Children at risk of anaphylaxis: A mixed-studies systematic review of parents' experiences and information needs

Caregiver experiences and needs in pediatric rheumatic disease: a mixed-methods systematic review protocol

INTRODUCTION

Understanding the genuine experiences and requirements of caregivers and implementing targeted interventions can have a positive impact on the physical and mental well-being of caregivers with children diagnosed with rheumatic diseases, ultimately reducing their burden and enhancing their quality of life. While there has been a gradual increase in research in this area in recent years, there remains a gap in the evidence that comprehensively and systematically reflects the actual experiences and needs of caregivers. We will employ a mixed-methods approach to evaluate the real-life experiences and requirements of caregivers for children diagnosed with rheumatic diseases to provide insights for both research and clinical interventions. METHODS AND ANALYSIS: All types of studies (quantitative, qualitative, and mixed-methods) involving caregivers of children aged 0 to 18 with rheumatic diseases will be included. We will conduct a comprehensive search across multiple databases, including MEDLINE (PubMed), Embase (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, WanFang, and VIP, as well as the grey literature, to identify primary studies published in either English or Chinese since 2000. Two independent reviewers will conduct the selection process and cross-check the data extraction. The focus of interest will be on understanding the experiences and needs of caregivers for pediatric rheumatic disease patients. In our systematic review, we will employ the 2018 version of the Mixed Methods Assessment Tool (MMAT) to evaluate study quality, and we will apply a convergent integration approach to synthesize the data.

ETHICS AND DISSEMINATION

Ethical approval is not needed, as no primary data will be collected. The results will be made available through a peer-reviewed publication.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 42023465302.

Methods for data extraction and data transformation in convergent integrated mixed methods systematic reviews

OBJECTIVE

The objective of this guidance paper is to describe data transformation involving qualitization, including when and how to undertake this process, and to clarify how it aligns with data extraction in order to expand on the current guidance for JBI convergent integrated mixed methods systematic reviews (MMSRs).

INTRODUCTION

The convergent integrated approach to MMSRs involves combining extracted data from both quantitative studies (including the quantitative components of mixed methods studies) and qualitative studies (including the qualitative components of mixed methods studies). This process requires data transformation, which can occur either by converting qualitative data into quantitative data (ie, quantitizing) or converting quantitative data into qualitative data (ie, qualitizing). Data transformation involving qualitization is poorly understood in the context of MMSRs, and there is confusion regarding how to undertake this process, with much of the literature specific to primary mixed methods studies. There is a need to expand current guidance and provide more practical advice to reviewers on how to undertake this process.

METHODS

The JBI MMSR Methodology Group took a multipronged approach to update its guidance. First, a structured search of the literature was conducted to determine what is known about data transformation, followed by analysis of a sample of systematic reviews that claimed to use the JBI convergent integrated approach to MMSRs. Approaches were summarized and used to inform the development of draft guidance. This guidance was iteratively revised following a series of online meetings, as well as presented to evidence synthesis experts at an international conference. Finally, the guidance was submitted to the JBI International Scientific Committee for discussion, feedback, and ratification.

RESULTS

There is uncertainty in the literature regarding the process of data transformation within the context of MMSRs, with ill-defined approaches provided and variation in practice. In JBI convergent integrated MMSRs, it is recommended that data extraction from quantitative studies (or mixed method studies reporting quantitative findings) stays as close as possible to the data reported in the primary studies. Where data are absent or insufficient to meet the needs of the MMSR, systematic reviewers may need to construct the narrative representation using relevant data from the primary studies. Following data extraction, the process of qualitization occurs where extracted data (both quantitative and qualitative) are assembled, and reviewers are required to conduct detailed examination across data to identify likenesses and create categories based on similarities in meaning.

CONCLUSION

To our knowledge, this is the most comprehensive guidance currently available for data extraction and qualitization for MMSRs. However, it is important to acknowledge the inherent variability in MMSRs and our methodology may need tailoring for certain situations. Further work will focus on examining how certainty and confidence in findings can be assessed within the framework of MMSRs.

