 5 min at a fresh gas flow of 10 l/min, and maintaining this flow for the duration of anesthesia.

Comparison of Average Weekly Pain Using Recalled Paper and Momentary Assessment Electronic Diary Reports in Children With Arthritis

Objective:The current study investigated the construct validity of a multidimensional pain diary for youth with juvenile idiopathic arthritis and also compared participants’ responses on electronic and retrospective diary measures. The purpose of the latter part of this study was to compare absolute agreement, between-person and within-person consistency and judged change in weekly pain between these 2 methods of assessing pain. Methods:A total of 70 adolescents with juvenile idiopathic arthritis completed both weekly recalled and momentary reports of pain over a 2-week period and assessed their change in pain over the 2-week period using a 5-point global change in pain scale. The Pearson correlations and intraclass correlation coefficients were computed to demonstrate 3 different ways of comparing the measures on both between-person and within-person basis. Results:Momentary ratings of pain episodes were consistently greater than weekly ratings of recalled pain. Moderate to strong consistency and agreement correlations were computed for between-person momentary and recalled pain intensity. However, these correlations were much weaker when the within-person data were analyzed. The judged change in pain across weeks was significantly associated with computed change in both average momentary and recalled pain. Discussion:This is one of the few studies to explore the relationship between the measurement methods of pain recall and momentary assessment in adolescents. The poor within-person correlations observed have important implications for research design and practice in pediatric pain.

Awareness during pediatric anesthesia: what is the position of European pediatric anesthesiologists?

Background:  The incidence of awareness in the pediatric population is reported as high as 1 : 125. An online survey was conducted about the current perception and practice of members of the British and French pediatric anesthesia societies regarding awareness during general anesthesia.