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: PURPOSE We determined if a difference in pain management occurred when topical anesthetics LMX ( formerly ELA-Max , lidocaine 4 % ) and EMLA ( lidocaine 2.5 % and prilocaine 2.5 % ) were compared in boys undergoing office meatotomy for symptomatic meatal stenosis . MATERIAL S AND METHODS A prospect i ve r and omized study was performed on 52 boys who underwent office meatotomy by a single pediatric urologist . Of the boys 26 , 2 to 9 years old ( mean age 4.4 ) underwent meatotomy 45 minutes after topical anesthetic application ( LMX 13 , EMLA 13 ) between February and December 2001 , 26 , ages 1 to 10 years old ( 4.6 ) underwent meatotomy 30 minutes after topical anesthetic application ( LMX 13 , EMLA 13 ) between April 2002 and January 2003 . A single pediatric urological nurse performed pain assessment using the Wong-Baker Faces scale before applying the anesthetic ointment and immediately following the procedure . Each child had either LMX or EMLA applied and covered with an occlusive dressing for either 45 or 30 minutes before the procedure . Oral acetaminophen ( 10 mg/kg ) was given at the time of anesthetic application . A meatotomy was then performed using a straight crushing hemostat for 1 to 2 minutes followed by incision . Mann-Whitney rank sum test was implemented to determine statistical significance . RESULTS Excellent procedure outcomes were experienced by all patients without recurrent meatal stenosis . CONCLUSIONS There was no significant difference between LMX and EMLA when applied 45 minutes before meatotomy . When applied 30 minutes before meatotomy LMX provided significantly superior pain management than EMLA Objective : To examine if observational pain assessment can be used for purpose s of triage in children aged > 3 years . Methods : A prospect i ve , single blind , controlled trial was undertaken in children who presented to the emergency department ( ED ) with pain .  Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score ( AHTPS ) , an observational tool design ed for triage , and a self-report tool , either the Wong-Baker Faces Pain Rating Scale ( WBS ) for 3–7-year-old children or a visual analogue scale ( VAS ) for 8–15-year-old children . Scores were compared by instrument ( observational and self-report ) and ED location ( waiting room and triage room ) . Results : 75 children ( 29 aged 3–7 years and 46 aged 8–15 years ) were enrolled in the study . The AHTPS scores were significantly lower than the scores measured by the WBS/VAS ( p<0.001 ) . The level of pain measured by both methods ( self-report , observational ) was lower in the triage room . Compared with the AHTPS , the WBS and VAS scored significantly lower in the triage room than in the waiting room ( p<0.042 and p<0.006 , respectively ) . Conclusions : Observational pain assessment underestimates children ’s perception of pain and should not be recommended in children aged > 3 years . Triage has a calming effect on children Background To determine whether healthcare professionals perceive the pain of infants differently due to their underst and ing of that infant 's level of risk for neurological impairment . Method Neonatal Intensive Care Units ( NICU 's ) at two tertiary pediatric centers . Ninety-five healthcare professionals who practice in the NICU ( 50 nurses , 19 physicians , 17 respiratory therapists , 9 other ) participated . They rated the pain ( 0–10 scale and 0–6 Faces Pain Scale ) , distress ( 0–10 ) ,  effectiveness of cuddling to relieve pain  ( 0–10 ) and  time to calm without intervention  ( seconds ) for nine video clips of neonates receiving a heel stick . Prior to each rating , they were provided with descriptions that suggested the infant had mild , moderate or severe risk for neurological impairment . Ratings were examined as a function of the level of risk described . Results Professionals ' ratings of pain , distress , and time to calm did not vary significantly with level of risk , but ratings of the effectiveness of cuddling were significantly lower as risk increased [ F ( 2,93 ) = 4.4 , p = .02 ] . No differences in ratings were found due to participants ' age , gender or site of study . Physicians ' ratings were significantly lower than nurses ' across ratings . Conclusion Professionals provided with visual information regarding an infants ' pain during a procedure did not display the belief that infants ' level of risk for neurological impairment affected their pain experience . Professionals ' estimates of the effectiveness of a nonpharmacological intervention did differ due to level of risk Conclusion . Mepivacaine applied in the epipharyngeal space as an adjuvant local anaesthetic does not reduce postoperative pain after adenoidectomy in children given high-dose paracetamol preoperatively . Objective . To evaluate the pain-reducing effect of an adjuvant local anaesthetic ( mepivacaine ) applied in the epipharyngeal space after outpatient adenoidectomy . Material and methods . This was a prospect i ve , r and omized , double-blind , placebo-controlled trial . Postoperative pain was assessed in 98 children aged 3–10 years using a  visual analogue scale ( VAS ) and the Wong – Baker FACES pain rating scale . The time between the end of surgery and discharge from hospital was recorded , as well as the need for extra pain medication in addition to the high-dose paracetamol ( acetaminophen ) that had been given preoperatively . Serum levels of mepivacaine  were analysed in 10 consecutive patients . Results . No difference was seen between the mepivacaine and control groups regarding postoperative pain as estimated using either the VAS or the Wong – Baker FACES pain rating scale . There were also no differences between the groups concerning the time to discharge from hospital and the need for extra pain medication before discharge . No mepivacaine  could be detected in the patients ’ sera Background : Nausea , vomiting and pain are common complications after  strabismus surgery in children .  Diclofenac , a non‐steroid anti‐inflammatory drug , is widely used to treat acute and chronic pain but there are few reports of its use given rectally in children undergoing strabismus surgery . This open r and omised study was design ed to investigate the analgesic and anti‐emetic properties of rectally administered diclofenac compared with opioid ( morphine ) given i.v . in connection with strabismus surgery in children BACKGROUND AND AIMS The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia . We aim ed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination , as compared to usual care , in 4- to 12-year-old children . METHODS In all , 239 children were enrolled by 25 family practitioners in an open-label study . After a pseudo-r and omization , usual pain management ( n = 132 ) was compared to a multifactorial strategy ( n = 107 ) associating preliminary application of an anesthesic patch , preferential use of specified vaccines , child education by the parents and the doctor , parental accompaniment and child distraction with soap bubbles during the procedure . The primary outcome ( i.e. child pain ) was assessed with a self-report scale named visual analog scale ( VAS ) of pain . RESULTS A significant decrease in pain was obtained using the multifactorial strategy , as assessed by self-reported VAS ( P < 0.0001 ) . This was confirmed by another self-report scale ( the facial pain scale revised : P = 0.005 ) , as well as with hetero-evaluations by GPs and parents [ Children 's Hospital of Eastern Ontario Pain Scale : P = 0.0007 ; GPs VAS ( P < 0.0001 ) , parents VAS ( P < 0.0001 ) ] , which were secondary outcome criteria . CONCLUSIONS This multifactorial method significantly decreases vaccination pain in 4- to 12-year-old children . This strategy could make vaccines more acceptable to children and may improve child-doctor relationships and contribute to a decrease in child fear about health care Background . Lidocaine – prilocaine cream ( EMLA ) is currently st and ard therapy to alleviate procedural pain in children . One of the disadvantages of lidocaine – prilocaine is the need to wait for 60 minutes for adequate skin anesthesia . Amethocaine gel ( Ametop ) is a new topical anesthetic that requires a shorter application time for skin anesthesia . Objectives . To compare the relative efficacy and safety of amethocaine gel and lidocaine – prilocaine cream in children with cancer undergoing Port-a-Cath puncture and to determine which patient factors influence judgments about pain . Methods . R and omized , blinded , crossover study . Each child received either 1 g of amethocaine gel for 30 minutes , preceded by a placebo gel for 30 minutes , or 1 g of lidocaine – prilocaine cream for 60 minutes . Children rated the pain using the faces scale , for which scores ranged from 0 to 5 . Parents and attending nurse operators rated pain on a 10-cm visual analog scale . Results . Thirty-nine children participated . The mean age was 10.2 years ( range : 5–16 years ) , and 69 % were male . There were no differences in mean pain assessment s between amethocaine and lidocaine – prilocaine as rated by the children ( 2.0 vs 0.5 ) , parents ( 2.6 vs 6.4 ) , or nurse operators ( 2.0 vs 0.9 ) . No serious adverse effects were detected with either preparation . Pain scores assigned by parents and children were not influenced by age , gender , duration of diagnosis , or anesthetic regimen ( amethocaine versus lidocaine – prilocaine ) in the child . Nurses , however , rated pain higher for younger children , and in males during pretreatment with lidocaine – prilocaine . Conclusion . Amethocaine achieves similar anesthesia to lidocaine – prilocaine during Port-a-Cath administration in children , with an application time that is half of lidocaine – prilocaine .  