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Krauss BA, Leroy PL, Krauss BS. Establishing trust with children. Eur J Pediatr 2024; 183:4185-4193. [PMID: 39136756 DOI: 10.1007/s00431-024-05704-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 09/20/2024]
Abstract
Trust forms the bedrock of the doctor-patient relationship. While establishing trust is a foundational skill for healthcare providers who care for children, there is no systematic approach to teaching this skill set, nor is there formal training during medical school or residency. Traditionally, these skills have been taught by example, in an unstructured and ad hoc manner, with trainees picking it up along the way by observing and modeling their instructors. Here, we define and examine the elements of establishing trust and describe a methodology for establishing trust and managing a child's emotional state during medical encounters.
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Affiliation(s)
- Benjamin A Krauss
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
| | - Piet L Leroy
- Department of Pediatrics, School of Health Professions Education, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Baruch S Krauss
- Department of Pediatrics, Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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2
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Carlsen Misic M, Olsson E, Thernström Blomqvist Y, Ullsten A. "Preparation Is Key": Parents' and Nurses' Perceptions of Combined Parent-Delivered Pain Management in Neonatal Care. CHILDREN (BASEL, SWITZERLAND) 2024; 11:781. [PMID: 39062231 PMCID: PMC11274501 DOI: 10.3390/children11070781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND There is a knowledge-to-practice gap regarding parent-delivered pain management, and few studies have investigated parents' and nurses' participation in and acceptance of combined parent-delivered pain-alleviating interventions such as skin-to-skin contact (SSC), breastfeeding, and parental musical presence. This study investigated parents' and nurses' perceptions of and reflections on experiencing combined parent-delivered pain management. METHODS This qualitative study applies a collaborative participatory action research design using ethnographic data collection methods such as focus groups, video observations, and video-stimulated recall interviews with parents and nurses. RESULTS The results concern three main categories, i.e., preparation, participation, and closeness, as well as various sub-categories. Preparations were central to enabling combined parent-delivered pain management. Participation was facilitated by parental musical presence, in which parents shifted their attention toward their infant. Closeness and presence during neonatal care helped parents become active during their infant's painful procedures. Parental lullaby singing created a calm and trusting atmosphere and after the procedure, both parents and nurses felt that they had successfully supported the infant through a potentially painful procedure. CONCLUSIONS Mental and practical preparation is central to implementing combined parent-delivered pain management. When parents and nurses explored the interventions, they found the methods feasible, promoting self-efficacy and confidence in both parents and nurses.
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Affiliation(s)
- Martina Carlsen Misic
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 70182 Örebro, Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 70182 Örebro, Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Hospital, 75185 Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, 75237 Uppsala, Sweden
| | - Alexandra Ullsten
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 70182 Örebro, Sweden
- Centre for Clinical Research and Education, Region Värmland, 65182 Karlstad, Sweden
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Mondardini MC, Pezzato S, Meneghini L, Agostiniani R, De Cassai A, D'Errico I, Minardi C, Sagredini R, Sbaraglia F, Testoni C, Toni F, Vason M, Amigoni A. Procedural sedation and analgesia in pediatric diagnostic and interventional radiology: An expert DELPHI consensus document developed by the ITALIAN scientific society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI). Paediatr Anaesth 2024. [PMID: 38808388 DOI: 10.1111/pan.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Children undergoing diagnostic and interventional radiology procedures often require sedation to achieve immobility and analgesia if the procedure is painful. In the past decades, leading scientific organizations have developed evidence-based guidelines for procedural sedation and analgesia in children outside of the operating room. Their recommendations are being applied to procedural sedation in radiology. However, some questions remain open regarding specific aspects contextualized to the radiology setting, such as elective prone sedation, the urgency of the procedure, when venous access or airway protection is required, and others. AIMS To address the unresolved issues of procedural sedation and analgesia in pediatric diagnostic and interventional radiology. METHODS An expert panel of pediatricians, pediatric anesthesiologists, intensivists, and neuroradiologists selected topics representative of current controversies and formulated research questions. Statements were developed by reviewing the literature for new evidence, comparing expertise and experience, and expressing opinions. Panelists' agreement with the statements was collected anonymously using the DELPHI method. RESULTS Twelve evidence-based or expert opinion incorporate are presented, considering risks, benefits, and applicability. CONCLUSIONS This consensus document, developed by a multidisciplinary panel of experts involved in the field, provides statements to improve the quality of decision-making practice in procedural sedation and analgesia in pediatric radiology.
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Affiliation(s)
| | - Stefano Pezzato
- Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luisa Meneghini
- Department of Pediatric Surgery, University Hospital of Padova, Padova, Italy
| | | | - Alessandro De Cassai
- Department of Medicine, Anaesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Ignazio D'Errico
- Department of Neuroradiology, University Hospital of Padova, Padova, Italy
| | - Carmelo Minardi
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Raffaella Sagredini
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Fabio Sbaraglia
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Gemelli IRCCS, Sacro Cuore Catholic University, Rome, Italy
| | - Caterina Testoni
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Toni
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Milo Vason
- Department of Emergency, Anaesthesiology and Intensive Care Unit, Arcispedale Sant'Anna, University of Ferrara, Cona, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, University Hospital of Padova, Padova, Italy
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Segers EW, Ketelaar M, de Man MACP, Schoonhoven L, van de Putte EM, van den Hoogen A. How to support children to develop and express their coping preferences around minor invasive medical procedures: children's and parents' perspectives. Eur J Pediatr 2023; 182:5553-5563. [PMID: 37787922 PMCID: PMC10746775 DOI: 10.1007/s00431-023-05222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
Invasive medical procedures in hospitals are major sources of stress in children, causing pain and fear. Non-pharmacological interventions are indispensable in effective pain and fear management. However, these interventions must be personalized to be effective. This qualitative study aims to gain insight into children's and parents' experiences, needs, and wishes related to supporting children to develop and express their coping preferences for dealing with pain and fear during minor invasive medical procedures in order to decrease pain and fear. A qualitative study using thematic analysis was performed. Data were collected through semi-structured interviews with children and parents who had undergone at least five minor invasive medical procedures in the last year. Nineteen children (8-18 years) and fourteen parents were interviewed individually. The experiences, needs, and wishes expressed in the interviews could be classified into one overarching theme, that of the personal process, and two content-related sub-themes: feeling trust and gaining control. The personal process was divided into two different phases, that of developing and of expressing coping preferences. Children and parents both reported it as a continuous process, different for every child, with their own unique needs. Children and parents expected personalized attention and tailored support from professionals. Conclusion: Professionals must combine clinical skills with child-tailored care. In the process of searching for and communicating about coping preferences, children's unique needs and personal boundaries will thereby be respected. This gives children and parents increased trust and control during invasive medical procedures. What is Known: • Untreated pain and stress caused by medical procedures can have severe and important short- and long-term consequences for children. Personalized non-pharmacological interventions are an essential element of procedural pain management. What is New: • A personalized coping strategy is important for children when undergoing medical procedures. Each individual child has a personal way of expressing their own coping strategy. Children and their parents need information and the space to develop and express their individual coping preferences. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures.
