超出生体重児に対する早期デキサメサゾン投与の有用性 : National Institute of Child Health and Human Development Neonatal research Network報告 (海外誌掲載論文の和文概要とそれに対するコメント)

I am delighted to announce the exciting news that we have received just under 900 abstracts for presentation in the scientific program of the VIth World Congress on Pain in Adelaide, April l-6, 1990. This 1s about a 50% increase in the number of abstracts submitted for the 1987 Congress in Hamburg and it represents by far the greatest number of scientific papers ever offered for the an IASP Congress. This surely reflects the healthy state of IASP and is also a very encouraging indlcator of the high level of activity in basic and clinical research in the field of pain throughout the world. Based upon our previous experience with the ratio of congress delegates to scientific abstracts, the Adelaide Congresses promises to be the largest world congress on pain we have so far held.

International association for the study of pain

Workforce shortages, late referrals, and palliative care program resource constraints present significant barriers to meeting the needs of hospitalized patients facing serious illnesses. The Center to Advance Palliative Care convened a consensus panel to select criteria by which patients at high risk for unmet palliative care needs can be identified in advance for a palliative care screening assessment. The consensus panel developed primary and secondary criteria for two checklists-one to use for screening at the time of admission and one for daily patient rounds. The consensus panel believes that by implementing a checklist approach to screening patients for unmet palliative care needs, combined with educational initiatives and other system-change work, hospital staff engaged in day-to-day patient care can identify a majority of such needs, reserving specialty palliative care services for more complex problems.

/pdf/identifying-patients-in-need-of-a-palliative-care-assessment-iruz0lblph.pdf

Identifying Patients in Need of a Palliative Care Assessment in the Hospital SettingA Consensus Report from the Center to Advance Palliative Care

NCL diseases — clinical perspectives

and youth with complex medical issues, especially those with technology dependencies, experience frequent and often lengthy hos- pitalizations. Hospital discharges for these children can be a compli- cated process that requires a deliberate, multistep approach. In addition to successful discharges to home, it is essential that pedi- atric providers develop and implement an interdisciplinary and co- ordinated plan of care that addresses the child's ongoing health care needs. The goal is to ensure that each child remains healthy, thrives, and obtains optimal medical home and developmental supports that promote ongoing care at home and minimize recurrent hospitaliza- tions. This clinical report presents an approach to discharging the child with complex medical needs with technology dependencies from hospital to home and then continually addressing the needs of the child and family in the home environment. Pediatrics 2012;129:996-1005

https://pediatrics.aappublications.org/content/pediatrics/early/2012/04/25/peds.2012-0606.full.pdf

Home Care of Children and Youth With Complex Health Care Needs and Technology Dependencies

Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention. Sources of pain in this population include acute-onset pain attributable to tissue injury or inflammation resulting in nociceptive pain, with pain then expected to resolve after treatment directed at the source. Other sources can result in chronic intermittent pain that, for many, occurs on a weekly to daily basis, commonly attributed to gastroesophageal reflux, spasticity, and hip subluxation. Most challenging are pain sources attributable to the impaired central nervous system, requiring empirical medication trials directed at causes that cannot be identified by diagnostic tests, such as central neuropathic pain. Interventions reviewed include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, α-agonists, and opioids. This clinical report aims to address, with evidence-based guidance, the inherent challenges with the goal to improve comfort throughout life in this vulnerable group of children.

https://pediatrics.aappublications.org/content/pediatrics/early/2017/05/18/peds.2017-1002.full.pdf

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

Pediatric Palliative Care

Neurologically impaired children have an increased frequency of recurrent pain and irritability that persist in some despite comprehensive evaluation and management of possible pain sources. We hypothesized that visceral hyperalgesia was a source of chronic unexplained irritability and report the outcome of gabapentin treatment in 9 severely neurologically impaired children. Caregivers reported marked improvement after treatment ranging from 3 months to 3 years. Nystagmus in 1 child was the only noted adverse effect. Visceral hyperalgesia may be a source of unexplained irritability in the neurologically impaired child. Symptoms may improve with gabapentin treatment.

Gabapentin successfully manages chronic unexplained irritability in children with severe neurologic impairment.

Background: How physicians are evaluated throughout their careers and how training programs are accredited has shifted from demonstrating what we teach and what we are learning to demonstrating the achievement of competence. Discussion: This article discusses some of the components involved with determining and providing necessary educational experiences. These steps apply to various educational needs and settings such as development of curriculum for training programs, clinical staff development, courses in continuing medical education, and identifying learning needs throughout practice. Covered in this article are three components to this process: needs assessment, development of learning objectives, and choosing a teaching approach. A needs assessment is a first step in this process and can be applied to determining revisions in curriculum, identifying needs in clinical staff development, and to self-identifying individual learner status. Once conducted, the identified curriculum needs are lin...

Educational Needs Assessment, Development of Learning Objectives, and Choosing a Teaching Approach

Purpose of review To review the role of pediatric palliative care (PPC) for children with metabolic and neurological diseases. Recent findings There is a growing body of literature in PPC, though it remains limited for children with metabolic and neurological diseases. Evidence indicates the benefit of PPC. Utilization of PPC programmes can facilitate communication, ensure that families are better informed, improve certainty with decisions, enhance positive emotions, result in fewer invasive interventions at the end of life, and have an impact on location of death. Barriers to utilization of PPC include concern about taking away hope and uncertainty about prognosis. Challenging areas for children with metabolic and neurological diseases include the identification of distressing symptoms and prognostic uncertainty. This article aims to review literature relevant to this group of children, as well as provide a framework when considering specific palliative care needs. Summary PPC for children with metabolic and neurological diseases can lessen a child's physical discomfort and enhance parental certainty with decision-making. These areas along with other needs throughout the illness trajectory and bereavement are being increasingly met by the growing availability of PPC programmes.

Julie Hauer

Papers

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

Pediatric Palliative Care

Gabapentin successfully manages chronic unexplained irritability in children with severe neurologic impairment.

Educational Needs Assessment, Development of Learning Objectives, and Choosing a Teaching Approach

Supportive and palliative care of children with metabolic and neurological diseases.