Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain.

A prospective controlled trial was conducted to compare the efficacy of an analgesic cream (eutectic mixture of local anesthetics, or EMLA) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients (age 6-16 years). The study also explored whether young patients can be taught and can use hypnosis independently as well as whether the therapeutic benefit depends on hypnotizability. Patients were randomized to 1 of 3 groups: local anesthetic, local anesthetic plus hypnosis, and local anesthetic plus attention. Results confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety and that they were rated as demonstrating less behavioral distress during the procedure. The level of hypnotizability was significantly associated with the magnitude of treatment benefit, and this benefit was maintained when patients used hypnosis independently.     

Multi-criteria evaluation of climate policy interactions

The effectiveness of a national climate policy instrument is affected by the presence of policy interactions with other instruments that were not forecasted before its implementation. The problem can be confronted during the design of the instrument by determining forms, types and size of emerging interactions. This paper presents a systematic approach for evaluating the aggregate effect of interactions using a combination of three multi-criteria methods, the analytical hierarchy process, the multi-attribute utility theory and the Simple Multi-Attribute Ranking Technique. The first is used for determining the weight coefficients for interaction forms and sub-criteria. The other two are used for grading policy interactions under a set of three criteria and their sub-criteria. The method is tested for two pairs of interactive instruments, IPPC and EU-ETS, EU-ETS and policies for the promotion of RES, within the Hellenic climate policy framework. Consistency and robustness tests are performed. Results are commented. Copyright © 2007 John Wiley & Sons, Ltd.