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Affiliation(s)
- Elisabeth W Segers
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjorie A C P de Man
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Elise M van de Putte
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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Bray L, Carter B, Kiernan J, Horowicz E, Dixon K, Ridley J, Robinson C, Simmons A, Craske J, Sinha S, Morton L, Nafria B, Forsner M, Rullander AC, Nilsson S, Darcy L, Karlsson K, Hubbuck C, Brenner M, Spencer-Little S, Evans K, Rowland A, Hilliard C, Preston J, Leroy PL, Roland D, Booth L, Davies J, Saron H, Mansson ME, Cox A, Ford K, Campbell S, Blamires J, Dickinson A, Neufeld M, Peck B, de Avila M, Feeg V, Mediani HS, Atout M, Majamanda MD, North N, Chambers C, Robichaud F. Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus. Eur J Pediatr 2023; 182:4707-4721. [PMID: 37566281 PMCID: PMC10587267 DOI: 10.1007/s00431-023-05131-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds. Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.
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Affiliation(s)
| | | | - Joann Kiernan
- Edge Hill University and Alder Hey Children’s Hospital, Liverpool, UK
| | | | | | - James Ridley
- Edge Hill University and National Restraint Reduction Network, Ormskirk, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carol Hilliard
- Children’s Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | | | - Piet L. Leroy
- Maastricht University Medical Centre / Maastricht University, Maastricht, The Netherlands
| | - Damian Roland
- University Hospitals of Leicester NHS Trust and Leicester University, Leicester, UK
| | | | | | | | | | - Ann Cox
- Midlands Partnership NHS Foundation Trust & Keele University, Keele, UK
| | - Karen Ford
- University of Tasmania and the Royal Hobart Hospital, Tasmani, Australia
| | | | - Julie Blamires
- Auckland University of Technology, Auckland, New Zealand
| | | | | | - Blake Peck
- Federation University, Victoria, Australia
| | | | - Veronica Feeg
- Molloy College in Rockville Centre, New York City, USA
| | | | | | | | - Natasha North
- The Harry Crossley Children’s Nursing Development Unit, University of Cape Town, Cape Town, South Africa
| | | | - Fanny Robichaud
- Ulluriaq, Ungava Tulattavik Health Center and UQAM UQO, Québec, Canada
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van den Berg S, Hoogeveen MO, van Winden TMS, Chegary M, Genco MS, Jonkman NH. Virtual reality hypnosis for needle-related procedural pain and fear management in children: a non-inferiority randomized trial. Eur J Pediatr 2023; 182:4421-4430. [PMID: 37486409 DOI: 10.1007/s00431-023-05116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Needle-related procedures can cause pain and fear in children and may lead to avoidance of future medical care. The aim of this study is to investigate whether virtual reality hypnosis (VRH) is non-inferior to medical hypnosis (MH) by a trained healthcare provider in reducing pain in children. This non-inferiority randomized trial was conducted at a teaching hospital in the Netherlands. Children aged 6 to 18 years were randomized to treatment with VRH or MH. The primary outcome was self-reported pain, using the Wong-Baker FACES Scale (WBFS) with the non-inferiority margin defined as a difference of 1.5 points. Secondary outcomes included observer-reported pain (Numeric Rating Scale), fear (scored by children and observers with the Children's Fear Scale), blood pressure, heart rate, treatment satisfaction, and adverse effects. We randomized 138 children to VRH or MH treatment and included 114 children in the analyses (VRH n = 60, MH n = 54). We found non-inferiority for VRH compared to MH on patient-reported pain (mean difference = - 0.17, 95%CI - 1.01;0.66). Secondary outcomes were comparable between VRH and MH groups. Both treatments scored high on patient satisfaction (VRH median = 9.0, MH median = 10.0, p = 0.512). CONCLUSION VRH may be an effective and safe treatment option besides MH for reducing patient-reported pain in children during a needle-related procedure. VRH was non-inferior to MH in patient-reported fear and both treatments were comparable in terms of patient-reported fear, observer-reported pain and fear, physical distress, and patient satisfaction. TRIAL REGISTRATION ICTRP https://trialsearch.who.int/ , trial ID NL9385; date registered: 03/04/2021. WHAT IS KNOWN • Medical hypnosis is effective in reducing procedural distress in children during needle-related procedures. • Virtual reality (VR) is an audiovisual electronic device that guides users into an immersive three-dimensional environment. WHAT IS NEW • This study shows that VR hypnosis is non-inferior to medical hypnosis in reducing pain and fear in children undergoing a needle-related procedure. • Both VR hypnosis and medical hypnosis were appreciated highly by children to distract them during needle-related procedures.
