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Biomedical subjects

G A Finley

Publications and source records attributed to G A Finley.

At least 19 recordsLinked to original sources
PubMed2007

Pain's impact on adaptive functioning.

BACKGROUND: Pain interferes with the functioning of typical children, but no study has examined its effect on children with pre-existing intellectual disabilities (ID). METHODS: Caregivers of 63 children observed their children for 2-h periods and recorded in 1-week diaries: pain presence, cause, intensity and duration. Caregivers also recorded the children's performance of pre-existing skills during each period. Proportion of skills displayed when pain was present and absent was compared. Fifty caregivers completed a second set of observations when pain was present and absent. RESULTS: Comparison of the first set of observations indicated children displayed significantly more abilities (64%) when pain-free (Pain-Free Day 1), than when pain was present (54%; Pain Day 1). Children displayed 64% of their possible abilities during Pain-Free Day 2, but only 53% during Pain Day 2. Pain impacted all areas of function (communication, daily living, social and motor skills). Children's physical and demographic characteristics did not moderate the impact of pain on function, but functioning of children with more severe ID was most impacted by pain. CONCLUSIONS: Children perform fewer adaptive skills when pain is present. This could affect long-term functioning as well, through reduced practice of skills.

Adaptation, Psychological↗
PubMed2003

The disruptive effect of chronic pain on mismatch negativity.

OBJECTIVE: To investigate the effect of chronic pain on processes that generate the mismatch negativity (MMN). METHODS: Twelve participants with a diagnosis of chronic intractable pain were tested before and after pain treatment. During testing, event-related potentials were recorded while participants performed tasks of varying difficulty. RESULTS: The amplitude of the MMN was found to be greater following a nerve block procedure compared to MMN amplitude when participants were experiencing chronic pain. This effect was found to occur in the MMN for difficult-to-detect tones elicited while participants were performing a simultaneous cognitively demanding visual task. MMN amplitude was found to be greater with attention to difficult-to-detect deviants during pain but not in no pain conditions. CONCLUSIONS: These results provide an electrophysiological correlate of previous findings that high levels of pain disrupt cognition during the performance of demanding tasks.

Acoustic Stimulation↗
PubMed2001

Low-concentration morphine infusion does not compromise packed red blood cell transfusion.

Regulations currently prohibit co-administration (through the same line) of red blood cell transfusions with continuous morphine infusions for pain management, resulting in additional intravenous access or interrupted analgesic therapy in seriously ill children. Packed cells that had been in contact with morphine 0.1 or 1.0 mg/mL and infused through a mock central venous catheter system showed no evidence of hemolysis when compared with control samples. There is thus no need to interrupt analgesic therapy or start another venous access line in order to give a coincident blood transfusion.

Analgesics, Opioid↗
PubMed2001

Measuring pain accurately in children with cognitive impairments: refinement of a caregiver scale.

OBJECTIVE: To examine whether typical pain behavior, as reported by caregivers, could be used prospectively to predict future pain behavior and to derive a subset of core items from the Non-Communicating Children's Pain Checklist. STUDY DESIGN: Caregivers (n = 33) of children with cognitive impairments completed the Non-Communicating Children's Pain Checklist retrospectively and immediately after subsequent episodes of pain and distress in their homes. Odds ratios were computed for checklist items, and multiple regressions were used to predict numerical pain and distress ratings with items that had significant odds ratios. A logistic regression was used to test whether the items found to predict pain could correctly classify the presence or absence of pain in a new cohort of 63 children with similar cognitive impairments. RESULTS: Seven of the checklist items had significant odds ratios: Cranky, Seeking Comfort, Change in Eyes, Less Active, Gesture to Part That Hurts, Tears, and Gasping. This subset of items significantly predicted numerical pain ratings by caregivers (multiple R =.70), but not distress ratings (multiple R =.31). In a second group of 63 children with cognitive impairments, this subset of items displayed 85% sensitivity and 89% specificity for pain. CONCLUSION: A subset of items from the Non-Communicating Children's Pain Checklist could predict pain in children with cognitive impairments. Caregivers' retrospective reports may be useful for clinicians making judgments about pain in these children.

