IntroductionAdolescents’ pain experiences are complex and multidimensional, and evaluating pain only from a sensory and affective point of view may be in many instances limiting and inadequate; this is the reason why it is of paramount importance to identify the tools which can better assess the pain experienced by young patients. A person-oriented approach is highly encouraged, as it may better investigate the cognitive and behavioral development typical of this age group. The aim of this review paper is to describe the available tools which are able to adequately assess pain intensity in adolescents, in particular those validated in Italian.MethodsWe conducted a systematic review using four databases: CINAHL, PsycINFO, PubMed and Cochrane, and selected all the articles published between January 1970 and November 2017. We selected all the papers reporting the validation process of pain assessment tools specifically tailored for adolescent patients (age range 10–18 years) and based on psychometric and linguistic parameters, and focused especially on the tools available in Italian and able to measure acute and chronic pain.ResultsThe results of our investigation have revealed the existence of 40 eligible tools, 17 of which are monodimensional and the remaining 23 multidimensional, more specifically tailored to assess both acute and chronic pain. Some of the instruments (26) were self-reports while others were classified as behavioral (13) and/or mixed. Only one tool turned out to be suitable for fragile adolescents, while six adopted a person-oriented approach that better emphasized the cognitive and behavioral process typical of the adolescent population. None of them has ever been validated in Italian.ConclusionValid and reliable psychometric tools specifically organized to provide a cultural and linguistic evaluation of the patient are indeed the most recommended instruments to assess the intensity of the pain experienced by the patient, as they may provide useful information to implement a health policy aimed at identifying the best assistance programs.
Introduction: To date, Emergency Department overcrowding represents one of the most important problems regarding the organisation of emergency healthcare. See and Treat was devised in England around the 1980s to provide an effective solution to the overcrowding issue. The Emergency Nurse Practitioner indicates a faster pathway in selected patients with certain characteristics. This model translates into a reduction in waiting times while maintaining the same quality of care. Aim: To evaluate the potential benefits for patients of the implementation of the See and Treat model within the Emergency Department. Materials and Methods: Using the GIPSE system, all Emergency Department entries from 2019 have been selected. Minor codes in the triage phase have been considered, as well as those potentially falling within the See and Treat protocol. Each included case has been associated to a See and Treat diagnosis. The waiting time and the time spent in the Emergency Department were derived from the data collected. Results: 9.41% of the sample is eligible for the See and Treat method, with an average waiting time of one hour and peaks of almost 4 hours for white codes. The application of the See and Treat model to the population covered by our study would reduce the waiting times at the Emergency Department by 6.99%, reduce the simultaneous presence of users on the Emergency Department by 8.88% and reduce the stay for other minor codes by 4.38%. Discussion: The percentage of patients treatable in the See and Treat system (11%) is in line with the Tuscany trial but statistically lower than the international context (from 63% to 90%). The results obtained from this study showed the significant impact that the See and Treat model could have on reducing overcrowding, positively affecting both users and staff.
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