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Affiliation(s)
- Sharron van den Berg
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
| | - Maurits O Hoogeveen
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Tijn M S van Winden
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Malika Chegary
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Mehmet S Genco
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Nini H Jonkman
- Department of Research and Epidemiology, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
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Thestrup J, Hybschmann J, Madsen TW, Bork NE, Sørensen JL, Afshari A, Borgwardt L, Berntsen M, Born AP, Aunsholt L, Larsen VA, Gjærde LK. Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis. Hosp Pediatr 2023; 13:e301-e313. [PMID: 37727937 DOI: 10.1542/hpeds.2023-007289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
CONTEXT Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required. OBJECTIVES To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety. DATA SOURCES We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022. STUDY SELECTION We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2-18 years) undergoing MRI. DATA EXTRACTION Standardized instruments were used to extract data and assess study quality. RESULTS Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48-0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51-0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years. LIMITATIONS There was substantial heterogeneity among nonrandomized studies. CONCLUSIONS Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.
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Affiliation(s)
| | | | | | | | - Jette L Sørensen
- Juliane Marie Centre and Mary Elizabeth's Hospital
- Department of Clinical Medicine, Faculty of Health and Medicine Sciences
| | | | | | | | | | - Lise Aunsholt
- Neonatology
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke A Larsen
- Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Line K Gjærde
- Juliane Marie Centre and Mary Elizabeth's Hospital
- Pediatrics and Adolescent Medicine, Neuropaediatric Unit
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Wabelo ON, Schmartz D, Giancursio M, De Pooter F, Caruso G, Fils JF, Van der Linden P. Prospective, randomized, double-blind, double-dummy, active-controlled, phase 3 clinical trial comparing the safety and efficacy of intranasal dexmedetomidine to oral midazolam as premedication for propofol sedation in pediatric patients undergoing magnetic resonance imaging: the MIDEX MRI trial. Trials 2023; 24:518. [PMID: 37568242 PMCID: PMC10422697 DOI: 10.1186/s13063-023-07529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Children under 6 years who need magnetic resonance imaging usually require sedation to obtain best quality images, but the optimal sedation protocol remains to be determined. In 2018, we showed a 22% interruption in image acquisition during magnetic resonance imaging when performing a propofol-based sedation using a bolus approach. As non-pharmacological premedication is often insufficient to reduce the anxiety of children related to parental separation, pharmacological premedication may be useful to facilitate the induction of anesthesia. In our institution, effective premedication is obtained oral intake of midazolam, though its administration relies on patients' compliance and could also lead to paradoxical reaction. Dexmedetomidine has a safe profile in the pediatric population and can therefore represent an interesting alternative. The primary objective of this trial is to demonstrate the superiority of intranasal dexmedetomidine compared to oral midazolam as premedication in reducing the occurrence of any event requiring temporary or definitive interruption of the examination to allow anesthesiologist intervention in children undergoing magnetic resonance imaging under propofol sedation. METHODS In this single-center, prospective, randomized, double-blind, double-dummy, active comparator-controlled, superiority trial, we planned to include 250 patients, aged 6 months to 6 years, undergoing a scheduled magnetic resonance imaging requiring the presence of an anesthesiologist. After informed consent, the patients will be randomized to receive either oral midazolam or intranasal dexmedetomidine as premedication. The data will be analyzed in intention to treat, using Kolmogorov-Smirnov Z, chi-square, Wilcoxon, and Mann-Whitney U tests. A P-value < 0.05 will be considered statistically significant. DISCUSSION The MIDEX MRI study will assess the efficacy of intranasal dexmedetomidine compared to oral midazolam to improve the quality of a propofol-based sedation prior to magnetic resonance imaging, without negative repercussion on the postoperative period. TRIAL REGISTRATION ClinicalTrial.gov NCT05192629 . Registered on 14 January 2022. Protocol version 2.1.
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Affiliation(s)
- Olivia Nzungu Wabelo
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Denis Schmartz
- Université Libre de Bruxelles, Brussels, Belgium.
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium.
| | - Mario Giancursio
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
| | - Françoise De Pooter
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
| | - Giulia Caruso
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
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9
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Clinical and psychosocial factors affecting treatment adherence in children with rheumatic heart disease. Cardiol Young 2022; 32:1668-1674. [PMID: 35791698 DOI: 10.1017/s1047951122002189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The present study aimed to investigate the outcomes of psychiatric symptoms and family functions on treatment adherence in children, in addition to sociodemographic characteristics and clinical factors related to the disease. MATERIAL AND METHOD The research sample consisted of 43 children who were followed up with rheumatic heart disease diagnosis during the study. Clinical features were obtained from the patient files. The family assessment device evaluating family functioning and the strengths and difficulties questionnaire scale to screen emotional and behavioural problems in children were used. RESULTS Considering the regularity of treatment in our patients, there were 31 (72%) patients adherent to secondary prophylaxis regularly, 7 (6.9%) patients were partially adherent, and 5 (11.6%) patients non-adherent. Patients were divided into treatment adherent (Group 1) and non-adherent (Group 2). There was no statistically significant impact on treatment adherence whether the patients receive enough information, lifestyle, fear of developing adverse effects, fear of addiction, lack of health insurance, difficulties in reaching the drug or hospital. However, the fear of syringes on treatment adherence had an effect statistically significantly (p = 0.047). Forgetting to get a prescription and/or take the drug when the time comes was statistically higher in the non-adherent group (p = 0.009). There was no statistically significant effect of psychosocial factors on treatment adherence between groups. DISCUSSION Providing an effective active recall system, involving primary care workers, providing training on the disease and its management, and a comprehensive pain management programme can improve the process, especially for cases where secondary prophylaxis is missed.