Caregivers↗
PubMed2001

A randomized double-blind, placebo-controlled trial of the EMLA patch for the reduction of pain associated with intramuscular injection in four to six-year-old children.

UNLABELLED: The effectiveness of a eutectic mixture lidocaine-prilocaine topical anaesthetic cream (EMLA) patch compared with a placebo patch in the reduction of pain associated with intramuscular immunization was evaluated. As part of the study, 161 children (aged 4-6-y) undergoing routine diphtheria, pertussis, tetanus and polio (DPTP) immunization in five urban and five rural private office settings were randomly assigned to an EMLA patch (n = 83) or a placebo patch control group (n = 78). Pain measurements included: child's self-report on a Faces Pain Scale; facial action on the Child Facial Coding System; the Children's Hospital of Eastern Ontario Pain Scale and parent and technician ratings on a Visual Analogue Scale. Parents also rated their own and their child's immunization-related anxiety on a Visual Analogue Scale. The EMLA patch group had significantly less pain on all four pain measures compared with the placebo group. Of the children in the placebo group, 43% had clinically significant pain, compared with 17% of children in the EMLA patch group. No severe adverse symptoms occurred as a result of either EMLA or placebo patch application. CONCLUSION: The EMLA patch reduced immunization pain in 4 to 6-y-old children during needle injection.

Anesthetics, Combined↗
PubMed2001

Assessing pediatric anesthesia practices for volunteer medical services abroad.

BACKGROUND: Anesthetic techniques and problems in volunteer medical services abroad are different from those of either the developed countries from which volunteers originate or the host country in which they serve because of differences in patient population, facilities, and goals for elective surgery. Assessing outcomes is hampered by the transience of medical teams and the global dispersion of providers. We studied general anesthesia techniques and outcomes in a large international voluntary surgical program. METHODS: Anesthesia providers and nurses participating in care of patients undergoing reconstructive plastic and orthopedic surgery by Operation Smile over an 18-month period were asked to complete a quality assurance data record for each case. Incomplete data were supplemented by reviewing the original patient records. RESULTS: General anesthesia was used in 87.1% of the 6,037 cases reviewed. The median age was 5 yr (25th-75th percentiles: 2-9 yr). Orofacial clefts accounted for more than 80% of procedures. Halothane mask induction was performed in 85.6% of patients; 96.3% of patients had tracheal intubation, which was facilitated with a muscle relaxant in 19.3%. Respiratory complications occurred during anesthesia in 5.0% of patients and during recovery (postanesthesia care unit) in 3.3%. Arrhythmias requiring therapy occurred in 1.5%, including three patients to whom cardiopulmonary resuscitation was administered. Prolonged ventilatory support was required in seven patients. There was one death. Inadvertent extubation during surgery occurred in 38 patients. Cancellation of surgery after induction of anesthesia occurred in 25 patients. Overall, complications were more common in younger children. CONCLUSIONS: Our study showed that in this setting it is feasible to track anesthesia practice patterns and adverse perioperative events. We identified issues for further examination.

Adolescent↗
PubMed2001

Pain treatment thresholds in children after major surgery.

OBJECTIVE: The objectives of this study were to use a self-report pain scale to examine child pain treatment thresholds after major surgery (i.e., the level of pain they are comfortable with before requiring analgesia), as well as to examine agreement between mother-, nurse-, and child-rated pain treatment thresholds. METHODS: Twenty-five children aged 6 to 16 years were interviewed for 3 consecutive days after major surgery. Subjects used the Faces Pain Scale to rate their current pain, worst postoperative pain, and pain level at which they would like to receive analgesia (the pain treatment threshold). Parents and nurses also estimated the child pain treatment thresholds. RESULTS: For day 1, mean pain was 1.86 of a maximum of 6, mean worst pain was 4.16, and mean pain treatment threshold was 2.28. For day 2, these values were 1.90, 4.10, and 2.54, and for day 3 they were 1.62, 4.56, and 1.85, respectively. Mean scores for all 3 days were as follows: pain, 1.79; worst pain, 4.15; and pain treatment threshold, 2.33. Although mother-nurse ratings were correlated (0.471), mother-child and nurse-child ratings were not significantly correlated. Using the pain treatment threshold as the criterion, 36% of our subjects were undermedicated after the first day of surgery. CONCLUSION: Pain treatment thresholds seem to be lower in children after major as compared with minor surgery. Parents and nurses are not accurate in rating child pain treatment thresholds. Parents tended to overestimate their child's pain treatment threshold, whereas nurses were less consistent in their scoring.