Pain assessment s were not influenced by age , gender , or duration of diagnosis of the child . Nurses may perceive that pain is greater for younger children and in males . lidocaine – prilocaine , amethocaine , pain , children , Port-a-Cath puncture Objective : Acute otitis media ( AOM ) is common in children , yet the optimal management of ear pain associated with AOM has not been well studied . We set out to determine the efficacy of topical aqueous 2 % lignocaine eardrops compared with a placebo ( saline ) for pain relief of AOM in children . Design : Double-blind , r and omised , placebo-controlled trial . Setting : Tertiary children ’s hospital emergency department . Patients and interventions : Children aged between 3 and 17 years with earache and AOM without evidence of perforation were eligible . Patients were r and omised to receive either 2 % lignocaine or saline eardrops ( placebo ) . Main outcome measures : Pain scores were measured before and after ear-drop administration . Patient and physician-interpreted pain scores were measured by using the Bieri faces pain scale and visual analogue scale at 10 , 20 and 30 minutes . The primary outcome measure was reduction in patient-measured pain scores by 50 % from the baseline . Secondary outcome measures were reduction in patient- measured pain scores by 25 % or by at least two points . Telephone follow-up occurred after 1 day and 1 week . Analysis was by intention to treat . Results : 63 children ( 31 were treated with lignocaine , 32 with placebo ) aged 3 to 12 years were enrolled . The groups were demographically and clinical ly similar , with similar proportions having received analgesia in the preceding 4 hours . Children receiving lignocaine showed significantly lower patient-measured pain scores with a reduction by 50 % from baseline at 10 minutes ( RR 2.06 , 95 % CI 1.03–4.11 , p = 0.03 ) and 30 minutes ( RR 1.44 , 95 % CI 1.07–1.93 , p = 0.009 ) but not at 20 minutes ( RR 1.35 95 % CI 0.88–2.06 ) . The response to lignocaine treatment showed significantly lower patient-measured pain scores for 25 % reduction at all time points and for two-point reduction at 10 minutes and favoured lignocaine at 20 minutes and 30 minutes without reaching statistical significance . There were no serious adverse events during the 30 minute follow-up period . Conclusion : This study suggests that topical aqueous 2 % lignocaine eardrops provide rapid relief for many young children presenting with ear pain attributed to AOM . The concurrent use of simple oral analgesia is a likely contributor to effective management of this painful childhood condition 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 
    Output:
    
agent
All 4 faces pain scales were found to be adequately supported by psychometric data .
When given a choice between faces scales , children preferred the WBFPRS .
Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS .
: For clinical use , we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use .
***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: PURPOSE We determined if a difference in pain management occurred when topical anesthetics LMX ( formerly ELA-Max , lidocaine 4 % ) and EMLA ( lidocaine 2.5 % and prilocaine 2.5 % ) were compared in boys undergoing office meatotomy for symptomatic meatal stenosis . MATERIAL S AND METHODS A prospect i ve r and omized study was performed on 52 boys who underwent office meatotomy by a single pediatric urologist . Of the boys 26 , 2 to 9 years old ( mean age 4.4 ) underwent meatotomy 45 minutes after topical anesthetic application ( LMX 13 , EMLA 13 ) between February and December 2001 , 26 , ages 1 to 10 years old ( 4.6 ) underwent meatotomy 30 minutes after topical anesthetic application ( LMX 13 , EMLA 13 ) between April 2002 and January 2003 . A single pediatric urological nurse performed pain assessment using the Wong-Baker Faces scale before applying the anesthetic ointment and immediately following the procedure . Each child had either LMX or EMLA applied and covered with an occlusive dressing for either 45 or 30 minutes before the procedure . Oral acetaminophen ( 10 mg/kg ) was given at the time of anesthetic application . A meatotomy was then performed using a straight crushing hemostat for 1 to 2 minutes followed by incision . Mann-Whitney rank sum test was implemented to determine statistical significance . RESULTS Excellent procedure outcomes were experienced by all patients without recurrent meatal stenosis . CONCLUSIONS There was no significant difference between LMX and EMLA when applied 45 minutes before meatotomy . When applied 30 minutes before meatotomy LMX provided significantly superior pain management than EMLA Objective : To examine if observational pain assessment can be used for purpose s of triage in children aged > 3 years . Methods : A prospect i ve , single blind , controlled trial was undertaken in children who presented to the emergency department ( ED ) with pain .  Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score ( AHTPS ) , an observational tool design ed for triage , and a self-report tool , either the Wong-Baker Faces Pain Rating Scale ( WBS ) for 3–7-year-old children or a visual analogue scale ( VAS ) for 8–15-year-old children . Scores were compared by instrument ( observational and self-report ) and ED location ( waiting room and triage room ) . Results : 75 children ( 29 aged 3–7 years and 46 aged 8–15 years ) were enrolled in the study . The AHTPS scores were significantly lower than the scores measured by the WBS/VAS ( p<0.001 ) . The level of pain measured by both methods ( self-report , observational ) was lower in the triage room . Compared with the AHTPS , the WBS and VAS scored significantly lower in the triage room than in the waiting room ( p<0.042 and p<0.006 , respectively ) . Conclusions : Observational pain assessment underestimates children ’s perception of pain and should not be recommended in children aged > 3 years . Triage has a calming effect on children Background To determine whether healthcare professionals perceive the pain of infants differently due to their underst and ing of that infant 's level of risk for neurological impairment . Method Neonatal Intensive Care Units ( NICU 's ) at two tertiary pediatric centers . Ninety-five healthcare professionals who practice in the NICU ( 50 nurses , 19 physicians , 17 respiratory therapists , 9 other ) participated . They rated the pain ( 0–10 scale and 0–6 Faces Pain Scale ) , distress ( 0–10 ) ,  effectiveness of cuddling to relieve pain  ( 0–10 ) and  time to calm without intervention  ( seconds ) for nine video clips of neonates receiving a heel stick . Prior to each rating , they were provided with descriptions that suggested the infant had mild , moderate or severe risk for neurological impairment . Ratings were examined as a function of the level of risk described . Results Professionals ' ratings of pain , distress , and time to calm did not vary significantly with level of risk , but ratings of the effectiveness of cuddling were significantly lower as risk increased [ F ( 2,93 ) = 4.4 , p = .02 ] . No differences in ratings were found due to participants ' age , gender or site of study . Physicians ' ratings were significantly lower than nurses ' across ratings . Conclusion Professionals provided with visual information regarding an infants ' pain during a procedure did not display the belief that infants ' level of risk for neurological impairment affected their pain experience . Professionals ' estimates of the effectiveness of a nonpharmacological intervention did differ due to level of risk Conclusion . Mepivacaine applied in the epipharyngeal space as an adjuvant local anaesthetic does not reduce postoperative pain after adenoidectomy in children given high-dose paracetamol preoperatively . Objective . To evaluate the pain-reducing effect of an adjuvant local anaesthetic ( mepivacaine ) applied in the epipharyngeal space after outpatient adenoidectomy . Material and methods . This was a prospect i ve , r and omized , double-blind , placebo-controlled trial . Postoperative pain was assessed in 98 children aged 3–10 years using a  visual analogue scale ( VAS ) and the Wong – Baker FACES pain rating scale . The time between the end of surgery and discharge from hospital was recorded , as well as the need for extra pain medication in addition to the high-dose paracetamol ( acetaminophen ) that had been given preoperatively . Serum levels of mepivacaine  were analysed in 10 consecutive patients . Results . No difference was seen between the mepivacaine and control groups regarding postoperative pain as estimated using either the VAS or the Wong – Baker FACES pain rating scale . There were also no differences between the groups concerning the time to discharge from hospital and the need for extra pain medication before discharge . No mepivacaine  could be detected in the patients ’ sera Background : Nausea , vomiting and pain are common complications after  strabismus surgery in children .  Diclofenac , a non‐steroid anti‐inflammatory drug , is widely used to treat acute and chronic pain but there are few reports of its use given rectally in children undergoing strabismus surgery . This open r and omised study was design ed to investigate the analgesic and anti‐emetic properties of rectally administered diclofenac compared with opioid ( morphine ) given i.v . in connection with strabismus surgery in children BACKGROUND AND AIMS The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia . We aim ed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination , as compared to usual care , in 4- to 12-year-old children . METHODS In all , 239 children were enrolled by 25 family practitioners in an open-label study . After a pseudo-r and omization , usual pain management ( n = 132 ) was compared to a multifactorial strategy ( n = 107 ) associating preliminary application of an anesthesic patch , preferential use of specified vaccines , child education by the parents and the doctor , parental accompaniment and child distraction with soap bubbles during the procedure . The primary outcome ( i.e. child pain ) was assessed with a self-report scale named visual analog scale ( VAS ) of pain . RESULTS A significant decrease in pain was obtained using the multifactorial strategy , as assessed by self-reported VAS ( P < 0.0001 ) . This was confirmed by another self-report scale ( the facial pain scale revised : P = 0.005 ) , as well as with hetero-evaluations by GPs and parents [ Children 's Hospital of Eastern Ontario Pain Scale : P = 0.0007 ; GPs VAS ( P < 0.0001 ) , parents VAS ( P < 0.0001 ) ] , which were secondary outcome criteria . CONCLUSIONS This multifactorial method significantly decreases vaccination pain in 4- to 12-year-old children . This strategy could make vaccines more acceptable to children and may improve child-doctor relationships and contribute to a decrease in child fear about health care Background . Lidocaine – prilocaine cream ( EMLA ) is currently st and ard therapy to alleviate procedural pain in children . One of the disadvantages of lidocaine – prilocaine is the need to wait for 60 minutes for adequate skin anesthesia . Amethocaine gel ( Ametop ) is a new topical anesthetic that requires a shorter application time for skin anesthesia . Objectives . To compare the relative efficacy and safety of amethocaine gel and lidocaine – prilocaine cream in children with cancer undergoing Port-a-Cath puncture and to determine which patient factors influence judgments about pain . Methods . R and omized , blinded , crossover study . Each child received either 1 g of amethocaine gel for 30 minutes , preceded by a placebo gel for 30 minutes , or 1 g of lidocaine – prilocaine cream for 60 minutes . Children rated the pain using the faces scale , for which scores ranged from 0 to 5 . Parents and attending nurse operators rated pain on a 10-cm visual analog scale . Results . Thirty-nine children participated . The mean age was 10.2 years ( range : 5–16 years ) , and 69 % were male . There were no differences in mean pain assessment s between amethocaine and lidocaine – prilocaine as rated by the children ( 2.0 vs 0.5 ) , parents ( 2.6 vs 6.4 ) , or nurse operators ( 2.0 vs 0.9 ) . No serious adverse effects were detected with either preparation . Pain scores assigned by parents and children were not influenced by age , gender , duration of diagnosis , or anesthetic regimen ( amethocaine versus lidocaine – prilocaine ) in the child . Nurses , however , rated pain higher for younger children , and in males during pretreatment with lidocaine – prilocaine . Conclusion . Amethocaine achieves similar anesthesia to lidocaine – prilocaine during Port-a-Cath administration in children , with an application time that is half of lidocaine – prilocaine .  Pain assessment s were not influenced by age , gender , or duration of diagnosis of the child . Nurses may perceive that pain is greater for younger children and in males . lidocaine – prilocaine , amethocaine , pain , children , Port-a-Cath puncture Objective : Acute otitis media ( AOM ) is common in children , yet the optimal management of ear pain associated with AOM has not been well studied . We set out to determine the efficacy of topical aqueous 2 % lignocaine eardrops compared with a placebo ( saline ) for pain relief of AOM in children . Design : Double-blind , r and omised , placebo-controlled trial . Setting : Tertiary children ’s hospital emergency department . Patients and interventions : Children aged between 3 and 17 years with earache and AOM without evidence of perforation were eligible . Patients were r and omised to receive either 2 % lignocaine or saline eardrops ( placebo ) . Main outcome measures : Pain scores were measured before and after ear-drop administration . Patient and physician-interpreted pain scores were measured by using the Bieri faces pain scale and visual analogue scale at 10 , 20 and 30 minutes . The primary outcome measure was reduction in patient-measured pain scores by 50 % from the baseline . Secondary outcome measures were reduction in patient- measured pain scores by 25 % or by at least two points . Telephone follow-up occurred after 1 day and 1 week . Analysis was by intention to treat . Results : 63 children ( 31 were treated with lignocaine , 32 with placebo ) aged 3 to 12 years were enrolled . The groups were demographically and clinical ly similar , with similar proportions having received analgesia in the preceding 4 hours . Children receiving lignocaine showed significantly lower patient-measured pain scores with a reduction by 50 % from baseline at 10 minutes ( RR 2.06 , 95 % CI 1.03–4.11 , p = 0.03 ) and 30 minutes ( RR 1.44 , 95 % CI 1.07–1.93 , p = 0.009 ) but not at 20 minutes ( RR 1.35 95 % CI 0.88–2.06 ) . The response to lignocaine treatment showed significantly lower patient-measured pain scores for 25 % reduction at all time points and for two-point reduction at 10 minutes and favoured lignocaine at 20 minutes and 30 minutes without reaching statistical significance . There were no serious adverse events during the 30 minute follow-up period . Conclusion : This study suggests that topical aqueous 2 % lignocaine eardrops provide rapid relief for many young children presenting with ear pain attributed to AOM . The concurrent use of simple oral analgesia is a likely contributor to effective management of this painful childhood condition 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 
    Output:
    