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Thybo KH, Friis SM, Aagaard G, Jensen CS, Dyekjaer CD, Jørgensen CH, Walther-Larsen S. A randomized controlled trial on virtual reality distraction during venous cannulation in young children. Acta Anaesthesiol Scand 2022; 66:1077-1082. [PMID: 35898121 PMCID: PMC9545199 DOI: 10.1111/aas.14120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives Pain management in children is often inadequate, and the single most common painful procedure in children who are hospitalized is needle procedures. Virtual reality (VR) has been shown to decrease anxiety and pain in children undergoing painful procedures primarily in children from the age of 7 years. Our aim for this study is to investigate patient satisfaction and pain reduction by using a three‐dimensional VR interactive game as a distraction in 4–7 years old children during venous cannulation. Methods In this randomized clinical trial, we enrolled 106 children aged 4–7 years who were scheduled for venous cannulation. Patients assigned to the control group were adherent to standard of care, including topical numbing cream, positioning, and distraction in this group by games of choice on a tablet/smartphone. In the study group, children were adherent to standard of care and were distracted by an interactive VR game. Primary outcomes were patient satisfaction and the procedural pain assessed by using Wong–Baker Faces Pain Rating Scale; secondary outcomes were the procedural time and any adverse events. Results We found an overall high level of patient satisfaction with our regime of topical numbing cream, positioning, and distraction. The primary outcome of pain during the procedure was median 20 mm (IQR 0–40) and 20 mm (IQR 0–55) (Wong–Baker 0–100 mm) in the VR group and the control group, respectively (difference: 0 mm, 95%CI: 0–20, p = .19). No significant difference was found in procedural times. The number of adverse effects was low, with no significant difference between the two groups. Conclusions VR distraction is an acceptable form of distraction for children 4–7 years old when combined with topical numbing cream and positioning during preoperative venous cannulation. No difference was found between VR‐ and smartphone/tablet distraction.
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Affiliation(s)
- Kasper H Thybo
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne M Friis
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Aagaard
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus S Jensen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Research Center for Emergency Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Charlotte D Dyekjaer
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Walther-Larsen
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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11
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Haley J, Engstrand SL, Cole A, Schenkel S, Hinsley K, Brawn B, Esch J, Ibla J, DeGrazia M. Safety and feasibility of the paediatric post-cardiac catheterisation Wrap: a pilot study. Cardiol Young 2022; 33:1-10. [PMID: 35105395 DOI: 10.1017/s1047951122000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The paediatric post-cardiac catheterisation Wrap (Wrap), an innovative medical safety device, swaddles young paediatric patients in a supine position aiding in immobilisation post-cardiac catheterisation. This pilot study investigated the feasibility and safety of using the Wrap on young paediatric patients during their bed rest period following cardiac catheterisation with femoral access. SETTING Boston Children's Hospital Cardiac Catheterization Lab. PARTICIPANTS 20 patients, ages 1-5 years and weighing 3-25 kg. METHODS Investigator-developed tools used to collect data included the Demographic and Outcome Measures Data Tool, the Parent/Caregiver Satisfaction, and Provider Ease of Use tools. They measured:1.The feasibility of using the Wrap2.Wrap ease of use from the nurse providers' perspective3.Parent satisfaction related to the Wrap4.Frequency of Wrap non-bleeding-related adverse events5.Frequency of rebleeding at femoral groin access sites. RESULTS The Wrap was feasible and safe; increased nurse provider satisfaction by allowing visualisation of the groin access sites while minimising the need for hands-on care; and increased parent satisfaction by allowing parents to hold and provide comfort while their child was on bed rest. IMPLICATIONS FOR RESEARCH The Wrap is a safe alternative to the current practice of swaddling with a bath blanket. Further studies are warranted to assess the Wrap's effectiveness in reducing the incidence of rebleeding events in the post-cardiac catheterisation period and explore clinical use outside of the Cardiac Catheterization Lab.
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Affiliation(s)
- Jennifer Haley
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Shannon L Engstrand
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Alexandra Cole
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Sara Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Hinsley
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Brenda Brawn
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Jesse Esch
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Juan Ibla
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Michele DeGrazia
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
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12
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Segers EW, Ketelaar M, Taddio A, de Man MACP, Schoonhoven L, van de Putte EM, van den Hoogen A. Exploring key elements of approaches that support childrens' preferences during painful and stressful medical procedures: A scoping review. J Pediatr Nurs 2022; 62:e16-e24. [PMID: 34266719 DOI: 10.1016/j.pedn.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
PROBLEM Children undergoing medical procedures can experience pain and distress. While numerous interventions exist to mitigate pain and distress, the ability to individualize the intervention to suit the needs and preferences of individual children is emerging as an important aspect of providing family-centered care and shared decision making. To date, the approaches for supporting children to express their preferences have not been systematically identified and described. A scoping review was conducted to identify such approaches and to describe the elements that are included in them. ELIGIBILITY CRITERIA Studies that (a) described approaches with the aim to support children to express their coping preferences during medical procedures; (b) included the option for children to choose coping interventions; (c) included a child (1--18 years). SAMPLE Searches were conducted in December 2019 and November 2020 in the following databases: Cinahl, Embase, PubMed and Psycinfo. RESULTS Thirteen studies were identified that included six distinct approaches. Four important key elements were identified: 1) Aid to express preferences or choice, 2) Information Provision, 3) Assessment of feelings/emotions, 4) Feedback/Reflection and Reward. CONCLUSIONS Identified approaches incorporate components of shared decision-making to support children in expressing their preferences during medical procedures and treatments. IMPLICATIONS Children undergoing medical procedures can be supported in expressing their coping needs and preferences by using components of shared decision-making.
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Affiliation(s)
- Elisabeth W Segers
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicin, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada
| | - Marjorie A C P de Man
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Elise M van de Putte
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - Agnes van den Hoogen
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
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13
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Gray JM, Roback MG. Case Studies of Challenges in Emergency Care for Children With Autism Spectrum Disorder. Pediatr Emerg Care 2021; 37:e1756-e1758. [PMID: 32205797 DOI: 10.1097/pec.0000000000002074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) affects more than 1% of children in the United States, with the rate of new diagnoses climbing significantly in the last 15 years. Emergent conditions and subsequent visits to the emergency department (ED) can be particularly challenging for children with ASD, most of whom also have comorbidities in addition to their deficits in social communication and interaction. In the emergency setting, these conditions can cause a range of behaviors that result in challenges for health care providers and may result in suboptimal experiences for children with ASD and their families. We present the ED course of 3 children with ASD to illustrate these challenges, emphasize successful strategies, and highlight opportunities for improvement.
