Assessment of Knowledge and Attitudes Regarding Acute Pediatric Pain Management Among Anesthesiologists, Pediatricians, and Pediatric Nurses: A Cross-Sectional Study from Jordan

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I enjoyed the opportunity to read and review this paper. As a pain specialist, I had to look up the original KASRP and take the test myself. I did this before reading the paper. I would point out that there are 41 responses. 37 T/F and multiple choice with each case having 2 responses. (Line 129)

I would suggest combining tables 2 and 3 since the only difference appears to be the correct response that is delineated in table 3. 

I think the conclusions are good. I do wonder about married vs single in the demographic section and would appreciate commentary on why that was chosen. 

Finally, I would caution against the use of the term "narcotic" in line 318 and would prefer the term opioid. In the US, narcotic can be considered a legal term and refer to substances of abuse.  Cocaine is classified as a narcotic in that sense so I will typically not use the term narcotic when speaking of medical opioids.

 

Comments on the Quality of English Language

I think the paper would benefit from an English editor. It's not that the English is exceptionally poor. I was able to understand what was being conveyed. However, the paper did not flow. There were some redundancies and fragmented sentences.

Eg, the first sentence in the introduction is a run-on sentence with "pain is" being a subject and verb and "it is" being a subject and verb. Needs either a period or semi-colon or conjunction, but a simple comma is not appropriate. 

Overall, I think the main issue with the paper is more to English grammar and flow rather than a methodologic problem. The science issues are minor. 

Author Response

Editor-in-Chief

Healthcare

 

Re: Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan. Manuscript ID: healthcare-3887715

 

Dear Editor and Reviewers,

My self and the co-authors are pleased to resubmit the manuscript entitled ‘Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan” to be considered for publication in Healthcare. The revised manuscript takes into consideration both the editorial and reviewers’ comments. Kindly find below a point-by-point response to those comments, along with an uploaded copy marked with MS track changes indicating changes to the manuscript.

 

 

 

 

 

 

Response to reviewer 1

Many thanks for your valuable comments and remarks, the authors will address each comment separately, and alterations will be amended in the revised manuscript accordingly:

• " I enjoyed the opportunity to read and review this paper. As a pain specialist, I had to look up the original KASRP and take the test myself. I did this before reading the paper. I would point out that there are 41 responses. 37 T/F and multiple choice with each case having 2 responses. (Line 129)." Thank you very much for your kind words.
• “I would suggest combining tables 2 and 3 since the only difference appears to be the correct response that is delineated in table 3.” Thank you very much. We have combined both tables.
• “I think the conclusions are good. I do wonder about married vs single in the demographic section and would appreciate commentary on why that was chosen.” Thank you very much for this point. We have included marital status as it may influence the working hours and subsequent exposure.
• “Finally, I would caution against the use of the term "narcotic" in line 318 and would prefer the term opioid. In the US, narcotic can be considered a legal term and refer to substances of abuse. Cocaine is classified as a narcotic in that sense so I will typically not use the term narcotic when speaking of medical opioids..” Thank you very much for your meaningful comment. We have replaced the term “narcotic” with “opioids”.
• " I think the paper would benefit from an English editor. It's not that the English is exceptionally poor. I was able to understand what was being conveyed. However, the paper did not flow. There were some redundancies and fragmented sentences. Eg, the first sentence in the introduction is a run-on sentence with "pain is" being a subject and verb and "it is" being a subject and verb. Needs either a period or semi-colon or conjunction, but a simple comma is not appropriate. Overall, I think the main issue with the paper is more to English grammar and flow rather than a methodologic problem. The science issues are minor." Thank you so much. We have performed an extensive English language editing.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Manuscript ID: healthcare-3887715

In this paper, the authors assessed the extent of knowledge of healthcare professionals about the management of acute pediatric pain. Although the topic itself is interesting, in my opinion the paper requires a few modifications.

Abstract section

The abstract covers the main aspect of the research, however,

The Methods and Results in the Abstract section require more information to give readers a better insight into this study, while the Introduction needs to be shortened. More detailed information of the KASRP questionnaire is needed in the Methods (e.g. is the questionnaire paper-based, online or interviews). General demographic information and educational data are written too extensively. It is necessary to adhere to the research objective and describe them in more detail as factors affecting the results of the KASRP questionnaire.

