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Research paper thumbnail of Training highly qualified health research personnel: the pain in Child Health consortium

Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur

Pain in Child Health (PICH) is a transdisciplinary, international research training consortium. P... more Pain in Child Health (PICH) is a transdisciplinary, international research training consortium. PICH has been funded since 2002 as a Strategic Training Initiative in Health Research of the Canadian Institutes of Health Research, with contributions from other funding partners and the founding participation of five Canadian universities. The goal of PICH has been to create a community of scholars in pediatric pain to improve child health outcomes. Quantitative analyses enumerated PICH faculty, trainees, training activities and scientific outputs. Interviews with PICH stakeholders were analyzed using qualitative methods capturing perceptions of the program's strengths, limitations, and opportunities for development and sustainability. PICH has supported 218 trainee members from 2002 through 2013, from 14 countries and more than 16 disciplines. The faculty at the end of 2013 comprised nine co-principal investigators, 14 Canadian coinvestigators, and 28 Canadian and international col...

Research paper thumbnail of The Postoperative Pain Assessment Skills pilot trial

Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur

BACKGROUND⁄ Pain-related misbeliefs among health care professionals (HCPs) are common and contrib... more BACKGROUND⁄ Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs' assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method - deteriorating patient-based simulation (DPS) - versus SPs for improving HCPs' pain knowledge and assessment skills. Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs' pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the P...

Research paper thumbnail of SP4 Efficacy across three simulation models used to teach nursing students complex cardiac pain management: a RCT

European Journal of Cardiovascular Nursing, 2009

Research paper thumbnail of Developing a standardized approach to the assessment of pain in children and youth presenting to pediatric rheumatology providers: a Delphi survey and consensus conference process followed by feasibility testing

Pediatric Rheumatology, 2012

Research paper thumbnail of Using an electronic pain diary to better understand pain in children and adolescents with arthritis

Research paper thumbnail of Review: Psychological interventions reduce the severity and frequency of chronic pain in children and adolescents

Research paper thumbnail of Quality and quantity of friendships, peer relationships, and teacher relationships in children with chronic pain: A systematic review

Research paper thumbnail of An Interfaculty Pain Curriculum: Lessons learned from six years experience

Research paper thumbnail of A systematic review of the effect of waiting for treatment for chronic pain

Research paper thumbnail of Overcoming Barriers to the Sexual Expression of Women With Developmental Disabilities

Research and Practice for Persons with Severe Disabilities, 2002

Research paper thumbnail of Reliability and validity of the Child Pain Anxiety Symptoms Scale (CPASS) in a clinical sample of children and adolescents with acute postsurgical pain

Pain, 2011

Pain anxiety refers to the cognitive, emotional, physiological, and behavioural reactions to the ... more Pain anxiety refers to the cognitive, emotional, physiological, and behavioural reactions to the experience or anticipation of pain. The Child Pain Anxiety Symptoms Scale (CPASS) has recently been developed and validated in a pediatric community sample. The goal of the present study was to examine the psychometric properties of the CPASS in a sample of children and adolescents with acute

Research paper thumbnail of People Tell Me I Can't Have Sex

Women & Therapy, 2003

Much of the information “known” about the personal beliefs and experiences of women with developm... more Much of the information “known” about the personal beliefs and experiences of women with developmental disabilities, their needs, desires, and sexual practices, have been gleaned from second-hand accounts and speculation. Utilizing direct interviews, this study was designed to assess women's level of knowledge, their access to resources and their feelings of control over choices concerning their bodies. Further, this study sought to examine the impact that disability has on sexuality from the women who experience it. Implications for future research are discussed.

Research paper thumbnail of Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis

Rheumatology, 2011

To determine and compare the prevalence of disturbed sleep in JIA and JDM and the relationship of... more To determine and compare the prevalence of disturbed sleep in JIA and JDM and the relationship of sleep disturbance to pain, function, disease activity and medications. One hundred fifty-five patients (115 JIA, 40 JDM) were randomly sampled and were mailed questionnaires. Sleep disturbance was assessed by the sleep self-report (SSR) and the children's sleep habits questionnaire (CSHQ). Fatigue, pain and function were assessed by the paediatric quality of life inventory (PedsQL) and disease activity by visual analogue scales (VASs). Joint counts were self-reported. Eighty-one per cent responded, of whom 44% reported disturbed sleep (CSHQ > 41); there were no differences between disease groups. Poor reported sleep (SSR) was highly correlated with PedsQL fatigue (r = 0.56, P < 0.0001). Fatigue was highly negatively correlated with quality of life (r = -0.77, P < 0.0001). The worst pain intensity in the last week was correlated to sleep disturbance (r = 0.32, P = 0.0005). Fatigue was associated with prednisone and DMARD use. Sleep disturbance and fatigue are prevalent among children with different rheumatic diseases. Sleep disturbance and fatigue are strongly associated with increased pain and decreased quality of life. Strategies aimed at improving sleep and reducing fatigue should be studied as possible ways of improving quality of life for children with rheumatic illness.