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Affiliation(s)
- James M Gray
- From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mark G Roback
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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14
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Sahyoun C, Cantais A, Gervaix A, Bressan S, Löllgen R, Krauss B. Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice. Eur J Pediatr 2021; 180:1799-1813. [PMID: 33511466 PMCID: PMC8105204 DOI: 10.1007/s00431-021-03930-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 12/27/2022]
Abstract
Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space. What is Known: • Effective and prompt analgesia, anxiolysis, and sedation (PSA) outside the operating theatre have become standard in managing pain and anxiety in children undergoing painful or anxiogenic diagnostic and therapeutic procedures. • We searched PubMed up to September 15, 2020, without any date limits or language restrictions, using different combinations of the MeSH terms "pediatrics," "hypnotics and sedatives," "conscious sedation," and "ambulatory surgical procedures" and the non-MeSH term "procedural sedation" and found no reports describing the current practice of pediatric PSA in Europe. What is New: • This study is, to the best of our knowledge, the first to shed light on the pediatric PSA practice in European EDs and uncovers important gaps in several domains, notably availability of sedation medications and topical anesthetics, safety aspects such as PSA provider training, availability of nonpharmacologic support to PSA, and high impact interventions such as nurse-directed triage analgesia. • Other identified barriers to PSA implementation include staff shortage, control of sedation medications by specialists outside the emergency department, and lack of space.
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Affiliation(s)
- Cyril Sahyoun
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland
| | - Aymeric Cantais
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland
| | - Alain Gervaix
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland
| | - Silvia Bressan
- Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Ruth Löllgen
- Pediatric Emergency Department, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Baruch Krauss
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
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15
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Cozzi G, Valerio P, Kennedy R. A narrative review with practical advice on how to decrease pain and distress during venepuncture and peripheral intravenous cannulation. Acta Paediatr 2021; 110:423-432. [PMID: 32772423 DOI: 10.1111/apa.15526] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
Venepuncture and peripheral intravenous cannulation are two of the most commonly paediatric performed medical procedures in many healthcare settings. These procedures can cause significant pain and distress at any age, during childhood, so appropriate management is strongly recommended. This review examines the evidence related to pain and distress management during venepuncture and peripheral intravenous cannulation, including preparing the environment, assessing and preparing patients, parental involvement and psychological and pharmacological interventions. It specifically refers to neonates, children with cognitive impairment and children with difficult intravenous access. We provide a brief management strategy, with easily implemented techniques to improve daily practice.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Paolo Valerio
- Department of Pediatrics OLVG Hospital Amsterdam The Netherlands
| | - Robert Kennedy
- Washington University School of Medicine St Louis MO USA
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16
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Bozdogan Yesilot S, Ciftci H, Ozcelik Z. The effect of virtual reality on mothers' anxiety during children's circumcision: A randomized controlled study. Int J Nurs Pract 2021; 27:e12906. [PMID: 33398905 DOI: 10.1111/ijn.12906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
AIM The aim of this study was to evaluate the effect of use of virtual reality headsets on mothers' anxiety, by distracting their attention, during their child's circumcision procedure. DESIGN This was a randomized controlled intervention study. METHODS The study used a pretest and posttest design and was carried out between April 15, 2019, and June 30, 2019, with 60 participants (n = 30 intervention and n = 30 control group). The data were collected using a personal information form, the State Anxiety Inventory and Faces Anxiety Scales. In the study, the participants in the intervention group watched videos through a virtual reality headset. RESULTS The socio-demographic characteristics of the intervention group and control group were similar in the pretest, except for the educational level. After the intervention, the intervention group's mean scores on the Faces Anxiety Scale, heart rate and respiration rates were significantly lower than those of the control group, but the difference between the mean State Anxiety Inventory scores was insignificant. CONCLUSION Distraction using videos produced by virtual reality headsets is effective in reducing mothers' moderate level anxiety. It is recommended that further studies should be conducted in different ambulatory surgery procedures.
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Affiliation(s)
| | - Hatice Ciftci
- General Surgery Operating Room, Adana City Training and Research Hospital, Adana, Turkey
| | - Zerrin Ozcelik
- Paediatric Surgery Department, Adana City Training and Research Hospital, Adana, Turkey
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17
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Tervonen M, Pokka T, Kallio M, Peltoniemi O. Systematic review and meta-analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation. Acta Paediatr 2020; 109:2008-2016. [PMID: 32400892 DOI: 10.1111/apa.15348] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022]
Abstract
AIM This systematic review and meta-analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room. METHODS Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Randomised controlled trials that compared intranasal dexmedetomidine with another sedative or placebo during paediatric procedural sedation were included. Trials that studied intranasal dexmedetomidine as a premedication before anaesthesia were excluded. The primary outcome was the success of the planned procedure. RESULTS We analysed seven randomised controlled trials of 730 patients: four trials with 570 patients compared dexmedetomidine with chloral hydrate and three trials with 160 patients compared dexmedetomidine with midazolam. The incidence of successfully completing the procedure did not differ between dexmedetomidine and chloral hydrate, but dexmedetomidine had a higher success rate than midazolam. The incidence of hypotension, bradycardia or respiratory complications did not differ between the sedatives used. Nausea and vomiting were more common in children treated with chloral hydrate than in those treated with other sedatives. CONCLUSION Intranasal dexmedetomidine was a safe and effective sedative for minor paediatric procedures.
