No abstract

Does pain or tissue damage in early life lead to hyperalgesia persisting into childhood? We performed a cross-sectional study in 164 infants to investigate whether major surgery within the first 3 months of life increases pain sensitivity to subsequent surgery and to elucidate whether subsequent surgery in the same dermatome or in a different dermatome leads to differences in pain sensitivity. All infants received standard intraoperative and postoperative pain management, with rescue analgesia guided by a treatment algorithm. Differences in pain sensitivity during surgery were assessed by the intraoperative fentanyl intake and by (nor)epinephrine plasma concentrations. Differences in postoperative pain sensitivity were assessed by the observational pain measures COMFORT and VAS, and by morphine intake and (nor)epinephrine plasma concentrations. Infants previously operated upon in the same dermatome needed more intraoperative fentanyl, had higher COMFORT and VAS scores, had greater (nor)epinephrine plasma concentrations, and needed also more morphine than did infants with no prior surgery. In contrast, infants who previously underwent surgery in another dermatome had only significant higher postoperative analgesic requirements and norepinephrine plasma concentrations in comparison with infants with no prior surgery. These preliminary differences may indicate the occurrence of spinal and supraspinal changes following neonatal surgery. We conclude that the long-term consequences of surgery in early infancy are greater in areas of prior tissue damage and that these effects may portend limited clinical but important neurobiological differences.

AimTo establish what leadership competencies are expected of master level‐educated nurses like the Advanced Practice Nurses and the Clinical Nurse Leaders as described in the international literature.BackgroundDevelopments in health care ask for well‐trained nurse leaders. Advanced Practice Nurses and Clinical Nurse Leaders are ideally positioned to lead healthcare reform in nursing. Nurses should be adequately equipped for this role based on internationally defined leadership competencies. Therefore, identifying leadership competencies and related attributes internationally is needed.DesignIntegrative review.MethodsEmbase, Medline and CINAHL databases were searched (January 2005–December 2018). Also, websites of international professional nursing organizations were searched for frameworks on leadership competencies. Study and framework selection, identification of competencies, quality appraisal of included studies and analysis of data were independently conducted by two researchers.ResultsFifteen studies and seven competency frameworks were included. Synthesis of 150 identified competencies led to a set of 30 core competencies in the clinical, professional, health systems. and health policy leadership domains. Most competencies fitted in one single domain the health policy domain contained the least competencies.ConclusionsThis synthesis of 30 core competencies within four leadership domains can be used for further development of evidence‐based curricula on leadership. Next steps include further refining of competencies, addressing gaps, and the linking of knowledge, skills, and attributes.ImpactThese findings contribute to leadership development for Advanced Practice Nurses and Clinical Nurse Leaders while aiming at improved health service delivery and guiding of health policies and reforms.

Summary Background  Skin disease can have a huge impact on quality of life for patients and their families. Nurses have an important role in the delivery of specialist dermatology services, and prescribing enhances the care they provide. The views of dermatology patients about nurse prescribing are unknown. Objectives  To explore the views of dermatology patients about nurse prescribing, and its impact on medicines management and concordance. Methods  Semistructured interviews were undertaken with a consecutive sample of 42 patients with acne, psoriasis or eczema who attended the clinics of seven dermatology specialist nurse prescribers. Primary and secondary care clinics were included to reflect settings in which nurses typically prescribe for patients within specialist dermatology services in England. Interviews addressed the effects of nurse prescribing on care, the patient’s medicine regimen, involvement in treatment decisions and concordance, and influences on medicine taking. Results  Patients believed that nurse prescribing improved access to, and efficiency of, dermatology services. Great value was placed on telephone contact with nurses, and local access. Information exchange and involvement in treatment decisions ensured that treatment plans were appropriate and motivated adherence. Nurses’ specialist knowledge, interactive and caring consultation style, and continuity of care improved confidence in the nurse and treatment concordance. Conclusions  Nurse prescribing can increase the efficiency of dermatology services. Patients experienced active involvement in decisions about their treatment which in turn contributed to concordance and adherence to treatment regimens. This study has important implications for maximizing resource use and improving access to and quality of care in dermatology specialist services.

NCA with morphine is an acceptable, safe, and effective method of postoperative analgesia for a wide range of ages and types of surgery in our practice. Morphine requirements increase with age, but there was also considerable inter-individual variation within age groups. PONV, itching, sedation, and respiratory depression are expected side effects. SAE are uncommon but the incidence is greatest in neonates.

Abstract. The Emissions Database for Global Atmospheric Research (EDGAR) compiles anthropogenic emissions data for greenhouse gases (GHG) and for multiple air pollutants based on international statistics and emission factors. EDGAR data provides quantitative support for atmospheric modelling and for mitigation scenario and impact assessment analyses as well as for policy evaluation. The new version v4.3.2 of the EDGAR emission inventory provides global estimates, disaggregated to IPCC-relevant source-sector levels, from 1970 (the year of EU's first Air Quality Directive) to 2012 (the end year of the first commitment period of the Kyoto Protocol (KP)). Strengths of EDGAR v4.3.2 include global geo-coverage (226 countries), continuity in time, and comprehensiveness in activities. Emissions of multiple chemical compounds, GHG as well as air pollutants, from relevant sources (fossil fuel activities but also, for example fermentation processes in agricultural activities) are compiled following a bottom-up (BU), fully-traceable and IPCC-based methodology. This paper describes EDGARv4.3.2 developments with respect to three major GHG (CO2, CH4, and N2O) derived from a wide range of human activities apart from the land-use, land-use change and forestry (LULUCF) sector and apart from Savannah burning; a companion paper quantifies and discusses emissions of air pollutants. Detailed information is included for each of the IPCC-relevant source-sectors, leading to global totals for 2010 (in the middle of the first KP commitment period) (with 95 % confidence interval in parentheses): 33.6 (±5.9) Pg CO2/yr, 0.34 (±0.16) Pg CH4/yr, and 7.2 (±3.7) Tg N2O/yr. We provide uncertainty factors in emissions data for the different GHGs and for three different groups of countries: OECD countries of 1990, countries with economies in transition in 1990, and the remaining countries in development (the UNFCCC non-Annex I parties). We document trends for the major emitting countries together with the European Union in more detail, demonstrating that effects of fuel markets and financial stability have had greater impacts on GHG trends than effects of income or population. These data (DOI: https://doi.org/10.2904/JRC_DATASET_EDGAR) are visualised with annual and monthly global emissions grid-maps of 0.1° ×0.1° for each source-sector; these data can be freely accessed from the EDGAR website http://edgar.jrc.ec.europa.eu/overview.php?v=432&SECURE=123.

This study demonstrates that the NFCS is a reliable, feasible, and valid tool for assessing postoperative pain. The reduction of the NFCS to 5 items increases the specificity for pain assessment without reducing the sensitivity and validity for detecting changes in pain.

Major surgery in combination with preemptive analgesia within the first months of life does not alter pain response to subsequent pain exposure in childhood. Greater exposure to early hospitalization influences the pain responses after prolonged time. These responses, however, diminish after a prolonged period of nonexposure.