Adolescent↗
PubMed2001

Comparison of postoperative pain: tonsillectomy by blunt dissection or electrocautery dissection.

PURPOSE: To compare post-operative pain in children undergoing tonsillectomy by blunt dissection or electrocautery. METHOD: Thirty-six children between the ages of 5 and 15 years were recruited for the study. Tonsillectomy was done in a standardized fashion with uniform anaesthetic practices. Each child kept a pain diary for 10 days, recording pain twice daily on a Visual Analog Scale and Faces Pain Scale. Doses of analgesics were recorded. RESULTS: There were no statistically significant differences in the pain scores for the groups, although there was a trend toward more pain in the blunt dissection group. There were more complications in this group, and these children used significantly more doses of acetaminophen. Sources of bias are discussed. CONCLUSION: These results suggest a trend toward greater postoperative pain in children who have tonsillectomies by blunt dissection techniques.

Adolescent↗
PubMed2000

Preliminary validation of an observational pain checklist for persons with cognitive impairments and inability to communicate verbally.

To obtain a preliminary validation of the Non-Communicating Children's Pain Checklist for individuals with an inability to communicate verbally, 32 caregivers of individuals with cognitive impairments aged 3 to 44 years retrospectively completed the Non-Communicating Children's Pain Checklist and rated item usefulness (0 to 10). In the second part of the study 33 caregivers completed the Checklist after two painful (e.g. burns, falls, surgery), one distressful (e.g. unwanted grooming, feared animal/noise), and one calm event (e.g. watching television). Checklist scores did not correlate with the age, sex, or physical limitations of individuals with an inability to communicate verbally. In the first part of the study Cronbach's alpha was 0.66; all mean usefulness ratings exceeded 5 out of 10. In the second part of the study after four items were removed, Cronbach's alpha was 0.79. Checklist scores during pain correlated with numerical ratings of pain intensity did not differ between the two pain events, and differed significantly from calm scores. Differences in Checklist scores during pain and distress were found for two subscales. The Checklist exhibits internal consistency, and preliminary evidence suggests it can detect pain and is reliable over time.

Adolescent↗
PubMed1998

Children's self-report of postoperative pain intensity and treatment threshold: determining the adequacy of medication.

OBJECTIVE: Many studies have shown indirectly that children are undermedicated for postoperative pain. In this study, we used a pain self-report scale to examine this more directly. METHODS: We performed a survey with 63 children who were postoperative from minor, uncomplicated surgery. Using the self-report scale, we determined the pain intensity at time of interview, the worst pain experienced postoperatively, and the intensity of pain that the subject felt to warrant pharmacologic intervention (the "treatment threshold"). A subgroup of 48 children was asked to indicate on the scale the intensities that represented mild, moderate, and severe pain. RESULTS: Mean (SD) pain at time of interview was 1.9 (1.7) on the 0-6 scale. Mean worst postoperative pain was 3.8 (1.8). The mean for treatment threshold was 3.2 (1.8). We found gender differences in regard to the judgments about the intensities representing mild, moderate, and severe pain, with girls rating these lower than did boys. Twenty-five percent of subjects reported pain that was mild, 29% reported moderate pain, and 46% reported severe pain. CONCLUSIONS: We found that 51% of subjects were undermedicated for postoperative pain, being required to suffer pain that was above their treatment threshold. By determining each subject's treatment threshold and estimate of moderate pain, we have better defined the intensity at which pain becomes clinically significant.