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Affiliation(s)
- Miikka Tervonen
- Department of Children and Adolescents Oulu University Hospital Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu University of Oulu Oulu Finland
| | - Tytti Pokka
- Department of Children and Adolescents Oulu University Hospital Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu University of Oulu Oulu Finland
| | - Merja Kallio
- Department of Children and Adolescents Oulu University Hospital Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu University of Oulu Oulu Finland
| | - Outi Peltoniemi
- Department of Children and Adolescents Oulu University Hospital Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu University of Oulu Oulu Finland
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18
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Robertson E, Treadgold C, Parker B, Quinn L. Positive distraction for children during burn wound care in Australia - An evaluation of the 'Captains on Call' pilot. J Pediatr Nurs 2020; 54:10-17. [PMID: 32570190 DOI: 10.1016/j.pedn.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Burn wound care procedures can cause severe pain to the child, and distress for both the child and caregivers. We evaluated a new Starlight Children's Foundation program, 'Captains on Call', which aims to provide positive distraction during burn wound care procedures to reduce the child's anxiety and pain. This paper presents a preliminary evaluation, using a qualitative design, of Captains on Call at the Women's and Children's Hospital, Australia. METHODS We conducted interviews with caregivers (n = 18), patients (n = 6), nurses (n = 5) and Captain Starlights (n = 3). Interviews focused on program impact and recommendations for how to improve the program. RESULTS We identified seven themes: (1) positive distraction from pain and boredom, (2) benefit of additional support, (3) creating positive memories of the hospital, (4) catering for unique needs of each patient and family, (5) general appreciation, (6) importance of regular visits, and (7) a desire to expand the program. All caregivers, nurses and patients reported that they were likely to recommend the program to others. CONCLUSION This study provides early evidence to support the benefit of the Captains on Call program to families and health professionals, as well as the feasibility in providing this integrated care.
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Affiliation(s)
- Eden Robertson
- Starlight Children's Foundation, Australia; School of Women's and Children's Health, UNSW Sydney, Australia.
| | - Claire Treadgold
- Starlight Children's Foundation, Australia; School of Women's and Children's Health, UNSW Sydney, Australia.
| | | | - Linda Quinn
- Burns Service, Women's and Children's Hospital, Australia
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19
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Costa LR, Bendo CB, Daher A, Heidari E, Rocha RS, Moreira APDSC, Moura LS, Banerjee A, Newton JT, Hosey MT. A curriculum for behaviour and oral healthcare management for dentally anxious children-Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE). Int J Paediatr Dent 2020; 30:556-569. [PMID: 32112461 DOI: 10.1111/ipd.12635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic. AIM To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP. DESIGN A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face-to-face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses. RESULTS Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%-30.0% have training in pharmacological techniques. The four-domain framework supporting the proposed curriculum is as follows: DA/DF/DBMP assessment, non-pharmacological and pharmacological approaches, and decision-making. CONCLUSION Dental curricula should be customised to solve the misconceptions and promote a comprehensive and positive attitude to DA/DF/DBMP by paediatric oral healthcare practitioners.
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Affiliation(s)
- Luciane R Costa
- Paediatric Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Cristiane B Bendo
- Department of Children's and Adolescents' Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Anelise Daher
- Paediatric Dentist, Brazilian Dental Association - Goiás section, Goiânia, Brazil
| | - Ellie Heidari
- Department of Sedation and Special Care Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - Renata Sá Rocha
- Faculty of Dentistry, Universidade Federal de Campina Grande, Patos, Brazil
| | | | | | - Avijit Banerjee
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - J Tim Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Marie T Hosey
- Paediatric Dentistry Centre of Oral Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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20
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Skaljic M, McGinnis A, Streicher JL. Comfort positioning during procedures in pediatric dermatology. Pediatr Dermatol 2020; 37:396-398. [PMID: 31990421 DOI: 10.1111/pde.14089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Procedures performed in pediatric dermatology can often be painful or distressing for patients and their families. Comfort positioning, which involves sitting the child upright, immobilized and held by a caretaker, is one strategy that may be employed in this setting; this measure has been shown to reduce patient distress, improve cooperation and give caretakers a more active role in the procedure. We demonstrate several positions of comfort for dermatologic procedures involving the arm, cheek, back and leg of a young child.
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Affiliation(s)
- Meliha Skaljic
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jenna L Streicher
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
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21
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Green SM, Roback MG, Krauss BS, Miner JR, Schneider S, Kivela PD, Nelson LS, Chumpitazi CE, Fisher JD, Gesek D, Jackson B, Kamat P, Kowalenko T, Lewis B, Papo M, Phillips D, Ruff S, Runde D, Tobin T, Vafaie N, Vargo J, Walser E, Yealy DM, O'Connor RE. Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline. Ann Emerg Med 2020; 73:e51-e65. [PMID: 31029297 DOI: 10.1016/j.annemergmed.2019.02.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 11/15/2022]
Abstract
The American College of Emergency Physicians (ACEP) organized a multidisciplinary effort to create a clinical practice guideline specific to unscheduled, time-sensitive procedural sedation, which differs in important ways from scheduled, elective procedural sedation. The purpose of this guideline is to serve as a resource for practitioners who perform unscheduled procedural sedation regardless of location or patient age. This document outlines the underlying background and rationale, and issues relating to staffing, practice, and quality improvement.