Some keywords need to be corrected. It is not recommended to use abbreviations in keywords. It is necessary that all keywords that are contained in the abstract and the rest of the text are listed in keywords. The word "analgesia" appears first in keywords.

Materials and Methods sections

The method is clear, however,

Line 85-87. The following sentence "Furthermore, this study aimed to assess the factors associated affecting the levels of knowledge of those healthcare providers regarding acute pain management in pediatrics." is redundant in the Material and Methods section.

It is necessary to explain how the respondents were included in the study (how they were invited to participate)?

Results sections

The results are novel for Jordan.

Table 1. What does the sign "*" after the word "Number*" in Table 1 represent? It would be more correct to write “Number (n)”.

Discussion section

The first few sentences in the Discussion section should contain the purpose of the research and the author's summary of the study that was done.

The first paragraph of the Discussion section “The most widely accepted definition of pain has been developed and refined over time by the International Association for the Study of Pain (IASP), which defines it as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” [7,16]. Pain can be classified as either acute or chronic based on its duration. Acute pain typically has a sudden onset and is shortlived, while chronic pain persists beyond the expected period of tissue healing [2]. While adults are generally able to understand and articulate their feelings and experiences, children—particularly infants and toddlers—often cannot. Therefore, accurately assessing pediatric pain requires careful observation of subtle physiological and behavioral changes associated with this unpleasant sensation [17].  Observable changes may include crying, motor responses, and alterations in facial expression, posture, appetite, activity level, and general appearance. Additionally, variations in vital signs may also be present [18]. Early intervention in response to pain is essential for ensuring pediatric well-being. Unrecognized and undertreated pain can negatively impact a child’s development, increase psychological distress (such as fear and anxiety), and potentially progress into chronic pain that persists into adulthood [2,19].” needs to be completely moved to the Introduction section.

Statistical data are written in the Results section, they are not repeated in the Discussions section. Apply this to the entire Discussion.

A discussion of the strengths of the study is missing in the Discussion section.

Conclusion section

It is preferable that the Conclusion section be a separate entity from the Discussion section. Complete sentences from the Conclusion in the Abstract are repeated in the Conclusion at the end of the Discussion section, which is not recommended and needs to be corrected. The Conclusions section needs to be improved in terms of introducing order into the writing using the analyzed variables, causes, consequences, and future benefits of this research.

References section

Technical corrections are necessary in the References section (ref. 5, 7, 29).

Comments for author File: Comments.pdf

Author Response

Editor-in-Chief

Healthcare

 

Re: Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan. Manuscript ID: healthcare-3887715

 

Dear Editor and Reviewers,

My self and the co-authors are pleased to resubmit the manuscript entitled ‘Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan” to be considered for publication in Healthcare. The revised manuscript takes into consideration both the editorial and reviewers’ comments. Kindly find below a point-by-point response to those comments, along with an uploaded copy marked with MS track changes indicating changes to the manuscript.

 

 

 

 

 

 

Response to reviewer 2

Many thanks for your valuable comments and remarks, the authors will address each comment separately, and alterations will be amended in the revised manuscript accordingly:

