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Canbulat Sahiner N, Ates Besirik S, Koroglu AY, Dilay S. The effectiveness of using animal-themed vacutainers to reduce pain and fear in children during bloodletting. Int Emerg Nurs 2025; 78:101549. [PMID: 39626519 DOI: 10.1016/j.ienj.2024.101549] [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: 06/16/2024] [Revised: 11/08/2024] [Accepted: 11/25/2024] [Indexed: 01/27/2025]
Abstract
INTRODUCTION This study aimed to compare the effects of vacutainers of three different animal characters on pain and fear in children during bloodletting. METHODS This randomized controlled trial included 180 children between the ages of 4 and 7 years who required bloodletting for routine control. Children were randomized into two groups: experimental and control groups. Routine bloodletting procedure was applied to those in the control group. Animal characters (butterfly, peacock and rabbit) chosen by children in the experimental group was attached to the vacutainer, and then their blood was drawn. The data were obtained by face-to-face interviews with the child, parent and observer before and after the procedure. Children's pain and fear/anxiety levels were evaluated using the Wong-Baker FACES Pain Scale and the Children's Fear Scale, respectively. RESULTS There was no statistically significant difference between the groups' pre-test scores with respect to age, BMI, gender, fear/anxiety assessments of the child, parent, and observer. Children in the experimental group had significantly lower pain and fear/anxiety levels after the procedure compared to those in the control group(p < 0.000). CONCLUSIONS Animal characters (butterfly, peacock and rabbit) attached to the vacutainer is effective in reducing both fear and pain levels in children during bloodletting.
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Affiliation(s)
- Nejla Canbulat Sahiner
- Karamanoglu Mehmetbey University Health Science Faculty, Nursing Department, Karaman, Turkey.
| | - Selda Ates Besirik
- Burdur Mehmet Akif Ersoy University, Bucak School of Health, Department of Nursing, Department of Pediatric Nursing, Burdur, Turkey.
| | | | - Seda Dilay
- Karamanoglu Mehmetbey University, Karaman, Turkey.
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2
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Chisenga CC, Phiri B, Ng'ombe H, Muchimba M, Liswaniso F, Bernshtein B, Cunningham AF, Sack D, Bosomprah S. Diagnostic accuracy of saliva-based testing as a Vibrio cholerae surveillance tool among naturally infected patients. Clin Exp Immunol 2025; 219:uxae092. [PMID: 39432681 DOI: 10.1093/cei/uxae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/29/2024] [Accepted: 10/16/2024] [Indexed: 10/23/2024] Open
Abstract
Saliva, as a diagnostic medium, offers a promising alternative to blood by virtue of its non-invasive collection, which enhances patient compliance, especially in paediatric and geriatric populations. In this study, we assessed the utility of saliva as a non-invasive medium for measuring Vibrio cholerae-specific serum antibodies in naturally infected individuals. We tested paired serum and saliva samples obtained from a total of 63 patients with cholera enrolled in a cohort study. Vibriocidal antibodies assay (IgM/IgG) as markers for accurate determination was used to determine cholera-specific antibody levels. Using receiver operating characteristics (ROC) curve, we found that the best cut-off that maximizes (sensitivity + specificity) is 10 titres. At this saliva titre, the sensitivity is 76.9% (95%CI: 60.9%, 87.7%) and specificity is 80.0% (95%CI: 56.6%, 92.5%). Using Spearman's correlation coefficient, we also found evidence of a positive correlation between V. cholerae saliva and serum antibodies (rho = 0.66, P < 0.001). In conclusion, saliva-based diagnostic cholera tests have high diagnostic accuracy and would be advantageous, cheaper, and quicker for early diagnosis of severe cholera outcomes.
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Affiliation(s)
- Caroline C Chisenga
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Phiri
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Harriet Ng'ombe
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mutinta Muchimba
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Fraser Liswaniso
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, UK
| | - David Sack
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samuel Bosomprah
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
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Saifullah KM, Mushtaq A, Azarikhah P, Prewett PD, Davies GJ, Faraji Rad Z. Micro-vibration assisted dual-layer spiral microneedles to rapidly extract dermal interstitial fluid for minimally invasive detection of glucose. MICROSYSTEMS & NANOENGINEERING 2025; 11:3. [PMID: 39774609 PMCID: PMC11706973 DOI: 10.1038/s41378-024-00850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/26/2024] [Accepted: 11/21/2024] [Indexed: 01/11/2025]
Abstract
Various hydrogels have been explored to create minimally invasive microneedles (MNs) to extract interstitial fluid (ISF). However, current methods are time-consuming and typically require 10-15 min to extract 3-5 mg of ISF. This study introduces two spiral-shaped swellable MN arrays: one made of gelatin methacryloyl (GelMA) and polyvinyl alcohol (PVA), and the other incorporating a combination of PVA, polyvinylpyrrolidone (PVP), and hyaluronic acid (HA) for fast ISF extraction. These MN arrays demonstrated a rapid swelling ratio of 560 ± 79.6% and 370 ± 34.1% in artificial ISF within 10 min, respectively. Additionally, this study proposes a novel method that combines MNs with a custom-designed Arduino-based applicator vibrating at frequency ranges (50-100 Hz) to improve skin penetration efficiency, thereby enhancing the uptake of ISF in ex vivo. This dynamic combination enables GelMA/PVA MNs to rapidly uptake 6.41 ± 1.01 mg of ISF in just 5 min, while PVA/PVP/HA MNs extract 5.38 ± 0.77 mg of ISF within the same timeframe. To validate the capability of the MNs to recover glucose as the target biomarker, a mild heating procedure is used, followed by determining glucose concentration using a D-glucose content assay kit. The efficient extraction of ISF and glucose detection capabilities of the spiral MNs suggest their potential for rapid and minimally invasive biomarker sensing.
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Affiliation(s)
- Khaled Mohammed Saifullah
- School of Engineering, University of Southern Queensland, Springfield, QLD, 4300, Australia
- Centre for Future Materials, Institute for Advanced Engineering and Space Sciences, University of Southern Queensland, Springfield, QLD, Australia
| | - Asim Mushtaq
- Centre for Future Materials, Institute for Advanced Engineering and Space Sciences, University of Southern Queensland, Springfield, QLD, Australia
| | - Pouria Azarikhah
- School of Engineering, University of Southern Queensland, Springfield, QLD, 4300, Australia
- Centre for Future Materials, Institute for Advanced Engineering and Space Sciences, University of Southern Queensland, Springfield, QLD, Australia
| | - Philip D Prewett
- School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
- Oxacus Ltd, Dorchester-on-Thames, OX10 7HN, UK
| | - Graham J Davies
- Faculty of Engineering, UNSW Australia, Sydney, NSW, 2052, Australia
- College of Engineering & Physical Sciences, School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Zahra Faraji Rad
- School of Engineering, University of Southern Queensland, Springfield, QLD, 4300, Australia.
- Centre for Future Materials, Institute for Advanced Engineering and Space Sciences, University of Southern Queensland, Springfield, QLD, Australia.
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Siegel P, Peterson BS. Advancing the treatment of anxiety disorders in transition-age youth: a review of the therapeutic effects of unconscious exposure. J Child Psychol Psychiatry 2025; 66:98-121. [PMID: 39128857 PMCID: PMC11652263 DOI: 10.1111/jcpp.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The real-world effectiveness of exposure-based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions. METHODS A PRISMA-based search yielded 20 controlled experiments based on three paradigms that tested if fear-related responses could be reduced without conscious awareness in highly phobic, transition-age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta-analyses of outcomes where feasible. RESULTS Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's d = 0.51-0.95) and self-reported fear (d = 0.45-1.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (d = 0.54-0.62) and concomitant physiological arousal (d = 0.55-0.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (d = 1.2-1.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (d = 0.70); (5) evoked ERPs suggesting encoding of extinction memories (d = 2.13); and (6) had these effects without inducing autonomic arousal or subjective fear. CONCLUSIONS Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition-age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. However, a number of limitations must be addressed to assess potential clinical impacts, including combining unconscious exposure with exposure therapy to boost treatment acceptance and efficacy.