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22
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Walther-Larsen S, Petersen T, Friis SM, Aagaard G, Drivenes B, Opstrup P. Immersive Virtual Reality for Pediatric Procedural Pain: A Randomized Clinical Trial. Hosp Pediatr 2019; 9:501-507. [PMID: 31160472 DOI: 10.1542/hpeds.2018-0249] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Pain management in children often is inadequate, and the single most common painful procedure in children who are hospitalized is needle procedures. Virtual reality (VR) is a promising and engaging intervention that may help to decrease anxiety and pain in children undergoing painful procedures. Our aim for this study is to investigate patient satisfaction and pain reduction by using a three-dimensional VR interactive game as a distraction. METHODS In this randomized clinical trial, we enrolled 64 children aged 7 to 16 years who were scheduled for venous cannulation. Patients assigned to the control group were adherent to our standard of care, including topical numbing cream, positioning, and distraction by a specialized pain nurse. In the study group, children were adherent to the standard of care and were distracted by an interactive VR game. Primary outcomes were patient satisfaction and the procedural pain assessed by using a visual analog score; secondary outcomes were the procedural time and any adverse events. RESULTS We found a high level of patient satisfaction with using the VR custom-made three-dimensional interactive game. All children (28 of 28 [100%]) in the VR group answered that they would prefer VR as a distraction for a later procedure, a borderline significant result compared with that of the control group (26 of 31 [84.9%]). No significant difference was found in pain scores and procedural times between the 2 groups. The number of adverse effects was low, with no significant difference between the 2 groups. CONCLUSIONS We found no difference in pain scores but higher satisfaction when using VR versus standard care as part of a multimodal approach for management of procedural pain in children.
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Affiliation(s)
- Søren Walther-Larsen
- The Pediatric Pain Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Trine Petersen
- The Pediatric Pain Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Susanne M Friis
- The Pediatric Pain Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Gitte Aagaard
- The Pediatric Pain Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Bergitte Drivenes
- The Pediatric Pain Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Pernille Opstrup
- The Pediatric Pain Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
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23
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Zielinska M, Bartkowska-Sniatkowska A, Becke K, Höhne C, Najafi N, Schaffrath E, Simic D, Vittinghoff M, Veyckemans F, Morton N. Safe pediatric procedural sedation and analgesia by anesthesiologists for elective procedures: A clinical practice statement from the European Society for Paediatric Anaesthesiology. Paediatr Anaesth 2019; 29:583-590. [PMID: 30793427 DOI: 10.1111/pan.13615] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/29/2019] [Accepted: 02/16/2019] [Indexed: 12/21/2022]
Abstract
The growing number of medical procedures performed in children that require cooperation of patients, lack of movement, anxiolysis or/and analgesia triggers the increased need for procedural sedation. This document presents the consensus statement of the European Society for Paediatric Anaesthesiology about the principles connected with the safe management of procedural sedation and analgesia (PSA) by anaesthesiologists for elective procedures in children. It does not aim to provide a legal statement on how and by whom PSA should be performed. The document highlights that any staff taking part in sedation of children must be appropriately trained with the required competencies and must be able to demonstrate regularly that they have maintained their knowledge, skills and clinical experience. The main goal of creating this document was to reflect the opinions of the community of the paediatric anaesthesiologists in Europe regarding how PSA for paediatric patients should be organized to make it safe.
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Affiliation(s)
- Marzena Zielinska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Alicja Bartkowska-Sniatkowska
- Department of Paediatric Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Karin Becke
- Department of Anaesthesiology, Paediatric Anaesthesiology and Intensive Care Medicine, Cnopf Childrens Hospital, Hospital Hallerwiese, Nürnberg, Germany
| | - Claudia Höhne
- Department of Anaesthesiology, Intensive Medicine and Pain Medicine, DRK Hospitals Berlin, Koepnick, Berlin, Germany
| | - Nadia Najafi
- Department of Anaesthesia and Perioperative Medicine, University Hospital Brussel, Free University of Brussels, Brussels, Belgium
| | - Eva Schaffrath
- Department of Anesthesiology, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Dusica Simic
- Department of Pediatric Anesthesia and Intensive Care, University Children`s Hospital, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Maria Vittinghoff
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Francis Veyckemans
- Section of Paediatric Anaesthesia, Hospital Jeanne de Flandre, Lille, France
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Affiliation(s)
- Benjamin A Krauss
- Division of Emergency Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Baruch S Krauss
- Division of Emergency Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA.
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Brown JJ, Gray JM, Roback MG, Sethuraman U, Farooqi A, Kannikeswaran N. Procedural sedation in children with autism spectrum disorders in the emergency department. Am J Emerg Med 2018; 37:1404-1408. [PMID: 30528052 DOI: 10.1016/j.ajem.2018.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED. METHODS We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009-December 2016. Data were collected on children 1-18 years of age with ASD who were sedated in the ED. RESULTS There were 6020 ED visits by children with ASD, 126 (2.1%) of whom received sedation. The most frequent indications for sedation were laceration repair (24.6%), incision and drainage (17.5%), diagnostic imaging (14.3%), and physical examination (11.9%). The most common sedatives used were ketamine (50.8%) and midazolam (50.8%). Ketamine was most commonly given intravenously (71.9%), while midazolam was usually given intranasally (71.9%). Procedures could not be completed in 4 (3.2%) patients, and adverse events were noted in 23 (18.3%) patients. Only four (3.2%) patients required supplemental oxygenation, and one received positive pressure ventilation. CONCLUSIONS Children with autism in the ED commonly received sedation; one in four of which were for non-painful diagnostic procedures or physical examination. Over one-third received sedation via a non-parenteral route for intended minimal sedation. Sedative medication dosing and observed adverse events were similar to those reported previously in children without ASD. Emergency providers must be prepared to meet the unique sedation needs of children with ASD.