Public Knowledge and Management Practices of Anaphylaxis in Al-Ahsa, Saudi Arabia: A Cross-Sectional Study

Introduction Anaphylaxis is a life-threatening allergic reaction that has a rapid onset and the potential for fatal outcomes. In Saudi Arabia, anaphylaxis has become more prevalent, particularly among children, yet the knowledge of underlying possible causes and pathogenesis and its management remains insufficient. This study aims to assess the level of awareness and management practices of anaphylaxis among residents of Al-Ahsa, Saudi Arabia. Methods A descriptive cross-sectional study was conducted from May to June 2024 among 384 participants in Al-Ahsa. Data were collected using an online, self-administered questionnaire distributed via social media platforms. We excluded those who refused to participate, those who were healthcare professionals, and those residing outside Al-Ahsa and were non-Saudi. The questionnaire comprised 21 items evaluating demographic characteristics and knowledge of anaphylaxis, including its clinical features, causes, risk factors, emergency actions, previous experiences, and appropriate responses to anaphylaxis signs. Results The study revealed that most participants (154, 40%) were aged 21-30 years, 234 (61%) were male, and 230 (60%) had a university education. Awareness of anaphylaxis was relatively high, with 271 participants (71%) reporting they had heard of the condition. Additionally, 221 participants (58%) recognized its potentially fatal nature. Knowledge of common triggers, such as food and insect stings, was high, with 344-366 participants (90-95%) identifying these as causes of anaphylaxis. However, recognition of less common triggers like latex was lower, with only 185 participants (48%) aware of this risk. When it came to treatment, just 71 participants (18%) correctly identified epinephrine as the first-line treatment for anaphylaxis. Although 160 participants (40%) indicated they would seek hospital care in an emergency, only 28 (7%) recognized the need to administer epinephrine. Overall, 245 participants (64%) demonstrated good knowledge of anaphylaxis. Significant differences in knowledge levels were observed based on gender (p = 0.017), marital status (p = 0.037), education level (p = 0.049), prior awareness of anaphylaxis (p = 0.002), and having witnessed an anaphylaxis case before (p = 0.007). Conclusion Awareness of proper anaphylaxis and allergy management, particularly the use of epinephrine, is notably lacking. Targeting public health awareness is essential to enhance public knowledge and preparedness for managing anaphylactic emergencies in Al-Ahsa, Saudi Arabia.

Prevalence and Characteristics of Accidental Ingestions Among Pediatric Food Allergy Patients

BACKGROUND

Despite a known diagnosis of food allergy, accidental ingestions continue to occur.

OBJECTIVE

To characterize accidental ingestions, including prevalence, risk factors, food allergen triggers, and severity of reactions.

METHODS

A prospective monthly survey developed by the Food Allergy Consortium at Northwestern University was administered to parents of food-allergic children between April 2015 and April 2017. The monthly survey included questions on any allergic reactions experienced in the previous month. In addition, chart reviews of 100 pediatric participants from Lurie Children's Hospital of Chicago allergy clinics (typical clinical encounters) were compared with the prospective survey results.

RESULTS

A total of 196 survey participants and 100 retrospective review subjects were analyzed-31.1% of participants from the surveyed cohort and 19.0% of participants from the retrospective review reported at least 1 accidental ingestion over 1 year. The rate of accidental ingestions reported in the prospective survey was high: 10% to 25% of participants each month reported an accidental ingestion, and multiple ingestions were common. Common triggers were milk, wheat, and tree nuts. In the retrospective cohort, the highest rate of accidental ingestion (25.0%) occurred for milk, followed by sesame (20.0%) and egg (18.8%). Rates of anaphylaxis after exposure were high in both the prospective and retrospective cohorts (33.1% and 16.7%, respectively).