Adolescent↗
PubMed1998

Agreement between child and parent reports of pain.

OBJECTIVE: Parents are often the primary source of information regarding their children's pain in both research and clinical practice. However, parent-child agreement on pain ratings has not been well established. The objective of the present study was to examine agreement between child- and parent-rated pain following minor surgery. SETTING: Tertiary care children's hospital. PARTICIPANTS: A total of 110 children (56.4% male) aged 7-12 years undergoing surgery and their parents. OUTCOME MEASURES: Parents and children independently rated pain intensity by using a 7-point Faces Pain Scale on the day of the child's surgery and the following 2 days. RESULTS: Correlations (both Pearson's and intraclass correlation coefficients) indicated a highly significant relationship between child and parent ratings. However, kappa statistics indicated only poor to fair agreement beyond chance. Parents tended to underestimate their children's pain on the day of surgery and the following day, but not on the second day following surgery. When children's and parents' pain ratings for each of the 3 days were collapsed into a no-pain/low-pain group or a clinically significant pain group, kappa statistics indicated fair to good agreement. Parents demonstrated low levels of sensitivity in identifying when their children were experiencing clinically significant pain. CONCLUSIONS: Correlations between parent and child pain reports do not accurately represent the relationship between these ratings and in fact overestimate the strength of the relationship. Parents' underestimation of their child's pain may contribute to inadequate pain control.

Adult↗
PubMed1997

Self-administration of over-the-counter medication for pain among adolescents.

OBJECTIVE: To examine over-the-counter (OTC) medication use and self-administration of medication among adolescents. DESIGN: In-person survey. SETTINGS: Three public junior high schools in Halifax, Nova Scotia. PARTICIPANTS: Six hundred fifty-one junior high school students (7th, 8th, and 9th grades). MAIN OUTCOME MEASURES: A questionnaire regarding OTC medication use and self-administration for head: stomach; ear and throat; muscle, joint, and back; and menstrual pains. RESULTS: Of those who reported taking medication, many adolescents (58.7%-95.9%) reported taking OTC medications for each pain. Medications and knowledge about medications were obtained from a variety of sources, primarily parents. Self-administration was widespread; 58.3% to 75.9% of adolescents reported taking an OTC medication for pain without first checking with an adult in the previous 3 months. Self-administration of medication without the knowledge of adults increased significantly from grades 7 to 9 for all types of pain. Girls tended to self-administer medication more than boys. Higher levels of pain frequency and intensity were related to higher levels of self-administration for all pains except muscle, joint, and back pain. Adolescents reported that they began to self-administer medication between the ages of 11 and 12 years. CONCLUSIONS: Although a relatively responsible picture of self-administration of medication emerges, some adolescents engaged in inappropriate OTC medication use (eg, the common use of aspirin), highlighting the importance of providing adolescents with correct information about these medications.

Adolescent↗
PubMed1997

A comparison of patient-controlled and fixed schedule analgesia after orthognathic surgery.

PURPOSE: The purpose of this prospective study was to compare the effectiveness of patient-controlled intravenous (i.v.) opioid analgesic administration (PCA) with fixed schedule and dosage oral/rectal administration of naproxen, and opioid analgesics intramuscularly/orally as needed (i.m./p.o. prn) for postoperative analgesia over a period of 48 to 56 hours after surgery. PATIENTS AND METHODS: There were 75 orthognathic patients aged 25.73 +/- 8.01 years, subdivided into three study groups of 25: codeine group (8 males, 17 females); naproxen group (5 males, 20 females) and PCA group (8 male, 17 females). The degree of analgesia was assessed every 4 hours from 8:00 AM to 8:00 PM hours on days 1 and 2 postsurgery using a visual analog scale (VAS). Mean daily and mean overall VAS scores were treated as parametric data and were analyzed accordingly. Mean daily VAS scores also were categorized as comfort days when mean scores were less than 3.0 cm, and as discomfort days when mean scores were equal to or greater than 3.0 cm. ANOVA were used to analyze patient demographics, pain scores, surgical time, fentanyl used during general anaesthesia, analgesic morphine equivalents, and vital signs. Chi-square tests were used to analyze sex, comfort (discomfort) days, and nausea and vomiting. Mean VAS ratings were analyzed using independent t-tests. RESULTS: The three groups were matched in demographics, surgical time, fentanyl used, and sex. The PCA group used less than half the amount of morphine equivalent as the codeine group (P = .0001). Both the naproxen and the PCA groups were significantly more comfortable than the codeine group during day 1 and day 2 postsurgery. The codeine group had significantly more episodes of nausea than either the naproxen or the PCA groups. CONCLUSION: In patients undergoing orthognathic surgery, the naproxen and PCA regimens provided better analgesia than the codeine regimen.