• " The abstract covers the main aspect of the research, however, The Methods and Results in the Abstract section require more information to give readers a better insight into this study, while the Introduction needs to be shortened. More detailed information of the KASRP questionnaire is needed in the Methods (e.g. is the questionnaire paper-based, online or interviews). General demographic information and educational data are written too extensively. It is necessary to adhere to the research objective and describe them in more detail as factors affecting the results of the KASRP questionnaire." Thank you very much for your kind words. We have modified the abstract in the revised manuscript.
• “Some keywords need to be corrected. It is not recommended to use abbreviations in keywords. It is necessary that all keywords that are contained in the abstract and the rest of the text are listed in keywords. The word "analgesia" appears first in keywords.” Thank you very much. We have modified the keywords.
• “Line 85-87. The following sentence "Furthermore, this study aimed to assess the factors associated affecting the levels of knowledge of those healthcare providers regarding acute pain management in pediatrics." is redundant in the Material and Methods section.” Thank you very much for this point. We have omitted this sentence from Methods.
• “It is necessary to explain how the respondents were included in the study (how they were invited to participate)?” Thank you very much for your meaningful comment. We have the list of all names of healthcare staff of the included specialties from hospital record. Then, the healthcare staff were visited during their break time and invited to participate.
• " The results are novel for Jordan. Table 1. What does the sign "*" after the word "Number*" in Table 1 represent? It would be more correct to write “Number (n)”." Thank you so much. * sign would indicate (at the footnote of the table) the total number of the sample which equals 137. This has been modified in the revised manuscript.
• “The first few sentences in the Discussion section should contain the purpose of the research and the author's summary of the study that was done.” Thank you so much. We have modified the first paragraph in the Discussion.
• “The first paragraph of the Discussion section “The most widely accepted definition of pain has been developed and refined over time by the International Association for the Study of Pain (IASP), which defines it as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” [7,16]. Pain can be classified as either acute or chronic based on its duration. Acute pain typically has a sudden onset and is shortlived, while chronic pain persists beyond the expected period of tissue healing [2]. While adults are generally able to understand and articulate their feelings and experiences, children—particularly infants and toddlers—often cannot. Therefore, accurately assessing pediatric pain requires careful observation of subtle physiological and behavioral changes associated with this unpleasant sensation [17]. Observable changes may include crying, motor responses, and alterations in facial expression, posture, appetite, activity level, and general appearance. Additionally, variations in vital signs may also be present [18]. Early intervention in response to pain is essential for ensuring pediatric well-being. Unrecognized and undertreated pain can negatively impact a child’s development, increase psychological distress (such as fear and anxiety), and potentially progress into chronic pain that persists into adulthood [2,19].” needs to be completely moved to the Introduction section.” Thank you so much. We have moved this paragraph completely to the Introduction section.
• “Statistical data are written in the Results section, they are not repeated in the Discussions section. Apply this to the entire Discussion.” Thank you so much. We have omitted any statistical data in the Discussion.
• “A discussion of the strengths of the study is missing in the Discussion section.” Thank you so much for your significant comment. We have elaborated more regarding the strengths of the manuscript in the revied Discussion.
• “It is preferable that the Conclusion section be a separate entity from the Discussion section. Complete sentences from the Conclusion in the Abstract are repeated in the Conclusion at the end of the Discussion section, which is not recommended and needs to be corrected. The Conclusions section needs to be improved in terms of introducing order into the writing using the analyzed variables, causes, consequences, and future benefits of this research.” Thank you so much for meaningful comment. We have modified the Conclusions in the revised manuscript.
• “Technical corrections are necessary in the References section (ref. 5, 7, 29).” Thank you so much. We have corrected the aforementioned references.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Manuscript Title: Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan s

Manuscript ID: healthcare-3887715

• The authors presented a very interesting study in the domain of “Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan s” so I recommend minor revisions before the final approval of the manuscript.

1. The authors described the study as a “quantitative descriptive cross-sectional mixed approach” but the methods clearly show only a standard cross-sectional survey. Kindly revise and correct it.
2. The authors mentioned detecting a difference of 1 with an SD of 2.75, requiring a minimum sample size of 60. However, they recruited 137 participants without recalculating for multiple groups (physicians vs. nurses vs. residents). This raises concerns regarding the statistical power for subgroup comparisons.
3. In Table 1, kindly explain the (*) at the bottom of the table.
4. In Table 4, please mention significant and non-significant criteria at the bottom of the table.
5. They reported using ANOVA for categorical versus numerical data without clarifying their assumptions. For multiple comparisons, no correction (e.g., Bonferroni correction) was applied.
6. The authors concluded that anesthesiologists had higher knowledge, probably because of training, without claims or evidence from the study.
7. Add updated studies to the literature review section.
8. Add an abbreviation section before the references.
9. The discussion section is good.