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Affiliation(s)
- Paul Siegel
- Department of Psychology, Purchase College, State University of New York, Purchase, NY, USA
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bradley S. Peterson
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Psychiatry, Children’s Hospital Los Angeles, Institute for the Developing Mind, Los Angeles, CA, USA
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Ten Berg F, Hessels J, Hosman A, Boerman S, Post MC, Balemans WAF, Mager HJ. Conservative Pulmonary Arteriovenous Malformation Screening in Children: Re-Evaluation of Safety. Pediatr Pulmonol 2025; 60:e27476. [PMID: 39789946 DOI: 10.1002/ppul.27476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 12/23/2024] [Accepted: 12/25/2024] [Indexed: 01/12/2025]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disease and screening to detect pulmonary arteriovenous malformations (PAVMs) is important to prevent complications. In adults, transthoracic contrast echocardiogram (TTCE) is used to screen PAVMs. In children, a conservative screening method seems to be sufficient to rule out major PAVMs and prevent them from PAVM-related complications. This study reevaluates the conservative noninvasive screening method using a larger cohort of children screened for HHT. METHODS This single-center observational cohort study includes children screened between December 1998 and December 2022. The screening consisted of medical history, physical examination, pulse oximetry, and chest radiography. Data regarding screening, PAVM presence and complications (including transient ischemic attack, stroke, brain abscess and hemoptysis) were collected using the Dutch HHT-patient database. RESULTS In total, 600 children, mean age 9.9 years (SD 4.3) were screened for the presence of PAVMs. None of the 600 children screened suffered any PAVM-related complications after a total of 7102 years of patient follow-up (251 children [42%] with a definite HHT-diagnosis, accounting for 3232 years of follow-up). In 32 patients (13% of children with HHT), a treatable PAVM was found during childhood. CONCLUSION This study confirms that a conservative PAVM screening method in children is safe to prevent complications related to PAVMs. Small PAVMs will be missed using this conservative approach, but without an increased risk of complications.
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Affiliation(s)
- Fleur Ten Berg
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Josefien Hessels
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Anna Hosman
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Sanne Boerman
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Walter A F Balemans
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Hans-Jurgen Mager
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Akay G, Uzun S, Oğuzhan H, Güdücü Tüfekci F. The Effect of storybook use in pediatric health services on children's fear and anxiety levels: A meta-analysis study. J Pediatr Nurs 2024:S0882-5963(24)00451-2. [PMID: 39730287 DOI: 10.1016/j.pedn.2024.12.006] [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: 08/22/2024] [Revised: 12/08/2024] [Accepted: 12/08/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND Invasive procedures are commonly used in pediatric healthcare, and storybooks can be used as an adjunct analgesic method. OBJECTIVES This study was conducted to evaluate the effectiveness of using storybooks as a distraction technique to reduce fear and anxiety in pediatric healthcare. This study was conducted with the aim of revealing the level of effect of storybook use on children's fear and anxiety level in pediatric health services. METHODS For this meta-analysis study, the studies were obtained by searching PubMed, Web of Scıence, Scopus, EBSCOhost, Google Scholar and YÖK Thesis Center databases in April-June 2024 without any year limitation. After the reviews, 15 studies were included in the study. The data were synthesized by meta-analysis and narrative methods. FINDINGS In this meta-analysis, it was found that storybook use in pediatric health services was effective on children's anxiety (SMD: -4.412, 95 % CI: -7.727 to -1.097; Z = -2.608, p = 0.009; I2 = 99.890 %) and fear (SMD: -1.13, 95 % CI: -1.71 to -0.54; Z = -3.78, p = 0.000; I2 = 83.065 %) levels. In addition, it was determined that the characteristics of the intervention group, age group, the characteristics and content of the storybook, the duration of the intervention and the time of the intervention played a role in the effectiveness of the storybook use intervention in pediatric health services on children's anxiety and fear levels. CONCLUSION The use of story books in children's health services reduces the level of fear and anxiety in children.
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Affiliation(s)
- Gamze Akay
- Artvin Coruh University, Faculty of Health Sciences, Department of Nursing, Artvin, Turkey.
| | - Sevda Uzun
- Department of Psychiatry Nursing, Gümüşhane University Faculty of Health Sciences, Gümüşhane, Turkey.
| | - Hatice Oğuzhan
- Gümüşhane University Vocational School of Health Services, Gümüşhane, Turkey.
| | - Fatma Güdücü Tüfekci
- Department of Child Health and Diseases Nursing, Atatürk University Faculty of Nursing, Erzurum, Turkey.
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Ma P, Li G, Meng D, Gan R, Fang P, Gao C, Wang D. The effects of increased screen time on post-surgical pain and pain memory among children with sleep-disordered breathing. Am J Otolaryngol 2024; 46:104550. [PMID: 39689419 DOI: 10.1016/j.amjoto.2024.104550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 11/28/2024] [Indexed: 12/19/2024]
Abstract
Adenotonsillectomy procedures can provide effective relief to children affected by sleep-disordered breathing (SDB), but the post-adenotonsillectomy pain management remains challenging, and the most effective approach to managing postoperative pain in these cases remains uncertain. The use of electronic media as a form of distraction therapy aimed at mitigating postoperative pain in children, it is unknown whether increases in screen time can effectively reduce persistent postoperative pain intensity or the incidence of negatively biased pain memories. A total of 107 SDB children undergoing adenotonsillectomy were enrolled and divided into two groups. Children in the intervention group were allowed to increase their screen time, while screen time was restricted for children in the control group. Child-reported pain intensity and negatively biased pain memories, pain-related fear were analyzed. The results indicated that no significant differences in initial postoperative pain intensity or fear were observed among groups. However, children in the intervention group did exhibit significantly reduced remembered Day 1 postoperative pain intensity (ηp2 = 0.043, p = 0.035), memory of worst pain intensity (ηp2 = 0.047, p = 0.027), and memory of worst pain-related fear (ηp2 = 0.042, p = 0.036) as compared to controls. Subgroup analyses based on age and gender indicated that males and school-aged children presented with lower scores for negatively biased pain memories. Our study exhibited the association between screen time and post-surgical pain intensity and negatively biased pain memories, These findings suggest that increasing screen time represents an effective approach to the postoperative management of negatively biased pain memories in certain subsets of children with SDB.
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Affiliation(s)
- Pengcheng Ma
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Otorhinolaryngology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Gang Li
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dongdong Meng
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruijia Gan
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ping Fang
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chaobing Gao
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong Wang
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Yun R, Kennedy KM, Titzler J, Ganesan A, Yamaguchi C, Zuniga-Hernandez M, Renavikar M, Brinda R, Jackson C, Rohovit S, Caruso TJ. A prospective, observational study of a pediatric affect and cooperation scale (HRAD±) for vascular access procedures. J Vasc Access 2024:11297298241302897. [PMID: 39639512 DOI: 10.1177/11297298241302897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Anxiety is common in pediatric patients, especially during vascular access procedures. Most well-studied affect and anxiety scales, including the Observation Scale of Behavioral Distress-Revised (OSBD-r), the modified Yale Preoperative Anxiety Scale (mYPAS), and the modified Induction Compliance Checklist (mICC), are too cumbersome for clinical use outside of research settings. HRAD± (Happy, Relaxed, Anxious, Distressed with yes/no to cooperation) is a clinically-efficient observational scale that evaluates pediatric procedural affect and cooperation. This study examined the clinical utility of HRAD± during vascular access procedures in children. The aims were to investigate the correlation of HRAD± to highly reliable, research-based affect and cooperation scales and to assess inter-rater reliability (IRR) between observers in this setting. METHODS This was a prospective, observational study conducted at Lucile Packard Children's Hospital Stanford. Inpatient participants were 1 month to 25 years old and undergoing a peripheral intravenous insertion or phlebotomy. Two trained research assistants (RAs) scored each patient independently during the vascular access procedure using HRAD±, OSBD-r, mYPAS, and mICC. Correlation analyses computed the associations between HRAD± and reference scales. IRR between RAs and vascular access providers was calculated using Fleiss' Kappa. RESULTS A total of 234 patients were included. HRAD± scores strongly correlated with OSBD-r and mYPAS (p < 0.0001, p < 0.0001, respectively). The cooperation assessment of HRAD± demonstrated strong correlation to mICC (p < 0.0001). IRR of HRAD± between research assistants and vascular access providers showed moderate agreement (p < 0.0001). CONCLUSION HRAD± demonstrated strong correlation to the reference affect and cooperation scales. This study supports the utility of HRAD± for rapid assessment of pediatric procedural anxiety and cooperation during vascular access procedures. HRAD± can serve as a practical tool for facilitating clinical decisions, and its wider incorporation into healthcare settings would importantly guide targeted interventions to reduce patient anxiety.