CONCLUSIONS

Accidental ingestion rates were high among food-allergic patients. Multiple exposures, especially to milk, were common. Incidence of anaphylaxis was also high, suggesting that ongoing patient education on allergen avoidance and accidental exposure is imperative.

Assessment of parental self-efficacy in managing child food-induced anaphylaxis and using adrenaline autoinjectors

BACKGROUND

Anaphylaxis is a life-threatening allergic reaction, associated with mental health burden in patients and caregivers. Intramuscular adrenaline via autoinjector (AAI) is the recommended treatment for the management of anaphylaxis in non-hospital settings; however, AAIs are underused. This study aimed to assess parental self-efficacy in managing child's anaphylaxis and administering AAI to understand how to effectively support families.

METHODS

Seventy-five parents of children with severe food allergy completed a questionnaire to measure parental self-efficacy in managing child food-induced anaphylaxis (PSEMA). We conducted an exploratory factor analysis with 12 items, using principal axis factoring as the extraction method. We used Cronbach's alpha to assess the internal consistency of the factors. We used the Anderson-Rubin approach to estimate the factors' scores and provide a kernel density estimate of their distributions. An assessment through linear regression between the total factors' score and total score was performed.

RESULTS

A five-factor model was identified. The factors that emerged were conceptually related to "F1. Manage Injection," "F2. Manage AAI Device," "F3. Manage Anaphylaxis," "F4. Manage Emergency," and "F5. Manage Emotions." The questionnaire demonstrated high internal consistency, with a Cronbach's alpha of 0.91 (95% CI: 0.87-0.94) The variation in the total score explained 90% of the variation in the factor score.

CONCLUSIONS

The PSEMA questionnaire promises to be an easy and effective tool for measuring parents' self-efficacy in managing anaphylaxis and AAI, allowing clinicians to identify gaps in education and provide effective training.

Seeking Care for Children with Intellectual and/or Developmental Disabilities in the Emergency Department: A Mixed Methods Systematic Review of Parents' Experiences and Information Needs

The objective of this review was to explore parents' experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents' self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child's IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child's condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents' desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents' experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.

Impact of Reaction Setting on the Management, Severity, and Outcome of Pediatric Food-Induced Anaphylaxis: A Cross-Sectional Study

BACKGROUND

Prompt epinephrine autoinjector (EAI) use is the primary treatment for anaphylaxis. However, limited Canadian data exist on the impact of reaction location on EAI use for food-induced anaphylaxis (FIA).

OBJECTIVE

We sought to investigate the setting, management, and severity of pediatric FIA.

METHODS

We recruited children presenting with FIA from 11 Canadian emergency departments. Patient demographics and the setting, management, and symptoms of FIA were collected by standardized questionnaire. Factors associated with prehospital EAI use and reaction severity were determined by logistic regression.

RESULTS

We recruited 3,604 children; 60.2% were male and the median age was 5.0 years (interquartile range 1.8-11.0). Among cases with a known location of FIA (85.0%), home was the most common setting (68.1%), followed by school/daycare (12.8%), other locations (11.4%; eg, park, car), and restaurants (7.4%). In the prehospital setting, EAI was administered in 36.7% of reactions at home, 66.7% in school/daycare, 40.2% in other locations, and 44.5% in restaurants. Relative to reactions occurring at school/daycare, prehospital EAI use was less likely at home (adjusted odds ratio [aOR] 0.80; 95% CI 0.76-0.84), in restaurants (aOR 0.81; 95% CI 0.75-0.87), and in other settings (aOR 0.77; 95% CI 0.73-0.83), when data were adjusted for reaction severity, sex, age, comorbidities, and province. The FIA setting was not associated with reaction severity or hospitalization.

CONCLUSIONS

Prehospital EAI use was higher at school/daycare than in other settings, potentially owing to the presence of policies and training on FIA. Setting-specific interventions including educational programs and policies/laws mandating training and stocking an EAI may improve anaphylaxis recognition and treatment.