human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The COSMIN checklist is a tool for evaluating the method ological quality of studies on measurement properties of health-related patient-reported outcomes . The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist ( n = 114 ) . Methods 75 articles evaluating measurement properties were r and omly selected from the bibliographic data base compiled by the Patient-Reported Outcome Measurement Group , Oxford , UK . Raters were asked to assess the method ological quality of three articles , using the COSMIN checklist . In a one-way design , percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item . Results 88 raters participated . Of the 75 selected articles , 26 articles were rated by four to six participants , and 49 by two or three participants . Overall , percentage agreement was appropriate ( 68 % was above 80 % agreement ) , and the kappa coefficients for the COSMIN items were low ( 61 % was below 0.40 , 6 % was above 0.75 ) . Reasons for low inter-rater agreement were need for subjective judgement , and accustom to different st and ards , terminology and definitions . Conclusions Results indicated that raters often choose the same response option , but that it is difficult on item level to distinguish between articles . When using the COSMIN checklist in a systematic review , we recommend getting some training and experience , completing it by two independent raters , and reaching consensus on one final rating . Instructions for using the checklist are improved The present study cross-vali date d self-report pain scales : Verbal Rating Scale ( VRS  ) ,  Facial Expression Scale ( FACES  ) ,  Color Analogue Scale ( CAS ) and Poker Chip Tool ( PCT ) in Thai children aged 5 - 12 years . The concordance with observational measure , Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) was also tested . Among 100 students , test-retest reliability of all self-report measures was moderate to good ( K = 0.501 - 0.712 ) and only FACES yielded acceptable face validity(IC > 0.5 ) . Validation in 87 patients , all scales showed construct and concurrent validity . FACES was the most preferred scale . Agreement of self-report measures and CHEOPS was better in the age group 5 - 8 years ( K = 0.417 - 0.826 ) than 9 - 12 years ( K = 0.231 - 0.529 ) . In conclusion , FACES is a valid , reliable and practical tool . Self-report measures are more in concordance with CHEOPS in the younger age group OBJECTIVE To determine the construct , content , and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department ( ED ) . METHODS A prospect i ve study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained . Children were excluded if they were intoxicated , had altered sensorium , were clinical ly unstable , did not speak English , or had developmental delays . Children marked their current pain severity on a st and ardized Color Analog Scale ( CAS ) and a 7-point Faces Pain Scale ( FPS ) . They were then asked whether their pain was mild , moderate , or severe . Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements . For assessing content validity , the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions . Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales . RESULTS A total of 60 children were enrolled , 30 with pain and 30 without , with a mean age of 9.3 + /- 3.3 years . Boys accounted for 38 of the enrollees ( 63.3 % ) . The median score before analgesic administration was 6.0 cm ( interquartile range [ IQR ] : 4.0 - 8.0 ) on the CAS and 3.0 faces ( IQR : 2.0 - 5.0 ) on the FPS ; after analgesic administration , the median scores decreased to 3.1 cm ( IQR : 1.1 - 4.3 ) and 2.0 faces ( IQR : 1.0 - 3.0 ) , respectively . As the reported pain intensity increased , so did the scores on the 2 pain scales . The 30 children with no pain had a median score on the CAS of 0.0 ( IQR : 0.0 - 1.0 ) and on the FPS of 0.0 ( IQR : 0.0 - 1.0 ) , whereas the 13 children with severe pain had a median CAS of 7.0 ( IQR : 6.0 - 8.0 ) and a median FPS of 5.0 ( IQR : 4.0 - 6.0 ) . The Spearman correlation coefficient between the CAS and the FPS was positive and strong ( r = 0.894 ) . CONCLUSION The CAS and the FPS exhibit construct , content , and convergent validity in the measurement of acute pain in children in the ED Objective To evaluate the psychometric properties of 4 measures of acute pain in youth with sickle cell disease ( SCD ) during a medical procedure . Methods Heart rate , child self-report , parent proxy-report , and observable pain behaviors were examined in 48 youth with SCD ages 2 to 17 years . Criterion validity for acute pain was assessed by responsiveness to a st and ardized painful stimulus ( venipuncture ) in a prospect i ve pre-post design . Convergent validity was evaluated through the correlation across measures in reactivity to the stimulus . Results Child self-reported pain , parent proxy-report , and behavioral distress scores increased in response to venipuncture ( concurrent and convergent validity ) . In contrast , heart rate did not reliably change in response to venipuncture . Extent of change in response to venipuncture showed moderate intercorrelation across child and parent pain ratings , and behavioral distress . Preprocedure pain ratings correlated with pain experienced during the procedure . An item analysis of observable pain behaviors suggested differences in the presentation of pain in SCD compared with previous pediatric research . Conclusions Criterion and convergent validity were demonstrated for child-report , parent-report , and observable pain behaviors . These measures seem to tap into distinct , yet overlapping aspects of the pain experience . Assessment of acute procedural pain responses in SCD requires evaluation of preprocedural pain due to the frequent presence of low-level , baseline pain There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children . Most preschool-aged children also lack the necessary cognitive development to use st and ard scales . We aim ed to evaluate the validity and feasibility of 2 novel simplified scales ( Simplified Faces Pain Scale , S-FPS ; Simplified Concrete Ordinal Scale , S-COS ) for preschool-aged children . These simplified scales used a 2-step self-report method : children were first asked whether they have pain ( yes/no ) ; only if yes , then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe . We recruited 180 3- to 6-year-old children undergoing routine blood collection . Each child was r and omly assigned 2 of 3 scales-S-FPS , S-COS , Faces Pain Scale-Revised (FPS-R)-to self-report pain before venipuncture , immediately after , and 5 minutes later , using both scales at each time-point . Pain was also assessed using observation ( Face Legs Activity Cry Consolability ) at each time point . The ability to discriminate pain from no pain was improved with S-FPS and S-COS , compared with the FPS-R , among 4-year-olds , but not 3-year-olds . Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales . The simplified scales can improve and simplify pain assessment for 4-year-olds . Quantitative pain rating remains challenging for 3-year-olds . PERSPECTIVE This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling . These scales demonstrated good validity and feasibility compared with the FPS-R , suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years BACKGROUND : Self-reported pain scores are used widely in clinical and research setting s , yet little is known about their interpretability in children . In this prospect i ve , observational study we evaluated the relationship between 0 to 10 numerical rating scale ( NRS ) pain scores and other self-reported , clinical ly meaningful outcomes , including perceived need for medicine ( PNM ) , pain relief ( PR ) , and perceived satisfaction ( PS ) with treatment in children postoperatively . METHODS : This study included children ages 7 to 16 years undergoing surgery associated with postoperative pain . One to 4 observations were recorded in each child within the first 24 hours postoperatively . At each assessment , children rated their pain with the NRS , stated their PNM , and rated their satisfaction with  pain management .  Assessment s were repeated within 1 to 2 hours , and children additionally rated their PR as the same , better , or worse in comparison with the earlier assessment . Receiver operator characteristic curves were developed to examine potential NRS cut-points for PNM and PS , and the minimum clinical ly significant difference ( MCSD ) in pain score associated with PR was calculated . RESULTS : Three hundred ninety-seven observations ( including 189 pairs ) were recorded in 113 children .  NRS scores associated with PNM were significantly higher than “ no need ” ( median 6 vs. 3 ; P < 0.001 ) . NRS scores > 4 had good sensitivity ( 0.81 ) and specificity ( 0.70 ) to discriminate PNM , but with a large number of false positives and negatives ( e.g. , 42 % of children with scores > 4 did not need analgesia ) . The MCSD in NRS scores was −1 ( 95 % confidence interval [ CI ] −0.5 to 1 ) or + 1 ( CI 0.5 to 2.7 ) in relation to feel “ a little better ” or “ worse , ” respectively ( P < 0.001 vs. the same ) . NRS scores > 6 had a sensitivity of 0.82 and specificity of 0.76 in discriminating dissatisfaction with treatment , yet 46 % and 24 % of children with scores > 6 , respectively , were somewhat to very satisfied with their analgesia . CONCLUSIONS : This study provides important information regarding the clinical interpretation of NRS pain scores in children . Data further support the NRS as a valid measure of pain intensity in relation to the child 's PNM , PR , and PS in the acute postoperative setting . However , the variability in scores in relation to other clinical ly meaningful outcomes suggests that application of cut-points for individual treatment decisions is inappropriate OBJECTIVE The purpose of this study is to quantify , using the  Color Analog Scale ( CAS ) , the degree of change in pain severity required to achieve a clinical ly significant