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Affiliation(s)
- James J Brown
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America.
| | - James M Gray
- University of Minnesota Medical School, Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America
| | - Mark G Roback
- University of Minnesota Medical School, Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America
| | - Usha Sethuraman
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
| | - Ahmad Farooqi
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
| | - Nirupama Kannikeswaran
- Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
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Engvall G, Lindh V, Mullaney T, Nyholm T, Lindh J, Ångström-Brännström C. Children's experiences and responses towards an intervention for psychological preparation for radiotherapy. Radiat Oncol 2018; 13:9. [PMID: 29357940 PMCID: PMC5778737 DOI: 10.1186/s13014-017-0942-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children can experience distress when undergoing radiotherapy as a reaction to being scared of and unfamiliar with the procedure. The aim was to evaluate children's experiences and responses towards an intervention for psychological preparation for radiotherapy. METHODS A case control design with qualitative content analysis of semi-structured interviews and statistical analysis of anxiety ratings were used for evaluating a strategy for psychological preparation and distraction. Fifty-seven children aged 2 to 18 years and their parents participated - 30 children in the baseline group and 27 in the intervention group. Child interviews were performed and the child and their parents rated the child's anxiety. RESULTS The intervention was most appropriate for the younger children, who enjoyed the digital story, the stuffed animal and training with their parents. There were some technical problems and the digital story was not detailed enough to fit exactly with various cancer diagnoses. Children described suggestions for improvement of the intervention. The ratings of the child's anxiety during radiation treatment showed no differences between the baseline group and the intervention group. CONCLUSIONS The children of all the age groups experienced their interventions as positive. The strength of the intervention was that it encouraged interaction within the family and provided an opportunity for siblings and peers to take part in what the child was going through. Future research on children's experiences to interventions should be encouraged. The intervention and the technical solutions could improve by further development. TRIAL REGISTRATION The study design was structured as an un-matched case-control study, baseline group vs. intervention group. TRIAL REGISTRATION ClinicalTrials.gov NCT02993978 , Protocol Record 2012-113-31 M. Retrospectively registered - 21 November 2016.
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Affiliation(s)
- Gunn Engvall
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Viveca Lindh
- Department of Nursing, Umea University, Umea, Sweden
| | | | - Tufve Nyholm
- Department of Radiation Sciences, Umea University, Umea, Sweden
| | - Jack Lindh
- Department of Radiation Sciences, Umea University, Umea, Sweden
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Gomes HS, Miranda AR, Viana KA, Batista AC, Costa PS, Daher A, Machado GDCM, Sado-Filho J, Vieira LAC, Corrêa-Faria P, Hosey MT, Costa LR. Intranasal sedation using ketamine and midazolam for pediatric dental treatment (NASO): study protocol for a randomized controlled trial. Trials 2017; 18:172. [PMID: 28399933 PMCID: PMC5387269 DOI: 10.1186/s13063-017-1919-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/29/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Uncooperative children may need to receive dental treatment under sedation, which is indicated when nonpharmacological behavior guidance is unsuccessful. There are randomized controlled trials (RCTs) comparing different sedative protocols for dental procedures; however, the evidence for superiority of one form over another is weak. The primary aim of this study is to investigate the efficacy of intranasally administered ketamine plus midazolam for the dental treatment of children. METHODS We have designed a three-armed, parallel RCT to assess intranasal sedation using ketamine/midazolam in terms of the following measures: efficacy, safety, and cost-effectiveness. Two- to 6-year-old healthy children, referred for dental treatment in a dental sedation center in Brazil due to uncooperative behavior and requiring restorative dental procedures, will be recruited. Each child will be randomly assigned to one of the three groups: A - Intranasal administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.2 mg/kg, maximum 5.0 mg); B - Oral administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.5 mg/kg, maximum 20 mg); and C - Oral administration of midazolam (1.0 mg/kg, maximum 20 mg). The primary outcome is the child's behavior assessed through an observational scale using digital videos of the restorative dental treatment under sedation. The secondary outcomes are as follows: acceptance of sedative administration; memory of intraoperative events; the child's stress; adverse events; the child's pain during the procedure; the parent's, dentists', and child's perceptions of sedation; and economic analysis. Measures will be taken at baseline and drug administration and during and after the dental procedure. The necessary sample size was estimated to be 84 children after a blinded interim analysis of the first 30 cases. DISCUSSION This study will provide data that can substantially add to science and pediatric dentistry as it examines the effect of sedative regimes from different perspectives (outcomes). TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02447289 . Registered on 11 May 2015, named "Midazolam and Ketamine Effect Administered Through the Nose for Sedation of Children for Dental Treatment (NASO)."
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Affiliation(s)
- Heloisa Sousa Gomes
- Dentistry Graduate Program, Faculdade de Odontologia (FO), Universidade Federal de Goiás (UFG), Goiânia, GO 74605-220 Brazil
| | - Analya Rodrigues Miranda
- Dentistry Graduate Program, Faculdade de Odontologia (FO), Universidade Federal de Goiás (UFG), Goiânia, GO 74605-220 Brazil
| | - Karolline Alves Viana
- Dentistry Graduate Program, Faculdade de Odontologia (FO), Universidade Federal de Goiás (UFG), Goiânia, GO 74605-220 Brazil
| | | | - Paulo Sucasas Costa
- Department of Pediatrics, Faculdade de Medicina (FM), UFG, Goiânia, GO 74605-020 Brazil
| | - Anelise Daher
- Dentistry Graduate Program, Faculdade de Odontologia (FO), Universidade Federal de Goiás (UFG), Goiânia, GO 74605-220 Brazil
| | | | - Joji Sado-Filho
- Health Sciences Graduate Program, FM/UFG, Goiânia, GO 74605-020 Brazil
| | | | - Patrícia Corrêa-Faria
- Dentistry Graduate Program, Faculdade de Odontologia (FO), Universidade Federal de Goiás (UFG), Goiânia, GO 74605-220 Brazil
| | - Marie Therese Hosey
- Pediatric Dentistry, Division of Population and Patient Health, King’s College London Dental Institute, Bessemer Road, London, SE5 9RS UK
| | - Luciane Rezende Costa
- Department of Oral Health, FO/UFG, Goiânia, GO 74605-220 Brazil
- Faculdade de Odontologia, Universidade Federal de Goiás, Primeira Avenida, Setor Universitário, CEP: 74605-220 Goiânia, Goiás Brazil
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Ullsten A. Family-centred music intervention - an emotional factor that modulates, modifies and alleviates infants' pain experiences. Acta Paediatr 2017; 106:361-362. [PMID: 28186375 DOI: 10.1111/apa.13731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alexandra Ullsten
- Department of Musicology; Örebro University; Örebro Sweden
- Music and Art Therapy Department; Värmland County Council; Karlstad Sweden
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