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Affiliation(s)
- Romy Yun
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | | | - Janet Titzler
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Avani Ganesan
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Craig Yamaguchi
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | | | - Meghana Renavikar
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Ryan Brinda
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Christian Jackson
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Stacie Rohovit
- Department of Neonatal Critical Care, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
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Segers EW, van den Hoogen A, Schoonhoven L, van de Putte EM, Ketelaar M. How to meet coping strategies and preferences of children during invasive medical procedures: perspectives of healthcare professionals. Eur J Pediatr 2024; 183:5291-5301. [PMID: 39384648 PMCID: PMC11527922 DOI: 10.1007/s00431-024-05802-1] [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: 07/29/2024] [Revised: 09/12/2024] [Accepted: 09/27/2024] [Indexed: 10/11/2024]
Abstract
Children with negative procedural experiences have an increased risk of fear and distress, with psychological consequences for subsequent procedures and future healthcare behaviors. Gaining control and feeling trust are important aspects for children to decrease fear. To enable professionals providing personal care during medical procedures, a systematic, evidence-based approach that supports children in expressing their preferences is needed. This study will gain insight into the experiences and needs of professionals involved in small invasive medical procedures to meet the coping strategies and preferences of children undergoing these procedures. A qualitative design was used to gain insight into professionals' perspectives. Data were collected through online focus groups with various professionals involved in medical procedures, such as anesthetists, laboratory staff, nurses, and pediatricians. Five interdisciplinary focus groups, with a total of 32 participants, were held. One overarching theme was revealed: "Balancing between different actors within the context of the hospital." Professionals reported they had to deal with different actors during a medical procedure: the child, the parent, the colleague, and themselves. Each actor had its own interests. They were aware of the child and parents' priority to gain control and feel trust. Nevertheless, they perceive organizational and personal aspects that hinder addressing these needs. CONCLUSION To provide personalized care, professionals experience balancing between the needs and interests of diverse actors during medical procedures. The findings underscore the importance of a policy supporting HCPs in integrating patient-centered care into practice through practical tools and training initiatives such as scenario training. WHAT IS KNOWN • Unresolved pain and stress arising from medical procedures can have significant short- and long-term impacts on children. Empowering children to gain control and fostering a sense of trust are crucial factors in reducing fear associated with medical procedures. • 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. WHAT IS NEW • Healthcare professionals vary in their awareness of children's needs during a medical procedure. Beside this, the organizational dynamics of the hospital, along with the presence of actors such as the child, parent, colleague, and oneself, collectively influence the conduct of medical procedures. • Providing person-centered care during medical procedures can present challenges. The results highlight the significance of a policy to assist healthcare professionals in incorporating patient-centered care into their practice through practical tools and a culture of self-reflections regarding patient-centered values.
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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.
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre 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
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, 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
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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10
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Signorelli C, Kelada L, Wakefield CE, Alchin JE, Adam I, Hoffmann P. Pilot testing "Teach Ted": A digital application for children undergoing blood tests and their parents. PEC INNOVATION 2024; 4:100251. [PMID: 38274175 PMCID: PMC10808896 DOI: 10.1016/j.pecinn.2023.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
Objective In this pilot study, we evaluated the acceptability and preliminary evidence of the impact of a new educational mobile application, "Teach Ted", for children undergoing blood tests. Methods Parents of children (4-10 years) completed questionnaires on anxiety and pain before their child had a blood test, and after using Teach Ted and receiving their blood test. Health professionals at each patient's blood test (e.g. technician/nurse) completed questionnaires on patient outcomes and procedure-related outcomes (e.g. time taken). Results Nine parents and eight health professionals participated. All but one parent (n = 8/9) reported Teach Ted was useful. Seventy-eight percent (n = 7/9) reported they would use Teach Ted again. All health professionals who completed the acceptability measure (n = 3/3) strongly agreed that Teach Ted was relevant/helpful. Many parents perceived Teach Ted helped reduce their/child's anxiety (n = 3/5, 60% and n = 4/6, 67% respectively), although child's pain and child's/parent's anxiety remained similar before and after using Teach Ted (all p > 0.05). The average blood test duration was 7.6 min (range ≤1 to 22), which health professionals (n = 3/3) reported was not elongated by offering Teach Ted. Conclusions Participants reported that Teach Ted was acceptable. Further evaluation of Teach Ted's impact on patient's outcomes are needed. Innovation Teach Ted is an innovative mobile application with potential to educate young children about their upcoming procedure and mitigate negative outcomes.
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Affiliation(s)
- Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Lauren Kelada
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Claire E. Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Joseph E. Alchin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Irene Adam
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Peta Hoffmann
- Acute Allied Health Services, Canberra Hospital, ACT, Australia
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11
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Ballard A, Khadra C, Fortin O, Guingo E, Trottier ED, Bailey B, Poonai N, Le May S. Cold and vibration for children undergoing needle-related procedures: A non-inferiority randomized clinical trial. PAEDIATRIC & NEONATAL PAIN 2024; 6:164-173. [PMID: 39677026 PMCID: PMC11645969 DOI: 10.1002/pne2.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 04/18/2024] [Accepted: 05/21/2024] [Indexed: 12/17/2024]
Abstract
The use of a rapid, easy-to-use intervention could improve needle-related procedural pain management practices in the context of the Emergency Department (ED). As such, the Buzzy device seems to be a promising alternative to topical anesthetics. The aim of this study was to determine if a cold vibrating device was non-inferior to a topical anesthetic cream for pain management in children undergoing needle-related procedures in the ED. In this randomized controlled non-inferiority trial, we enrolled children between 4 and 17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to either the cold vibrating device or topical anesthetic (4% liposomal lidocaine; standard of care). The primary outcome was the mean difference (MD) in adjusted procedural pain intensity on the 0-10 Color Analogue Scale (CAS), using a non-inferiority margin of 0.70. A total of 352 participants were randomized (cold vibration device n = 176, topical anesthetic cream n = 176). Adjusted procedural pain scores' MD between groups was 0.56 (95% CI:-0.08-1.20) on the CAS, showing that the cold vibrating device was not considered non-inferior to topical anesthetic. The cold vibrating device was not considered non-inferior to the topical anesthetic cream for pain management in children during a needle-related procedure in the ED. As topical anesthetic creams require an application time of 30 min, cost approximately CAD $40.00 per tube, are underused in the ED setting, the cold vibrating device remains a promising alternative as it is a rapid, easy-to-use, and reusable device.