Adolescent↗
PubMed1997

Coping with pain and surgery: children's and parents' perspectives.

This article examines relations between coping with general and postoperative pain. Children's and parent's coping ratings, and the contribution of temperament and coping to postoperative adjustment. Before and after day surgery, 7-to 12-year-olds (n = 124) rated their coping with pain. Parents rated their child's coping and temperament pain and distress were rated on the day of and 2 days following surgery. Coping with general and postoperative pain were moderately correlated (median r = .48). Except for distraction, all types of coping strategies were used more frequently for general than postoperative pain. Correlations between child and parent coping ratings were moderate (median r = .36). After controlling for emotionality and medications, lower levels of emotion-focused avoidance and higher levels of distraction were related to lower pain and distress. After controlling for a priori surgical group (no-low pain; moderate-high pain), emotionality, and medications, lower levels of emotion-focused avoidance were related to lower pain and distress but distraction was no longer significant in a number of the regressions. Coping with pain has trait-like qualities but differences in the nature and context of pain create differences in strategy use. Level of pain appears to influence the type of coping strategies used. Interventions should target children's use of distraction and minimize us of emotion-focused avoidance.

Journal Article↗
PubMed1996

Development and preliminary validation of a postoperative pain measure for parents.

Parents are now primarily responsible for the at home assessment and treatment of their children's pain following minor surgery. Although some research has suggested that parents underestimate their children's pain following surgery, no behavioral measure exists to assist parents in pain assessment. The Postoperative Pain Measure for Parents was developed based on cues parents reported using to assess their children's pain (e.g. changes in appetite, activity level). The purpose of the present study was to develop and validate this measure by examining the relation between parent-report of child behaviors and child-rated pain. Subjects were 110 children (56.4% male) aged 7-12 years undergoing day surgery at a tertiary-care children's hospital and their parents. Parents and children completed a pain diary for the 2 days following surgery. Children rated their pain and emotional distress and parents rated the presence or absence of specific behaviors from a checklist. Correlations were conducted between each of the 29 behavioral items and child-rated pain on Day 1; 14 items with correlations less than 0.30 were dropped. The remaining 15 items were subjected to a principal axis factor analysis. A one-factor solution was the best fit for the data. The items were then summed to yield a total score out of 15. Internal consistency reliabilities for the measure and correlations with child-rated pain were high on both days following surgery. Child-rated pain and emotional distress were moderately correlated. The Postoperative Pain Measure for Parents was also positively correlated with child-rated emotional distress on both days following surgery. As child-rated pain decreased from Day 1 to Day 2, so did scores on the behavioral measure. The Postoperative Pain Measure for Parents was successful in discriminating between children who had undergone no/low pain surgeries and children who had undergone moderate to high pain surgeries. There were no significant differences in scores on the behavioral measure for child age or sex. Using a cut-off score of six out of 15, the measure showed excellent sensitivity (> 80%) and specificity (> 80%) in selecting children who reported clinically significant levels of pain. This study provides preliminary evidence for the use of the Postoperative Pain Measure for Parents as a valid assessment tool with children between the ages of 7-12 years following day surgery. It is internally consistent and strongly related to child-rated pain. Future research should explore the use of this measure with a younger sample and children with developmental delays.

Adult↗