Research paper thumbnail of Measurement Properties of Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatrics: A Systematic Review

Research paper thumbnail of Construct validity of a multidimensional electronic pain diary for adolescents with arthritis

PAIN, 2008

The aim of this study was to evaluate the construct validity and feasibility of a multidimensiona... more The aim of this study was to evaluate the construct validity and feasibility of a multidimensional electronic pain diary (e-Ouch(c)) 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 2weeks using the e-Ouch(c). In Study 2, 36 adolescents recorded their pain three times a day for 1week before and 2weeks after joint injections. Adolescents in both studies completed multiple measures to determine the construct validity and feasibility of the e-Ouch(c). Adolescents reported mild levels of pain intensity, unpleasantness, and interference as well as stiffness, and mild to moderate levels of fatigue. e-Ouch(c) 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(c) 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(c) electronic diary in adolescents with JIA. Use of real-time data capture approaches should be considered in future studies of chronic arthritis.

Research paper thumbnail of Nerve resection and re-location may relieve causalgia: A case report

Pain, 2007

This article reports the relief of severe causalgia of the right infra-orbital nerve by nerve sec... more This article reports the relief of severe causalgia of the right infra-orbital nerve by nerve section and re-location in a 14-year-old boy who had worsening neuropathic pain (NP) and was housebound and refractory to all analgesics for 14 months. His infra-orbital nerve was sectioned and re-located into his buccal fat pad. Severe steady burning, electric shock-like pain and allodynia disappeared and he was able to return to school and an increasingly normal life at one year post-operatively and is pain-free at 3 years and 6 months of follow-up. With NP further deafferentation can cause a worsening of the pain or anaesthesia dolorosa. In this instance there was dramatic and then sequential, gradual and complete resolution of all components of this particular form of NP. Therefore, in selected patients with causalgia this nerve re-location technique may help in symptom resolution and improve quality of life.

Research paper thumbnail of Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents

Research paper thumbnail of Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes

PAIN®, 2014

Hospitalized children frequently receive inadequate pain assessment and management despite substa... more Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6 months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (P<0.001) and had a greater proportion of patients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/10) and severe (7-10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes.

Research paper thumbnail of An integrated undergraduate pain curriculum, based on IASP curricula, for six Health Science Faculties

Research paper thumbnail of Commentary: The Journal of Pediatric Psychology Should Adopt the CONSORT Statement as a Way of Improving the Evidence Base in Pediatric Psychology

Journal of Pediatric Psychology, 2003

Research paper thumbnail of Training highly qualified health research personnel: the pain in Child Health consortium

Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur

Pain in Child Health (PICH) is a transdisciplinary, international research training consortium. P... more Pain in Child Health (PICH) is a transdisciplinary, international research training consortium. PICH has been funded since 2002 as a Strategic Training Initiative in Health Research of the Canadian Institutes of Health Research, with contributions from other funding partners and the founding participation of five Canadian universities. The goal of PICH has been to create a community of scholars in pediatric pain to improve child health outcomes. Quantitative analyses enumerated PICH faculty, trainees, training activities and scientific outputs. Interviews with PICH stakeholders were analyzed using qualitative methods capturing perceptions of the program's strengths, limitations, and opportunities for development and sustainability. PICH has supported 218 trainee members from 2002 through 2013, from 14 countries and more than 16 disciplines. The faculty at the end of 2013 comprised nine co-principal investigators, 14 Canadian coinvestigators, and 28 Canadian and international col...

Research paper thumbnail of The Postoperative Pain Assessment Skills pilot trial

Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur

BACKGROUND⁄ Pain-related misbeliefs among health care professionals (HCPs) are common and contrib... more BACKGROUND⁄ Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs' assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method - deteriorating patient-based simulation (DPS) - versus SPs for improving HCPs' pain knowledge and assessment skills. Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs' pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the P...

Research paper thumbnail of SP4 Efficacy across three simulation models used to teach nursing students complex cardiac pain management: a RCT

European Journal of Cardiovascular Nursing, 2009

Research paper thumbnail of Developing a standardized approach to the assessment of pain in children and youth presenting to pediatric rheumatology providers: a Delphi survey and consensus conference process followed by feasibility testing

Pediatric Rheumatology, 2012

Research paper thumbnail of Using an electronic pain diary to better understand pain in children and adolescents with arthritis

Research paper thumbnail of Review: Psychological interventions reduce the severity and frequency of chronic pain in children and adolescents

Research paper thumbnail of Quality and quantity of friendships, peer relationships, and teacher relationships in children with chronic pain: A systematic review

Research paper thumbnail of An Interfaculty Pain Curriculum: Lessons learned from six years experience

Research paper thumbnail of A systematic review of the effect of waiting for treatment for chronic pain

Research paper thumbnail of Overcoming Barriers to the Sexual Expression of Women With Developmental Disabilities

Research and Practice for Persons with Severe Disabilities, 2002

Research paper thumbnail of Reliability and validity of the Child Pain Anxiety Symptoms Scale (CPASS) in a clinical sample of children and adolescents with acute postsurgical pain