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Affiliation(s)
- Ariane Ballard
- Faculty of NursingUniversité de MontréalMontréalQuebecCanada
- CHU Sainte‐Justine Research CentreMontréalQuebecCanada
| | - Christelle Khadra
- Faculty of NursingUniversité de MontréalMontréalQuebecCanada
- CHU Sainte‐Justine Research CentreMontréalQuebecCanada
| | | | - Estelle Guingo
- CHU Sainte‐Justine Research CentreMontréalQuebecCanada
- Université du Québec en Abitibi‐TémiscamingueRouyn‐NorandaQuebecCanada
| | - Evelyne D. Trottier
- Department of Pediatric Emergency MedicineCHU Sainte‐JustineMontréalQuebecCanada
- Department of PediatricsUniversité de MontréalMontréalQuebecCanada
| | - Benoit Bailey
- Department of Pediatric Emergency MedicineCHU Sainte‐JustineMontréalQuebecCanada
- Department of PediatricsUniversité de MontréalMontréalQuebecCanada
| | - Naveen Poonai
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
- Children's Health Research Institute, London Health Sciences CentreLondonOntarioCanada
| | - Sylvie Le May
- Faculty of NursingUniversité de MontréalMontréalQuebecCanada
- CHU Sainte‐Justine Research CentreMontréalQuebecCanada
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12
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Wilkirson E, Li D, Lillehoj PB. Lateral Flow-Based Skin Patch for Rapid Detection of Protein Biomarkers in Human Dermal Interstitial Fluid. ACS Sens 2024; 9:5792-5801. [PMID: 39455057 PMCID: PMC11590092 DOI: 10.1021/acssensors.4c00956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/29/2024] [Accepted: 09/06/2024] [Indexed: 10/28/2024]
Abstract
Rapid diagnostic tests (RDTs) offer valuable diagnostic information in a quick, easy-to-use and low-cost format. While RDTs are one of the most commonly used tools for in vitro diagnostic testing, they require the collection of a blood sample, which is painful, poses risks of infection and can lead to complications. We introduce a blood-free point-of-care diagnostic test for the rapid detection of protein biomarkers in dermal interstitial fluid (ISF). This device consists of a lateral flow immunochromatographic assay (LFIA) integrated within a microfluidic skin patch. ISF is collected from the skin using a microneedle array and vacuum-assisted extraction system integrated in the patch, and transported through the lateral flow strip via surface tension. Using this skin patch platform, we demonstrate in situ detection of anti-tetanus toxoid IgG and SARS-CoV-2 neutralizing antibodies, which could be accurately detected in human ISF in <20 min. We envision that this device can be readily modified to detect other protein biomarkers in dermal ISF, making it a promising tool for rapid diagnostic testing.
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Affiliation(s)
- Elizabeth
C. Wilkirson
- Department
of Mechanical Engineering, Rice University, Houston, Texas 77005, United States
| | - Danika Li
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Peter B. Lillehoj
- Department
of Mechanical Engineering, Rice University, Houston, Texas 77005, United States
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
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13
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Ates Besirik S, Canbulat Sahiner N. Comparison of the effectiveness of three different distraction methods in reducing pain and anxiety during blood drawing in children: A randomized controlled study. J Pediatr Nurs 2024; 79:225-233. [PMID: 39303378 DOI: 10.1016/j.pedn.2024.09.009] [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: 04/16/2024] [Revised: 08/20/2024] [Accepted: 09/13/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Healthcare professionals need to use effective pain and anxiety-relieving methods during blood drawing in children. AIM This study aimed to compare the effects of three different distraction methods (Virtual Reality Glasses, Kaleidoscope, and Distraction Cards) in reducing pain and anxiety during blood drawing in children. METHODS This study was a randomized controlled study. The research was conducted on 400 children between the ages of 7 and 11 years who required blood for routine check-ups upon the doctor's request and who met the sample selection criteria. Children were randomized into four groups: Virtual Reality Glasses, Kaleidoscope, Distraction Cards, and Control Group. Data were collected using the Interview and Observation Form, Wong-Baker FACES Pain Rating Scale, and Children's Fear Scale. Wong-Baker FACES and Children's Fear Scale were assessed and reported by children, parent, and observer. FINDINGS Pain assessments of the child, parent, and observer after the procedure, and anxiety assessments of the parent, and observer after the procedure in the Virtual Reality Glasses, Kaleidoscope, and Distraction Cards Group were significantly lower than the Control Group (p < 0.001). CONCLUSIONS All three methods applied to the child during blood drawing were effective in reducing the child's pain and anxiety level. However, it was found that the most effective method to relieve pain and anxiety is virtual reality glasses. PRACTICE IMPLICATIONS These results contribute to the pain and anxiety management of children during blood drawing. CLINICAL TRIAL REGISTRATION NUMBER NCT06192498.
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Affiliation(s)
- Selda Ates Besirik
- Burdur Mehmet Akif Ersoy University, Bucak School of Health, Department of Nursing, Department of Pediatric Nursing, Burdur, Turkey.
| | - Nejla Canbulat Sahiner
- Karamanoglu Mehmetbey University Health Science Faculty, Nursing Department, Karaman, Turkey
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14
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MacNeil M, Hundert A, Campbell-Yeo M. Soothing and Distress Behaviors of Infants, Parents, and Clinicians During Childhood Vaccinations. Pain Manag Nurs 2024; 25:e327-e335. [PMID: 38991909 DOI: 10.1016/j.pmn.2024.05.002] [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: 06/06/2023] [Revised: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The purpose of this study was to describe the behaviors of infants who were born preterm, their parents, and clinicians during 2-, 6-, 12-, and 18-month vaccinations. METHODS Vaccination sessions were video recorded for 3-5 minutes. The proportion of 5-second intervals in which distress and soothing behavior by infants, parents, and clinicians was coded using the Measure of Adult and Infant Soothing and Distress. Coding consisted of three phases: baseline/anticipatory (60 seconds prior to first needle), procedure (first needle to removal of final needle), and recovery (up to 180 seconds after removal of final needle). RESULTS A total of 64 infants were included. Distress behavior by infants during the baseline phase ranged from 13% (12-month vaccinations) to 29% (2-month). There was limited anticipatory soothing behavior from parents (10% [12-month] to 50% [2-month]) and clinicians (6% [12-month] to 17% [2-month]). Distress behavior in infants during the procedure ranged from 43% (18-month) to 96% (2-month). There was limited soothing behavior during the procedure from parents (10% [12-month] to 81% [12-month]) and clinicians (13% [12-month] to 71% [2-month]). Few infants received additional pain-reducing interventions, including skin-to-skin contact, 24% oral sucrose, and topical anesthetic. DISCUSSION Despite infant distress, there was limited anticipatory behavior from parents and clinicians. Two-month-old infants displayed the most distress across all time points yet received the least amount of treatment and proximal parent and clinician behavior. Additional implementation efforts are required to increase awareness and practice uptake among parents and clinicians to ensure infants receive equitable and effective pain management.
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Affiliation(s)
- Morgan MacNeil
- School of Nursing, Dalhousie University, Halifax, NS, Canada; Faculty of Health, Dalhousie University, Halifax, NS, Canada; MOM-LINC Lab, IWK Health, Halifax, NS, Canada
| | | | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, NS, Canada; Faculty of Health, Dalhousie University, Halifax, NS, Canada; MOM-LINC Lab, IWK Health, Halifax, NS, Canada; Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
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15
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Suleman SK, Yahya N, Nilsson S, Enskär K. Comparative efficacy of pharmacological and non-pharmacological interventions for mitigating pain and anxiety associated with venipuncture: a randomised controlled trial. BMJ Paediatr Open 2024; 8:e002881. [PMID: 39251366 PMCID: PMC11733780 DOI: 10.1136/bmjpo-2024-002881] [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: 07/02/2024] [Accepted: 08/21/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Venipuncture is one of the most commonly performed medical procedures in paediatric care, but it can also be one of the most painful and distressing experiences for patients. Finding effective strategies to manage pain and fear associated with venipuncture is crucial for improving the paediatric patient experience and promoting positive health outcomes. This study aimed to evaluate the efficacy of a combined approach using a topical analgesic cream (TKTX cream) and a distraction technique (Trace Image and Colouring for Kids-Book, TICK-B) in reducing pain intensity and fear levels in children undergoing venipuncture procedures. METHODS We conducted this randomised controlled trial among 176 children aged 6-12 years undergoing venipuncture. Participants were randomly assigned to four groups: TICK-B, TKTX cream, TICK-B+TKTX cream and a control group. Pain and fear were measured using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale. The study was carried out from 20 February 2024 to 1 June 2024 at the emergency unit of Heevi paediatric teaching hospital in the Kurdistan region of Iraq. In the intervention groups, TICK-B was applied for 2-3 min before needle insertion, and TKTX cream was applied 20 min before the venipuncture procedure. All outcome measures were evaluated 2-3 min after the completion of the venipuncture procedure. RESULTS The combined TICK-B (colouring book) and TKTX cream (topical anaesthetic) intervention was the most effective in reducing both pain intensity (mean score 2.80 vs 7.24 in the control, p<0.001) and fear levels (mean score 0.93 vs 2.83 in the control, p<0.001) during and after venipuncture procedures compared with individual interventions and control. CONCLUSIONS The combined TICK-B distraction and TKTX cream topical anaesthetic intervention was the most effective in reducing pain intensity and fear during and after venipuncture in children, providing a practical strategy for healthcare providers to optimise needle procedure management. TRIAL REGISTRATION NUMBER NCT06326125.