improvement in pain . METHODS A prospect i ve descriptive study , using convenience sampling of children aged 5 and 12 years presenting to a pediatric emergency department ( ED ) with acute pain , was done . Children were asked to mark their pain severity on a previously vali date d CAS . After a pain intervention , the child was again asked to mark their pain intensity on the CAS and asked to describe the relative change in their pain . The main outcome measure was to quantify the smallest change required for the child to state that their pain was improved . RESULTS One hundred twenty-six children with a mean age of 8.6 years ( SD , 2.8 years ) were enrolled . Males accounted for 56 % . Pain was traumatic in 47.6 % and nontraumatic in 52.4 % . Of the 126 pain comparisons made , 28 children described their pain as " the same " and had a mean change in score of -0.10 cm ( 95 % confidence interval [ CI ] , -2.27 to 2.07 cm ) . Pain was judged to be a " little less " in 58 children , and the CAS score changed by a mean of -2.4 cm ( 95 % CI , -3.15 to -1.72 cm ) . In the 29 children who judged their pain to be " much less , " the CAS score decreased by a mean of -5.4 cm ( 95 % CI , -6.50 to -4.40 ) . CONCLUSION A decrease on the CAS pain scale of 2.4 cm ( 95 % CI , 2.95 - 1.92 ) is a clinical ly significant change in pain for children aged 5 to 12 years with acute pain . The CAS is a valuable tool in assessing responses to pain interventions OBJECTIVES The Wong-Baker FACES Pain Rating Scale ( WBS ) , used in children to rate pain severity , has been vali date d outside the emergency department ( ED ) , mostly for chronic pain . The authors vali date d the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale ( VAS ) for each face of the WBS and determined the relationship between the WBS and VAS . The hypothesis was that the pain severity ratings on the WBS would be highly correlated ( Spearman 's rho > 0.80 ) with those on a VAS . METHODS This was a prospect i ve , observational study of children ages 8 - 17 years with pain presenting to a suburban , academic pediatric ED . Children rated their pain severity on a six-item ordinal faces scale ( WBS ) from none to worst and a 100-mm VAS from least to most . Analysis of variance ( ANOVA ) was used to compare mean VAS scores across the six ordinal categories 
    Output:
    
agent
Based on available evidence , the NRS-11 , FPS-R , and CAS were strongly recommended for self-report of acute pain .
Only weak recommendations could be made for self-report measures for postoperative and chronic pain .
No measures were recommended for children younger than 6 years , identifying a need for further measurement refinement in this age range .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The COSMIN checklist is a tool for evaluating the method ological quality of studies on measurement properties of health-related patient-reported outcomes . The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist ( n = 114 ) . Methods 75 articles evaluating measurement properties were r and omly selected from the bibliographic data base compiled by the Patient-Reported Outcome Measurement Group , Oxford , UK . Raters were asked to assess the method ological quality of three articles , using the COSMIN checklist . In a one-way design , percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item . Results 88 raters participated . Of the 75 selected articles , 26 articles were rated by four to six participants , and 49 by two or three participants . Overall , percentage agreement was appropriate ( 68 % was above 80 % agreement ) , and the kappa coefficients for the COSMIN items were low ( 61 % was below 0.40 , 6 % was above 0.75 ) . Reasons for low inter-rater agreement were need for subjective judgement , and accustom to different st and ards , terminology and definitions . Conclusions Results indicated that raters often choose the same response option , but that it is difficult on item level to distinguish between articles . When using the COSMIN checklist in a systematic review , we recommend getting some training and experience , completing it by two independent raters , and reaching consensus on one final rating . Instructions for using the checklist are improved The present study cross-vali date d self-report pain scales : Verbal Rating Scale ( VRS  ) ,  Facial Expression Scale ( FACES  ) ,  Color Analogue Scale ( CAS ) and Poker Chip Tool ( PCT ) in Thai children aged 5 - 12 years . The concordance with observational measure , Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) was also tested . Among 100 students , test-retest reliability of all self-report measures was moderate to good ( K = 0.501 - 0.712 ) and only FACES yielded acceptable face validity(IC > 0.5 ) . Validation in 87 patients , all scales showed construct and concurrent validity . FACES was the most preferred scale . Agreement of self-report measures and CHEOPS was better in the age group 5 - 8 years ( K = 0.417 - 0.826 ) than 9 - 12 years ( K = 0.231 - 0.529 ) . In conclusion , FACES is a valid , reliable and practical tool . Self-report measures are more in concordance with CHEOPS in the younger age group OBJECTIVE To determine the construct , content , and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department ( ED ) . METHODS A prospect i ve study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained . Children were excluded if they were intoxicated , had altered sensorium , were clinical ly unstable , did not speak English , or had developmental delays . Children marked their current pain severity on a st and ardized Color Analog Scale ( CAS ) and a 7-point Faces Pain Scale ( FPS ) . They were then asked whether their pain was mild , moderate , or severe . Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements . For assessing content validity , the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions . Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales . RESULTS A total of 60 children were enrolled , 30 with pain and 30 without , with a mean age of 9.3 + /- 3.3 years . Boys accounted for 38 of the enrollees ( 63.3 % ) . The median score before analgesic administration was 6.0 cm ( interquartile range [ IQR ] : 4.0 - 8.0 ) on the CAS and 3.0 faces ( IQR : 2.0 - 5.0 ) on the FPS ; after analgesic administration , the median scores decreased to 3.1 cm ( IQR : 1.1 - 4.3 ) and 2.0 faces ( IQR : 1.0 - 3.0 ) , respectively . As the reported pain intensity increased , so did the scores on the 2 pain scales . The 30 children with no pain had a median score on the CAS of 0.0 ( IQR : 0.0 - 1.0 ) and on the FPS of 0.0 ( IQR : 0.0 - 1.0 ) , whereas the 13 children with severe pain had a median CAS of 7.0 ( IQR : 6.0 - 8.0 ) and a median FPS of 5.0 ( IQR : 4.0 - 6.0 ) . The Spearman correlation coefficient between the CAS and the FPS was positive and strong ( r = 0.894 ) . CONCLUSION The CAS and the FPS exhibit construct , content , and convergent validity in the measurement of acute pain in children in the ED Objective To evaluate the psychometric properties of 4 measures of acute pain in youth with sickle cell disease ( SCD ) during a medical procedure . Methods Heart rate , child self-report , parent proxy-report , and observable pain behaviors were examined in 48 youth with SCD ages 2 to 17 years . Criterion validity for acute pain was assessed by responsiveness to a st and ardized painful stimulus ( venipuncture ) in a prospect i ve pre-post design . Convergent validity was evaluated through the correlation across measures in reactivity to the stimulus . Results Child self-reported pain , parent proxy-report , and behavioral distress scores increased in response to venipuncture ( concurrent and convergent validity ) . In contrast , heart rate did not reliably change in response to venipuncture . Extent of change in response to venipuncture showed moderate intercorrelation across child and parent pain ratings , and behavioral distress . Preprocedure pain ratings correlated with pain experienced during the procedure . An item analysis of observable pain behaviors suggested differences in the presentation of pain in SCD compared with previous pediatric research . Conclusions Criterion and convergent validity were demonstrated for child-report , parent-report , and observable pain behaviors . These measures seem to tap into distinct , yet overlapping aspects of the pain experience . Assessment of acute procedural pain responses in SCD requires evaluation of preprocedural pain due to the frequent presence of low-level , baseline pain There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children . Most preschool-aged children also lack the necessary cognitive development to use st and ard scales . We aim ed to evaluate the validity and feasibility of 2 novel simplified scales ( Simplified Faces Pain Scale , S-FPS ; Simplified Concrete Ordinal Scale , S-COS ) for preschool-aged children . These simplified scales used a 2-step self-report method : children were first asked whether they have pain ( yes/no ) ; only if yes , then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe . We recruited 180 3- to 6-year-old children undergoing routine blood collection . Each child was r and omly assigned 2 of 3 scales-S-FPS , S-COS , Faces Pain Scale-Revised (FPS-R)-to self-report pain before venipuncture , immediately after , and 5 minutes later , using both scales at each time-point . Pain was also assessed using observation ( Face Legs Activity Cry Consolability ) at each time point . The ability to discriminate pain from no pain was improved with S-FPS and S-COS , compared with the FPS-R , among 4-year-olds , but not 3-year-olds . Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales . The simplified scales can improve and simplify pain assessment for 4-year-olds . Quantitative pain rating remains challenging for 3-year-olds . PERSPECTIVE This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling . These scales demonstrated good validity and feasibility compared with the FPS-R , suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years BACKGROUND : Self-reported pain scores are used widely in clinical and research setting s , yet little is known about their interpretability in children . In this prospect i ve , observational study we evaluated the relationship between 0 to 10 numerical rating scale ( NRS ) pain scores and other self-reported , clinical ly meaningful outcomes , including perceived need for medicine ( PNM ) , pain relief ( PR ) , and perceived satisfaction ( PS ) with treatment in children postoperatively . METHODS : This study included children ages 7 to 16 years undergoing surgery associated with postoperative pain . One to 4 observations were recorded in each child within the first 24 hours postoperatively . At each assessment , children rated their pain with the NRS , stated their PNM , and rated their satisfaction with  pain management .  Assessment s were repeated within 1 to 2 hours , and children additionally rated their PR as the same , better , or worse in comparison with the earlier assessment . Receiver operator characteristic curves were developed to examine potential NRS cut-points for PNM and PS , and the minimum clinical ly significant difference ( MCSD ) in pain score associated with PR was calculated . RESULTS : Three hundred ninety-seven observations ( including 189 pairs ) were recorded in 113 children .  NRS scores associated with PNM were significantly higher than “ no need ” ( median 6 vs. 3 ; P < 0.001 ) . NRS scores > 4 had good sensitivity ( 0.81 ) and specificity ( 0.70 ) to discriminate PNM , but with a large number of false positives and negatives ( e.g. , 42 % of children with scores > 4 did not need analgesia ) . The MCSD in NRS scores was −1 ( 95 % confidence interval [ CI ] −0.5 to 1 ) or + 1 ( CI 0.5 to 2.7 ) in relation to feel “ a little better ” or “ worse , ” respectively ( P < 0.001 vs. the same ) . NRS scores > 6 had a sensitivity of 0.82 and specificity of 0.76 in discriminating dissatisfaction with treatment , yet 46 % and 24 % of children with scores > 6 , respectively , were somewhat to very satisfied with their analgesia . CONCLUSIONS : This study provides important information regarding the clinical interpretation of NRS pain scores in children . Data further support the NRS as a valid measure of pain intensity in relation to the child 's PNM , PR , and PS in the acute postoperative setting . However , the variability in scores in relation to other clinical ly meaningful outcomes suggests that application of cut-points for individual treatment decisions is inappropriate OBJECTIVE The purpose of this study is to quantify , using the  Color Analog Scale ( CAS ) , the degree of change in pain severity required to achieve a clinical ly significant improvement in pain . METHODS A prospect i ve descriptive study , using convenience sampling of children aged 5 and 12 years presenting to a pediatric emergency department ( ED ) with acute pain , was done . Children were asked to mark their pain severity on a previously vali date d CAS . After a pain intervention , the child was again asked to mark their pain intensity on the CAS and asked to describe the relative change in their pain . The main outcome measure was to quantify the smallest change required for the child to state that their pain was improved . RESULTS One hundred twenty-six children with a mean age of 8.6 years ( SD , 2.8 years ) were enrolled . Males accounted for 56 % . Pain was traumatic in 47.6 % and nontraumatic in 52.4 % . Of the 126 pain comparisons made , 28 children described their pain as " the same " and had a mean change in score of -0.10 cm ( 95 % confidence interval [ CI ] , -2.27 to 2.07 cm ) . Pain was judged to be a " little less " in 58 children , and the CAS score changed by a mean of -2.4 cm ( 95 % CI , -3.15 to -1.72 cm ) . In the 29 children who judged their pain to be " much less , " the CAS score decreased by a mean of -5.4 cm ( 95 % CI , -6.50 to -4.40 ) . CONCLUSION A decrease on the CAS pain scale of 2.4 cm ( 95 % CI , 2.95 - 1.92 ) is a clinical ly significant change in pain for children aged 5 to 12 years with acute pain . The CAS is a valuable tool in assessing responses to pain interventions OBJECTIVES The Wong-Baker FACES Pain Rating Scale ( WBS ) , used in children to rate pain severity , has been vali date d outside the emergency department ( ED ) , mostly for chronic pain . The authors vali date d the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale ( VAS ) for each face of the WBS and determined the relationship between the WBS and VAS . The hypothesis was that the pain severity ratings on the WBS would be highly correlated ( Spearman 's rho > 0.80 ) with those on a VAS . METHODS This was a prospect i ve , observational study of children ages 8 - 17 years with pain presenting to a suburban , academic pediatric ED . Children rated their pain severity on a six-item ordinal faces scale ( WBS ) from none to worst and a 100-mm VAS from least to most . Analysis of variance ( ANOVA ) was used to compare mean VAS scores across the six ordinal categories 
    Output:
    