Author Response

Editor-in-Chief

Healthcare

 

Re: Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan. Manuscript ID: healthcare-3887715

 

Dear Editor and Reviewers,

My self and the co-authors are pleased to resubmit the manuscript entitled ‘Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan” to be considered for publication in Healthcare. The revised manuscript takes into consideration both the editorial and reviewers’ comments. Kindly find below a point-by-point response to those comments, along with an uploaded copy marked with MS track changes indicating changes to the manuscript.

 

 

 

 

 

 

Response to reviewer 3

Many thanks for your valuable comments and remarks, the authors will address each comment separately, and alterations will be amended in the revised manuscript accordingly:

• " The authors described the study as a “quantitative descriptive cross-sectional mixed approach” but the methods clearly show only a standard cross-sectional survey. Kindly revise and correct it." Thank you very much for your kind words. We have corrected this statement.
• “The authors mentioned detecting a difference of 1 with an SD of 2.75, requiring a minimum sample size of 60. However, they recruited 137 participants without recalculating for multiple groups (physicians vs. nurses vs. residents). This raises concerns regarding the statistical power for subgroup comparisons.” Thank you very much. We have modified statistical power equation in the statistical analysis.
• “In Table 1, kindly explain the (*) at the bottom of the table.” Thank you very much for this point. The (*) is referred to the total number of participants (137), it was added.
• “In Table 4, please mention significant and non-significant criteria at the bottom of the table.” Thank you very much for your meaningful comment. The criteria for significance was added at the end of the table.
• " They reported using ANOVA for categorical versus numerical data without clarifying their assumptions. For multiple comparisons, no correction (e.g., Bonferroni correction) was applied." Thank you so much. We have elaborated more regarding the assumptions.
• “The authors concluded that anesthesiologists had higher knowledge, probably because of training, without claims or evidence from the study..” Thank you so much. We have added an evidence from a study for this claim.
• “Add updated studies to the literature review section..” Thank you so much. We have added updated references to the study.
• “Add an abbreviation section before the references..” Thank you so much. We have added abbreviations section to the references.
• “The discussion section is good..” Thank you so much for your comment

 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the revisions. The English does indeed flow better. I would have it reviewed one last time by an English professor prior to publication as I still found a few issues:

Line 144-145 is an incomplete sentence: Changing working to work would make it complete.

Line 159: The KASRP has 22 T/F and 15 mult choice along with the 4 case responses = 41 (not 40).

Line 255:  Table 2 should be singular with the combination of the tables (Still appears to be Tables)

Line 341: Period after the references creates incomplete sentence out of "Which highlights..."

 

These were noted on quick review. There were a few other potential English issues that should be resolved by an editor. 

Comments on the Quality of English Language

Improved flow of the English. See notes above.

Author Response

Editor-in-Chief

Healthcare

 

Re: Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan. Manuscript ID: healthcare-3887715-round 2

 

Dear Editor and Reviewer,

Again, myself and the co-authors are pleased to resubmit the manuscript entitled ‘Assessment of knowledge and attitudes regarding acute pediatric pain management among anesthesiologists, pediatricians and pediatric nurses: A cross-sectional study from Jordan” to be considered for publication in Healthcare. The revised manuscript takes into consideration both the editorial and reviewers’ comments. Kindly find below a point-by-point response to those comments, along with an uploaded copy marked with MS track changes indicating changes to the manuscript.

Your efforts in improving our manuscript are much appreciated. Thousands of thanks

 

 

 

 

 

 

Response to reviewer 1

Thank you again for your efforts, we will not forget your efforts:

• Thank you for the revisions. The English does indeed flow better. I would have it reviewed one last time by an English professor prior to publication as I still found a few issues." Thank you very much for your kind words. Further English language editing was done.
• “Line 159: The KASRP has 22 T/F and 15 mult choice along with the 4 case responses = 41 (not 40).” Thank you very much. The MCQ are 14 not 15. So, the total is 40.
• “Line 255: Table 2 should be singular with the combination of the tables (Still appears to be Tables).”  Thank you very much for this point. It was corrected.
• Line 341: Period after the references creates incomplete sentence out of "Which highlights." Thank you very much for your meaningful comment. It was corrected

Author Response File: Author Response.pdf