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Affiliation(s)
| | - Nizer Yahya
- Pedaitric Medicine, University of Duhok School of Medicine, Dohuk City, Iraq
| | - Stefan Nilsson
- Göteborgs universitet Sahlgrenska Akademin, Goteborg, Sweden
| | - Karin Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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16
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Chen MKY, Sebaratnam DF. Light at the end of the tunnel: Laser in pediatric patients. J Am Acad Dermatol 2024:S0190-9622(24)02811-1. [PMID: 39251028 DOI: 10.1016/j.jaad.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024]
Affiliation(s)
- Michelle K Y Chen
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia; South Western Sydney Clinical Campuses, Liverpool Hospital, Liverpool, NSW, Australia.
| | - Deshan F Sebaratnam
- South Western Sydney Clinical Campuses, Liverpool Hospital, Liverpool, NSW, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
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17
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Galst IM, Høxbro Knudsen M, Hjuler T. Distracting children with virtual reality during otomicroscopy: A randomised control trial. Int J Pediatr Otorhinolaryngol 2024; 184:112045. [PMID: 39121683 DOI: 10.1016/j.ijporl.2024.112045] [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: 04/19/2024] [Revised: 06/25/2024] [Accepted: 07/14/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Virtual Reality (VR) is a successful distraction method for reducing procedure-related pain in children, though it has never been studied during otomicroscopy. Therefore, we investigated the efficacy of VR as a distraction method during otomicroscopy. METHODS This Randomised Control Trial (RCT) included 60 children aged 4-15 years. The patients were randomised to receive distraction by VR, tablet, or no distraction. Procedure-related pain was scored by patients and compared with previous examinations. RESULTS Patients' experience with otomicroscopy was significantly improved with VR compared to tablet (p < 0.05) and no distraction (p < 0.01). Pain scores did not differ significantly between groups. CONCLUSION VR did not reduce pain scores, but it improved the children's experience with otomicroscopy without causing significant adverse outcomes.
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Affiliation(s)
- Ida Marie Galst
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.
| | - Marie Høxbro Knudsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.
| | - Thomas Hjuler
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.
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18
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İyi Z, İşler A, Özer Z. Effectiveness of ShotBlocker application on reducing the pain of needle-related procedures in children: A systematic review and meta-analysis. J Pediatr Nurs 2024; 78:e438-e447. [PMID: 39129083 DOI: 10.1016/j.pedn.2024.08.006] [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: 02/11/2024] [Revised: 07/22/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
PROBLEM Needle-related procedures are quite common throughout life, especially during childhood. Pain caused by these procedures is the most common complication. ShotBlocker is an alternative non-pharmacological method to reduce pain during injection-related procedures. However, the effectiveness of the ShotBlocker application in children for reducing pain needle-related procedures remains unclear. This review aimed to evaluate the effectiveness of ShotBlocker application on pain during needle-related procedures in children from Randomized Controlled Trials. ELIGIBILITY CRITERIA Eight electronic databases were searched until November 2023 for articles published in English. The methodological quality and evidence strength were appraised using the Cochrane Risk of Bias 2 tool and the GRADE approach. A random-effects model was used to determine the effect of the ShotBlocker application on pain levels. The review included results involving assessments from the child, parents, and an observer in pain evaluation. SAMPLE A total of nine studies with 1205 children patients were included. RESULTS The evaluation data showed that ShotBlocker application significantly reduced the pain caused by needle-related procedures in children. The Cochrane GRADE approach showed moderate level evidence for the effect of ShotBlocker application on pain during needle procedures. CONCLUSIONS As a result of the studies included in this meta-analysis, it was determined that ShotBlocker application significantly reduced the pain caused by needle-related procedures in children. IMPLICATIONS ShotBlocker, a non-pharmacological method, can be used by pediatric nurses to reduce pain during needle-related procedures in children. Randomized controlled studies with well-designed methods are needed to create strong evidence in this field.
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Affiliation(s)
- Zahide İyi
- Department of Pediatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Ayşegül İşler
- Department of Pediatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Zeynep Özer
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
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19
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Saleh SES, Abozed HW. Technology and Children's health: Effect of virtual reality on pain and clinical outcomes during hydrotherapy for children with burns. J Pediatr Nurs 2024; 78:e155-e166. [PMID: 38971634 DOI: 10.1016/j.pedn.2024.06.031] [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: 03/18/2024] [Revised: 06/30/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Virtual Reality (VR) has been frequently used as an engaging, interactive, and effective non-pharmacological distraction technique for children during painful procedures, including burnt wound care. AIM This study aimed to evaluate the effect of virtual reality on pain and clinical outcomes during hydrotherapy for children with burns. DESIGN A randomized controlled pretest, during, and post-test research design was utilized. METHODS Sixty children with burns underwent hydrotherapy, divided randomly and assigned equally into two groups. Children of the control group received the standard pharmacological treatment of the unit to manage pain and stabilize their physiological parameters throughout the three days of study. Children of the virtual reality intervention group received all basic standard care as the control group plus VR intervention across different software content, and interaction immersion designs which took place using a cell phone coupled with the three-dimensional (3D) image glasses. Outcome measures were physiological parameters, wound healing, and Face, Leg, Activity, Cry and Consolability (FLACC) Behavioral Pain Assessment Scale. SETTING This study was carried out in the burns unit at the Plastic, Reconstructive, and Burns Surgery Center affiliated to Mansoura University, from September to November 2023. RESULTS Children in the study group had lower pain scores, more stable physiological parameters, and higher rates of wound healing compared to the control group with a statistically significant difference between both groups. CONCLUSION Using VR intervention significantly reduced pain intensity, enhanced physiological parameters and promoted the rate of wound healing in children with burns during hydrotherapy.
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Affiliation(s)
| | - Hend Wageh Abozed
- Pediatric Nursing Department, Faculty of Nursing, Mansoura University, Egypt.
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20
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Rance K, Blaiss M, Gupta P, Nolte H, Scott EP, Gardner DD. Degree of fear of needles and preferred allergy immunotherapy treatment among children with allergic rhinitis: caregiver survey results. Front Pediatr 2024; 12:1447619. [PMID: 39156023 PMCID: PMC11327818 DOI: 10.3389/fped.2024.1447619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction A child's fear of needles may impact the preferred route of allergy immunotherapy (AIT) when choosing between subcutaneous immunotherapy (allergy shots) or sublingual immunotherapy (SLIT). A survey was conducted to understand caregiver health-seeking behavior for children with allergic rhinitis with or without conjunctivitis (AR/C) and explore if fear of needles impacted AIT decisions. Methods Caregivers of children ages 5-17 years with AR/C were recruited from the Dynata US research panel to participate in an online survey from May-June 2023. The survey received institutional review board exemption status. SLIT-tablets were described as "under-the-tongue tablets". Results About a third (34%) of surveyed caregivers (n = 437) reported their child had a severe fear of needles and 47% reported moderate fear. Of surveyed caregivers, 53% and 43% reported they had discussed allergy shots and SLIT-tablets, respectively, with their child's physician. SLIT-tablets were preferred by 84% of caregivers; 6% preferred injections and 10% had no preference. Caregivers of children with a severe fear of needles had the highest preference for SLIT-tablets (95%) vs. injections (2%); 85% and 60% of caregivers of children with moderate and low fear, respectively, preferred SLIT-tablets. Among caregivers of children with a severe fear of needles, a higher percentage agreed that their child would welcome taking SLIT-tablets than that their child would accept taking an ongoing series of allergy shots (93% vs. 43%, respectively). Conclusions Most caregivers preferred SLIT-tablets over allergy shots for their child with AR/C. Preference for SLIT-tablets corresponded with the child's degree of fear of needles. Fear of needles should be included in AIT shared decision-making conversations.
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Affiliation(s)
| | - Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta, GA, United States
| | - Payel Gupta
- Mount Sinai Hospital, New York, NY, United States
| | | | - Erin P. Scott
- Scott Medical Communications, LLC, Tyler, TX, United States
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21
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Abouchaleh N, Bayart C. Strategies to minimize procedure-related pain and anxiety: lessons from pediatric dermatology. Curr Opin Pediatr 2024; 36:406-410. [PMID: 38957126 DOI: 10.1097/mop.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Recent studies have suggested that prolonged or repeated episodes of general anesthesia early in childhood may adversely affect neurodevelopment. This, combined with rising healthcare costs and decreasing access, has sparked interest in performing pediatric procedures in the office setting when possible. It is essential to address the physical and psychological discomfort that often accompany this experience, particularly in children. RECENT FINDINGS Healthcare providers performing procedures on children can draw from a spectrum of established techniques, new technology, and novel use of medications to decrease peri-procedural pain and anxiety. These techniques include distraction, optimization of local anesthesia, and mild to moderate sedation. SUMMARY We recommend using a combination of techniques to minimize pain and anxiety to improve safety, decrease healthcare costs, improve patient experience, and prevent childhood trauma and persistent negative perception of the healthcare system.
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Affiliation(s)
| | - Cheryl Bayart
- Cincinnati Children's Hospital Medical Center, University of Cincinnati-Affiliate, Cincinnati, Ohio, USA
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22
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Phillips K, Callaghan BL, Webb A, Kan J, Ooi CY, Kasparian NA. MEDIC: Development and validation of a new instrument to assess emotional reactivity to medical stimuli in a representative community sample of adults. J Psychiatr Res 2024; 176:265-275. [PMID: 38901391 DOI: 10.1016/j.jpsychires.2024.06.021] [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: 03/08/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
To support investigation of the etiology and psychophysiology of medical traumatic stress, we developed a standardized set of emotionally-salient medical images, called the 'MEDical Image Collection' (MEDIC), for use in neuroimaging or psychological research. This study aimed to establish internal consistency, test re-test reliability, and congruent validity of the image set. A representative sample of 300 adults in the United States were recruited via research recruitment platform, Prolific. Participants rated 124 images depicting medical stimuli on one of two dimensions: emotional arousal (i.e., how strongly an evoked emotion is felt) or affective valence (i.e., how positive or negative the evoked emotion is). Sociodemographic and health-related characteristics, including experiences during the COVID-19 pandemic, were also assessed. To assess test re-test reliability, a subset (n = 200) rated the images on the same dimension a second time, 3 months later. The MEDIC image set was found to: (a) elicit a range of emotional arousal and valence ratings, (b) have excellent inter-rater reliability, (c) moderate test-retest reliability, and (d) good face validity. Results indicate the new MEDIC 124-image set is a reliable and valid instrument, enabling researchers to provide context-specific and emotionally-salient stimuli to individuals when studying affective responses in relation to health and medicine.
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Affiliation(s)
- Katelyn Phillips
- School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, University of New South Wales (UNSW Sydney). UNSW Sydney, High St, Kensington, NSW, 2052, Australia
| | - Bridget L Callaghan
- Department of Psychology, University of California Los Angeles, 1285 Psychology Building Box, Los Angeles, CA, 951563, USA
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, 88 Mallett St, Camperdown, NSW, 2050, Australia
| | - Janice Kan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, TAS, 7001, Australia
| | - Chee Y Ooi
- School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, University of New South Wales (UNSW Sydney). UNSW Sydney, High St, Kensington, NSW, 2052, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, Australia; Sydney Children's Hospital, High St, Randwick, NSW, 2031, Australia
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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23
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Roessler De Angulo N, Postier AC, Purser L, Ngo L, Sun K, Friedrichsdorf S. Assessment and Treatment of Pain in Hospitalized Children at a Tertiary Children's Hospital: A Cross-Sectional Mixed Methods Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:874. [PMID: 39062323 PMCID: PMC11276427 DOI: 10.3390/children11070874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
(1) Background: Acute pain in hospitalized children remains under-recognized and under-treated. Our objective is to benchmark pain assessment, documentation, treatment, and patient experience in children admitted to a US children's hospital. (2) Methods: A cross-sectional, mixed-method survey of pain for children hospitalized ≥24 h. Charts were reviewed for modalities of pain assessment and treatment for all inpatients. If pain was documented, patients/caregivers were surveyed regarding their experience with pain and its management. (3) Results: Chart review: All 107 patients had ≥1 pain score documented. A total of 47 patients had a pain score ≥0, 35 (74.5%) of whom had ≥1 moderate-severe score. Seventy (65.4%) patients received ≥1 intervention for pain, including medications from ≥1 class (e.g., opioids) (n = 55, 51.4%) and/or integrative/non-pharmacologic intervention(s) (n = 39, 36.4%). There were assessment and documentation gaps. Patient survey: A total of 39 (83.0%) interviews were attempted; 25 (53.2%) were completed. The worst pain was mostly caused by acute illness (n = 13, 52%) and painful procedures (n = 10, 40%). Suggestions for improvement included increasing the use of integrative modalities and optimizing patient-clinician communication. (4) Conclusions: All patients admitted ≥24 h had ≥1 pain score documented; however, gaps in documentation were common. Multimodal treatment and integrative modalities were underutilized. Procedures were a frequent cause of under-treated pain, prompting an institution-wide quality improvement project.
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Affiliation(s)
- Nadia Roessler De Angulo
- Stad Center for Pediatric Pain, Palliative & Integrative Medicine, Benioff Children’s Hospital, Department of Pediatrics, University of California San Francisco, 1855 Fourth St., 4th Floor, San Francisco, CA 94158, USA; (A.C.P.)
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Martin SR, Heyming TW, Valdez BJ, Salas LH, Cohen LL, Fortier MA, Lee K, Kaplan S, Kain ZN. Observational Behavioral Coding in the Pediatric Emergency Department: Development of the Emergency Department Child Behavior Coding System. J Emerg Med 2024; 67:e50-e59. [PMID: 38821846 PMCID: PMC11181611 DOI: 10.1016/j.jemermed.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/06/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Despite improvements over the past decade, children continue to experience significant pain and distress surrounding invasive procedures in the emergency department (ED). To assess the impact of newly developed interventions, we must create more reliable and valid behavioral assessment tools that have been validated for the unique settings of pediatric EDs. OBJECTIVE This study aimed to create and test the Emergency Department Child Behavior Coding System (ED-CBCS) for the assessment of child distress and nondistress behaviors surrounding pediatric ED procedures. METHODS Via an iterative process, a multidisciplinary expert panel developed the ED-CBCS, an advanced time-based behavioral coding measure. Inter-rater reliability and concurrent validity were examined using 38 videos of children aged from 2 to 12 years undergoing laceration procedures. Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were used to examine concurrent validity. RESULTS The final ED-CBCS included 27 child distress and nondistress behaviors. Time-unit κ values from 0.64 to 0.98 and event alignment κ values from 0.62 to 1.00 indicated good to excellent inter-rater reliability for all but one of the individual codes. ED-CBCS distress (B = 1.26; p < 0.001) and nondistress behaviors (B = -0.69, p = 0.025) were independently significantly associated with FLACC scores, indicating concurrent validity. CONCLUSIONS We developed a psychometrically sound tool tailored for pediatric ED procedures. Future work could use this measure to better identify behavioral targets and test the effects of interventions to relieve pediatric ED pain and distress.
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Affiliation(s)
- Sarah R Martin
- Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, California; Center on Stress and Health, University of California, Irvine, California; Emergency Medicine, Children's Hospital of Orange County, Orange, California.
| | - Theodore W Heyming
- Emergency Medicine, Children's Hospital of Orange County, Orange, California; Department of Emergency Medicine, University of California, Irvine, Orange, California
| | - Brooke J Valdez
- Emergency Medicine, Children's Hospital of Orange County, Orange, California
| | - Luis H Salas
- Emergency Medicine, Children's Hospital of Orange County, Orange, California
| | - Lindsey L Cohen
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Michelle A Fortier
- Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, California; Center on Stress and Health, University of California, Irvine, California; Sue and Bill Gross School of Nursing, University of California, Irvine, California; Children's Hospital of Orange County, Orange, California
| | - Kent Lee
- Emergency Medicine, Children's Hospital of Orange County, Orange, California
| | - Sherrie Kaplan
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, California
| | - Zeev N Kain
- Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, California; Center on Stress and Health, University of California, Irvine, California; Children's Hospital of Orange County, Orange, California; Child Study Center, Yale University, New Haven, Connecticut
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Gorski LA. Update: The 2024 Infusion Therapy Standards of Practice. Home Healthc Now 2024; 42:198-205. [PMID: 38975817 DOI: 10.1097/nhh.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
The Infusion Therapy Standards of Practice provide evidence-based recommendations for infusion and access device related care in any healthcare setting. Developed and published by the Infusion Nurses Society, the Standards have increased the frequency of the revision process from an every 5-year cycle to a 3-year cycle due to the growing base of literature and to deliver the most updated and current practice recommendations. This article provides an overview of the development process and a brief description of selected standards. Notably, a new standard entitled Home Infusion Therapy was added in this latest edition. The Standards are an essential reference that should be available to every home care agency that provides home infusion therapy.
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Affiliation(s)
- Lisa A Gorski
- Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, is a Clinical Education Specialist, Ascension at Home, and Editor, Home Healthcare Now
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Gold JI, Akbar KM, Avila S, Ngo NH, Klein MJ. Exploring Relations Between Unique Patient Characteristics and Virtual Reality Immersion Level on Anxiety and Pain in Patients Undergoing Venipuncture: Secondary Analysis of a Randomized Control Trial. J Med Internet Res 2024; 26:e53196. [PMID: 38949862 PMCID: PMC11250034 DOI: 10.2196/53196] [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: 09/28/2023] [Revised: 03/07/2024] [Accepted: 03/20/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Virtual reality (VR) is a well-researched digital intervention that has been used for managing acute pain and anxiety in pediatric patients undergoing various medical procedures. This study focuses on investigating the role of unique patient characteristics and VR immersion level on the effectiveness of VR for managing pediatric pain and anxiety during venipuncture. OBJECTIVE The purpose of this study is to determine how specific patient characteristics and level of immersion during a VR intervention impact anxiety and pain levels for pediatric patients undergoing venipuncture procedures. METHODS This study is a secondary data analysis of 2 combined, previously published randomized control trials on 252 pediatric patients aged 10-21 years observed at Children's Hospital Los Angeles from April 12, 2017, to July 24, 2019. One randomized clinical trial was conducted in 3 clinical environments examining peripheral intravenous catheter placement (radiology and an infusion center) and blood draw (phlebotomy). Conditional process analysis was used to conduct moderation and mediation analyses to assess the impact of immersion level during the VR intervention. RESULTS Significant moderation was found between the level of immersion and anxiety sensitivity when predicting postprocedural anxiety (P=.01). Patients exhibiting the highest anxiety sensitivity within the standard of care yielded a 1.9 (95% CI 0.9-2.8; P<.001)-point elevation in postprocedural anxiety relative to individuals with high immersion levels. No other significant factors were found to mediate or moderate the effect of immersion on either postprocedural anxiety or pain. CONCLUSIONS VR is most effective for patients with higher anxiety sensitivity who report feeling highly immersed. Age, location of the procedure, and gender of the patient were not found to significantly impact VR's success in managing levels of postprocedural pain or anxiety, suggesting that immersive VR may be a beneficial intervention for a broad pediatric population. TRIAL REGISTRATION ClinicalTrials.gov NCT04268901; https://clinicaltrials.gov/study/NCT04268901.
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Affiliation(s)
- Jeffrey I Gold
- Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Krystal M Akbar
- The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sandra Avila
- The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Nhat H Ngo
- Department of Anesthesiology Critical Care Medicine, The Biobehavioral Pain Lab, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Margaret J Klein
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
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Dentry T, O'Neill J, Raj S, Gardiner K, Savarirayan R. Exploring the family experience of children aged 2-4 years receiving daily vosoritide injections: A qualitative study. J Pediatr Nurs 2024; 77:e167-e176. [PMID: 38604940 DOI: 10.1016/j.pedn.2024.04.007] [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: 01/25/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Vosoritide is administered as a daily subcutaneous injection in children with achondroplasia. In clinical trials, families of children aged 2-4 years reported difficulty with drug administration due to child fear, pain, and distress. Study aims were to gain a better understanding of the current vosoritide administration experience in this cohort and to investigate whether topical anaesthesia and ice application prior to injections improved the child and family experience. DESIGN AND METHODS A qualitative descriptive study design ensured in-depth understanding of family experience. Parents were interviewed to explore experience of vosoritide administration for their child at two time points, before (Phase 1) and after (Phase 2) the introduction of topical anaesthesia and ice application prior to injections. Interviews were analysed using thematic analysis. RESULTS Seven families participated. Children's ages ranged from 2 years 2 months to 3 years 11 months. Five themes emerged from data analysis: (1) The reality of the burden of care; (2) Child experience as the greatest obstacle; (3) Parents juggle multiple emotional considerations; (4) Many factors may impact experience; and (5) Short-term and long-term impacts. CONCLUSIONS Administration of vosoritide in this cohort presents multiple challenges for families. Factors which influenced experience differed between families. Responses to topical anaesthesia and ice application also varied between children, improving administration experience for some children and worsening experience for others. PRACTICE IMPLICATIONS This study highlights the need for individualised care for young children receiving daily injections. Support should be provided to families to identify factors that improve experience.
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Affiliation(s)
- Tessa Dentry
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Jenny O'Neill
- The Royal Children's Hospital, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Supriya Raj
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kaya Gardiner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ravi Savarirayan
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
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Shah SA, Oakes RS, Jewell CM. Advancing immunotherapy using biomaterials to control tissue, cellular, and molecular level immune signaling in skin. Adv Drug Deliv Rev 2024; 209:115315. [PMID: 38670230 PMCID: PMC11111363 DOI: 10.1016/j.addr.2024.115315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/20/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Immunotherapies have been transformative in many areas, including cancer treatments, allergies, and autoimmune diseases. However, significant challenges persist in extending the reach of these technologies to new indications and patients. Some of the major hurdles include narrow applicability to patient groups, transient efficacy, high cost burdens, poor immunogenicity, and side effects or off-target toxicity that results from lack of disease-specificity and inefficient delivery. Thus, there is a significant need for strategies that control immune responses generated by immunotherapies while targeting infection, cancer, allergy, and autoimmunity. Being the outermost barrier of the body and the first line of host defense, the skin presents a unique immunological interface to achieve these goals. The skin contains a high concentration of specialized immune cells, such as antigen-presenting cells and tissue-resident memory T cells. These cells feature diverse and potent combinations of immune receptors, providing access to cellular and molecular level control to modulate immune responses. Thus, skin provides accessible tissue, cellular, and molecular level controls that can be harnessed to improve immunotherapies. Biomaterial platforms - microneedles, nano- and micro-particles, scaffolds, and other technologies - are uniquely capable of modulating the specialized immunological niche in skin by targeting these distinct biological levels of control. This review highlights recent pre-clinical and clinical advances in biomaterial-based approaches to target and modulate immune signaling in the skin at the tissue, cellular, and molecular levels for immunotherapeutic applications. We begin by discussing skin cytoarchitecture and resident immune cells to establish the biological rationale for skin-targeting immunotherapies. This is followed by a critical presentation of biomaterial-based pre-clinical and clinical studies aimed at controlling the immune response in the skin for immunotherapy and therapeutic vaccine applications in cancer, allergy, and autoimmunity.
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Affiliation(s)
- Shrey A Shah
- Fischell Department of Bioengineering, University of Maryland, College Park, 8278 Paint Branch Drive, College Park, MD 20742, USA
| | - Robert S Oakes
- Fischell Department of Bioengineering, University of Maryland, College Park, 8278 Paint Branch Drive, College Park, MD 20742, USA; Department of Veterans Affairs, VA Maryland Health Care System, 10. N Green Street, Baltimore, MD 21201, USA
| | - Christopher M Jewell
- Fischell Department of Bioengineering, University of Maryland, College Park, 8278 Paint Branch Drive, College Park, MD 20742, USA; Department of Veterans Affairs, VA Maryland Health Care System, 10. N Green Street, Baltimore, MD 21201, USA; Robert E. Fischell Institute for Biomedical Devices, 8278 Paint Branch Drive, College Park, MD 20742, USA; Department of Microbiology and Immunology, University of Maryland Medical School, Baltimore, MD, 21201, USA; Marlene and Stewart Greenebaum Cancer Center, 22 S. Greene Street, Suite N9E17, Baltimore, MD, 21201, USA.
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Pope N, Keyser J, Crellin D, Palmer G, South M, Harrison D. An Australian survey of health professionals' perceptions of use and usefulness of electronic medical records in hospitalised children's pain care. J Child Health Care 2024:13674935241256254. [PMID: 38809661 DOI: 10.1177/13674935241256254] [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: 05/31/2024]
Abstract
Pain in hospitalised children is common, yet inadequately treated. Electronic medical records (EMRs) can improve care quality and outcomes during hospitalisation. Little is known about how clinicians use EMRs in caring for children with pain. This national cross-sectional survey examined the perceptions of clinician-EMR users about current and potential use of EMRs in children's pain care. One hundred and ninety-four clinicians responded (n = 81, 74% nurses; n = 21, 19% doctors; n = 7, 6% other); most used Epic (n = 53/109, 49%) or Cerner (n = 42/109, 38%). Most (n = 84/113, 74%) agreed EMRs supported their initiation of pharmacological pain interventions. Fewer agreed EMRs supported initiation of physical (n = 49/113, 43%) or psychological interventions (n = 41/111, 37%). Forty-four percent reported their EMR had prompt reminders for pain care. Prompts were perceived as useful (n = 40/51, 78%). Most agreed EMRs supported pain care provision (n = 94/110, 85%) and documentation (n = 99/111, 89%). Only 39% (n = 40/102) agreed EMRs improved pain treatment, and 31% (n = 32/103) agreed EMRs improved how they involve children and families in pain care. Findings provide recommendations for EMR designs that support clinicians' understanding of the multidimensionality of children's pain and drive comprehensive assessments and treatments. This contribution will inform future translational research on harnessing technology to support child and family partnerships in care.
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Affiliation(s)
- Nicole Pope
- Department of Nursing Research, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing, Melbourne School of Health Sciences Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- The Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Child Health Evaluative Services, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Janelle Keyser
- Acute Pain Service, Queensland Children's Hospital and Health Service, Brisbane, QLD, Australia
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Dianne Crellin
- Department of Nursing, Melbourne School of Health Sciences Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- The Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Greta Palmer
- The Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, Melbourne School of Health Sciences Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, VIC, Australia
| | - Mike South
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, Melbourne School of Health Sciences Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, VIC, Australia
- Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Denise Harrison
- Department of Nursing, Melbourne School of Health Sciences Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- The Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
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Alwafi H, Naser AY, Alsaleh NA, Asiri JK, Almontashri RM, Alqarni LM, Salawati RS, Alsharif A, Aldhahir AM, Alqarni AA, Hafiz W, Alqahtani JS, Salawati E, Almatrafi MA, Bahlol M. Prevalence, factors associated and management of needle phobia among the general population in Saudi Arabia and Egypt. BMC Psychiatry 2024; 24:363. [PMID: 38745314 PMCID: PMC11094992 DOI: 10.1186/s12888-024-05757-5] [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: 01/09/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated. METHODS A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student's t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia. RESULTS A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41-50 years), widowed, those with bachelor's degrees and higher education, and those unemployed were more likely to have needle phobia compared to others. CONCLUSION Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41-50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others.
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Affiliation(s)
- Hassan Alwafi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, 8WMR+23J Mecca, Al Abdeyah, Alawali, Mecca, Saudi Arabia.
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Nada A Alsaleh
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | | | - Alaa Alsharif
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waleed Hafiz
- Department of Internal Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Emad Salawati
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed A Almatrafi
- Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohamed Bahlol
- Speciality of Pharmaceutical Management and Economics, Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
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Karppa E, Puura K, Jyskä I, Turunen M, Palmu S. Case Report: Virtual natural environment solution helped a child cope with a painful procedure. Front Pediatr 2024; 12:1355046. [PMID: 38756972 PMCID: PMC11096552 DOI: 10.3389/fped.2024.1355046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/05/2024] [Indexed: 05/18/2024] Open
Abstract
Fear of needles is a common phenomenon that can affect the patient's ability to function and to seek medical help. Novel treatment practices are needed to help children cope with this fear. Based on user feedback, immersive virtual reality applications are effective when distracting the patient during a painful procedure. Better understanding of how virtual reality solutions affect the autonomic nervous system should be acquired. We present the case of a 12-year-old boy attending our study examining a novel virtual reality (VR) relaxation method (VirNE). The clinical study aims to determine if pain and anxiety can be relieved by relaxation that has been induced by a virtual natural environment and guided relaxation exercise-mediated autonomic nervous system stimulation. The patient was able to overcome his fear of needles with the help of the guided relaxation and found significant relief from the distress he was experiencing on his monthly visits to the hospital due to his long-term illness requiring repetitious intravenous cannulations.
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Affiliation(s)
- Elina Karppa
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Children and Adolescents, Tampere University Hospital, Tampere, Finland
- Ostrobothnia Wellbeing Services County, Kuusamo Health Center, Kuusamo, Finland
| | - Kaija Puura
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Children and Adolescents, Tampere University Hospital, Tampere, Finland
| | - Ilmari Jyskä
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Markku Turunen
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Sauli Palmu
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Children and Adolescents, Tampere University Hospital, Tampere, Finland
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Killian HJ, Deacy A, Edmundson E, Raab L, Schurman JV. If we know better, why don't we do better? A rapid quality improvement project to increase utilization of comfort measures to reduce pain and distress in children in a COVID-19 mass vaccination clinic. J Pediatr Nurs 2024; 76:e93-e100. [PMID: 38307756 DOI: 10.1016/j.pedn.2024.01.024] [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: 08/01/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Many evidence-based tools exist to address pain and distress associated with injections; however, there remains a large gap between the knowledge of these tools and their utilization. Our hospital began a quality improvement (QI) project prior to COVID-19, with the goal of increasing the utilization of Comfort Promise measures during needle procedures. When COVID-19 vaccinations were approved, our mass vaccination clinics provided an opportunity to rapidly increase utilization across the institution. The primary aim was to increase the percentage of comfort measures (CM) offered with COVID-19 vaccinations. METHODS Through this QI project, nurses and other professionals implemented CMs during COVID mass vaccination clinics. