Efficacy of a cartoon and photograph montage storybook in preparing children for voiding cystourethrogram

A Hero's Journey: Supporting children throughout inpatient psychiatric hospitalization using a therapeutic comic book

PROBLEM

Art- and narrative-based interventions are an integral component of pediatric inpatient psychiatric care. We describe a novel therapeutic comic book we developed for hospitalized children and young adolescents.

METHODS

A Hero's Journey is a 38-page zine that can be freely downloaded and photocopied for distribution. The short booklet is intended to demystify and offer guidance throughout the experience of hospitalization, promote interaction and socialization, provide scaffolding for skill-building, and prepare patients for moving forward after discharge.

FINDINGS

The underlying foundations of the booklet include: 1) Theoretical sources (Joseph Campbell's hero's journey; Donald Schön's reflective practice; and the principles of narrative medicine); and 2) Clinical sources (collaborative problem solving; cognitive-behavioral therapy, and trauma-informed care). We articulate how each page relates to the different components, and how individual pages can be used as worksheets for practice of specific skills. We next provide suggestions on how best to use the booklet: from arrival at the emergency room, through inpatient hospitalization, and toward discharge. We also propose ways for staff, caregivers, and any child-facing adult to make use of this clinical resource in support of a patient's recovery and reintegration into their community.

CONCLUSIONS

Even though not yet empirically tested, this therapeutic comic book is available for dissemination free of cost. We encourage leaders in nursing and therapeutic recreation to try using this resource in their emergency room and milieu settings.

Interventions and methods to prepare, educate or familiarise children and young people for radiological procedures: a scoping review

Children attending hospital for radiological procedures can experience uncertainty, anxiety and distress; this can result in sub-optimal experiences for children, poor scan quality and the need for radiological procedures to be rescheduled or sedation to be used. The preparation and education of children before clinical procedures has been shown to have a positive influence on procedural outcomes. This scoping review aimed to locate and examine the evidence relating to non-invasive interventions and methods to prepare, educate and familiarise children for radiological procedures within a healthcare setting. A comprehensive search strategy identified 36 articles. A narrative synthesis approach was adopted to make sense of the key findings. Studies investigated a range of radiological procedures (MRI, plain radiographs, CT, fluoroscopy and Micturating cystourethrogram) using a wide range of interventions (smartphone applications, storybooks, videos, mock scanners) which varied by method, mode of delivery and target audience. The outcomes used to evaluate the value and impact of the interventions are wide, varied and inconsistently applied making it difficult to judge which interventions offer the optimal impact on scan quality, scan completion and children’s experiences. This review highlights that there is a need to further understand which specific elements of the non-invasive interventions ‘work best’ for children. There is a need for consistency on the outcomes measured and for these measures to include child-centred outcomes alongside scan quality and length of radiological procedure.

Creating patient-directed education in pediatric dermatology: A guide for creators

Current medical literature and practice utilize limited resources to enhance pediatric patients' coping with and understanding of disease. Here, we provide a template for accessing current resources and developing practice-specific written materials focused on the child's experience.

Emotional experiences of reading health educational manga encouraging behavioral changes: a non-randomized controlled trial

OBJECTIVE

Educational health manga are used to promote health behavior change. This study thus seeks to achieve the following objectives: identify the emotional experience of reading educational health manga, understand the effects of facilitating the psychological mediators of behavior change through emotional experiences, and compare the effectiveness of educational health manga with conventional materials.

DESIGN

A non-randomized controlled trial with six conditions was conducted. Target behaviors were physical activity and healthy diet. Individuals aged 20-69 years (n = 1,680) were assigned three manga intervention conditions and three control conditions (visual image-based, narrative text, and general text material).

MAIN OUTCOME MEASURES

Participants were asked about their emotional experience while reading either intervention material or control material and its perceived positive influence on enhancing psychological mediators.

RESULTS

Four factors relevant to emotional experiences were identified: risk perception, familiarity, satisfaction, and realism. Emotional experience strongly predicted the psychological mediators of behavior change. Analysis of differences among the six conditions revealed that exposure to educational health manga led to greater satisfaction and increased knowledge. Participants assigned manga conditions experienced superior emotional experiences and outcomes.

CONCLUSIONS

Those assigned manga conditions experienced superior emotional experiences and outcomes. The efficacy of educational health manga in encouraging psychological mediators of change was confirmed.Trial registration: UMIN Japan identifier: UMIN000034369.

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.

What's the story? An analysis of children's books about atopic dermatitis

BACKGROUND/OBJECTIVES

Atopic dermatitis is an inflammatory skin condition with significant disease burden. Bibliotherapy, the use of storybooks to understand an illness, has been proven effective in several pediatric disorders but has not been studied in dermatologic disease. The purpose of this study was to assess the availability of storybooks about atopic dermatitis and analyze them based on adherence to American Academy of Dermatology guidelines for the treatment of atopic dermatitis, readability, author qualifications, cost, and availability.

METHODS

Selection criteria included that the books were primarily about atopic dermatitis, were illustrated, cost less than $25, and were written in English. Storybooks were identified using an Internet search of the Google, Amazon, and Barnes & Noble websites. Flesch-Kincaid Grade Level was used to calculate reading level.

RESULTS

Twenty-three storybooks were identified. The mean cost of the storybooks was $8.2 ± 7.0. Authors included mothers, professional authors, and medical professionals. Mean reading grade level was 4.1 ± 1.5. Of American Academy of Dermatology-recommended treatments, most storybooks mentioned moisturizers or bathing. Fewer than half discussed moisturizing after bathing, topical corticosteroids, wet wrap therapy, oral antihistamines, antimicrobials, systemic agents, or phototherapy. None mentioned topical calcineurin inhibitors or bleach baths.

CONCLUSION

Storybooks about atopic dermatitis are available. Of those reviewed, none covered all the American Academy of Dermatology treatment guidelines. Studies have shown that bibliotherapy can be useful for education and behavioral modification for pediatric diseases, and future studies are needed to examine whether comprehensive, accurate storybooks about atopic dermatitis improve clinical outcomes or improve the quality of life of individuals with atopic dermatitis and their caregivers.

Children’s anxious reactions to an invasive medical procedure: The role of medical and non-medical fears

This study investigated the relationship of medical and non-medical fears to children’s anxiety, pain, and distress during an invasive medical procedure, the voiding cystourethrogram. Parents of 34 children completed the Fear Survey Schedule-II prior to their child’s procedure. Child distress behaviors during the procedure were audiotaped and coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Ratings of child procedural anxiety and pain were obtained from children, parents, and examining technologists within minutes following the procedure. Associations were observed between medical fears, procedural anxiety (parent and staff reports), and coded distress behaviors. Findings may inform preparation efforts to reduce anxiety around invasive medical procedures.

Distress experienced during pediatric VCUGs - a granular, prospective assessment using the brief behavioral distress scale

BACKGROUND

In spite of decades of experience with the procedure, controversy persists as to the overall distress experienced by children and the routine need for sedation in children undergoing voiding cystourethrograms (VCUG). Many studies have attempted to address these issues, often divided into one camp that champions routine sedation while another group believes that pretest preparation is often all that is needed. At the root of these issues are some of the limitations of previous studies as most incorporate inherently subjective parental questionnaires to determine distress levels rather than using an objective, unbiased observer.

OBJECTIVE

The objective of this study is to use a validated and reliable tool (the brief behavioral distress scale) to objectively evaluate the distress experienced during VCUGs.

MATERIALS AND METHODS

A prospective study of 26 children (ages 3-7 years old) was performed by the pediatric radiology department at a large urban academic medical center. Patients were evaluated for distress during 12 separate VCUG steps beginning with the patient entering the room and ending with the clothing being replaced at study completion.

RESULTS

Using a general linear model (repeated measures analysis of variance (ANOVA)), significant distress was identified during two phases of the examination, catheter insertion (P-values ranging <0.001-0.19) and the full bladder phase (P-values ranging 0.005-0.043). The mean distress score for catheter insertion (mean: 1.38, standard deviation [SD]: 1.098) was nearly three times higher than the next most distressful step, i.e. full bladder (mean: 0.65, SD: 0.745). Additionally, entering the room was perceived as significantly more distressing than the catheter out (P = 0.016) and clothing replacement phase (P = 0.006).

CONCLUSION

We find that despite there being significantly increased distress during the catheter insertion and full bladder phases, the distress levels during VCUGs are markedly less than in previous reports. Even the most distressful stage, catheterization, was less stressful than previously reported with levels closer to that of minor distress evinced by comfort-seeking behavior from a parent rather than more significant distress resulting in screaming. Our findings corroborate and expand on the conclusion of the effectiveness of pretest preparation and child life specialist involvement.