Pain, 2011

Pain anxiety refers to the cognitive, emotional, physiological, and behavioural reactions to the ... more Pain anxiety refers to the cognitive, emotional, physiological, and behavioural reactions to the experience or anticipation of pain. The Child Pain Anxiety Symptoms Scale (CPASS) has recently been developed and validated in a pediatric community sample. The goal of the present study was to examine the psychometric properties of the CPASS in a sample of children and adolescents with acute

Research paper thumbnail of People Tell Me I Can't Have Sex

Women & Therapy, 2003

Much of the information “known” about the personal beliefs and experiences of women with developm... more Much of the information “known” about the personal beliefs and experiences of women with developmental disabilities, their needs, desires, and sexual practices, have been gleaned from second-hand accounts and speculation. Utilizing direct interviews, this study was designed to assess women's level of knowledge, their access to resources and their feelings of control over choices concerning their bodies. Further, this study sought to examine the impact that disability has on sexuality from the women who experience it. Implications for future research are discussed.

Research paper thumbnail of Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis

Rheumatology, 2011

To determine and compare the prevalence of disturbed sleep in JIA and JDM and the relationship of... more To determine and compare the prevalence of disturbed sleep in JIA and JDM and the relationship of sleep disturbance to pain, function, disease activity and medications. One hundred fifty-five patients (115 JIA, 40 JDM) were randomly sampled and were mailed questionnaires. Sleep disturbance was assessed by the sleep self-report (SSR) and the children's sleep habits questionnaire (CSHQ). Fatigue, pain and function were assessed by the paediatric quality of life inventory (PedsQL) and disease activity by visual analogue scales (VASs). Joint counts were self-reported. Eighty-one per cent responded, of whom 44% reported disturbed sleep (CSHQ > 41); there were no differences between disease groups. Poor reported sleep (SSR) was highly correlated with PedsQL fatigue (r = 0.56, P < 0.0001). Fatigue was highly negatively correlated with quality of life (r = -0.77, P < 0.0001). The worst pain intensity in the last week was correlated to sleep disturbance (r = 0.32, P = 0.0005). Fatigue was associated with prednisone and DMARD use. Sleep disturbance and fatigue are prevalent among children with different rheumatic diseases. Sleep disturbance and fatigue are strongly associated with increased pain and decreased quality of life. Strategies aimed at improving sleep and reducing fatigue should be studied as possible ways of improving quality of life for children with rheumatic illness.

Research paper thumbnail of Measurement Properties of Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatrics: A Systematic Review

Research paper thumbnail of Construct validity of a multidimensional electronic pain diary for adolescents with arthritis

PAIN, 2008

The aim of this study was to evaluate the construct validity and feasibility of a multidimensiona... more The aim of this study was to evaluate the construct validity and feasibility of a multidimensional electronic pain diary (e-Ouch(c)) 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 2weeks using the e-Ouch(c). In Study 2, 36 adolescents recorded their pain three times a day for 1week before and 2weeks after joint injections. Adolescents in both studies completed multiple measures to determine the construct validity and feasibility of the e-Ouch(c). Adolescents reported mild levels of pain intensity, unpleasantness, and interference as well as stiffness, and mild to moderate levels of fatigue. e-Ouch(c) 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(c) 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(c) electronic diary in adolescents with JIA. Use of real-time data capture approaches should be considered in future studies of chronic arthritis.

Research paper thumbnail of Nerve resection and re-location may relieve causalgia: A case report

Pain, 2007

This article reports the relief of severe causalgia of the right infra-orbital nerve by nerve sec... more This article reports the relief of severe causalgia of the right infra-orbital nerve by nerve section and re-location in a 14-year-old boy who had worsening neuropathic pain (NP) and was housebound and refractory to all analgesics for 14 months. His infra-orbital nerve was sectioned and re-located into his buccal fat pad. Severe steady burning, electric shock-like pain and allodynia disappeared and he was able to return to school and an increasingly normal life at one year post-operatively and is pain-free at 3 years and 6 months of follow-up. With NP further deafferentation can cause a worsening of the pain or anaesthesia dolorosa. In this instance there was dramatic and then sequential, gradual and complete resolution of all components of this particular form of NP. Therefore, in selected patients with causalgia this nerve re-location technique may help in symptom resolution and improve quality of life.

Research paper thumbnail of Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents

Research paper thumbnail of Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes

PAIN®, 2014

Hospitalized children frequently receive inadequate pain assessment and management despite substa... more Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6 months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (P<0.001) and had a greater proportion of patients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/10) and severe (7-10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes.

Research paper thumbnail of An integrated undergraduate pain curriculum, based on IASP curricula, for six Health Science Faculties

Research paper thumbnail of Commentary: The Journal of Pediatric Psychology Should Adopt the CONSORT Statement as a Way of Improving the Evidence Base in Pediatric Psychology

Journal of Pediatric Psychology, 2003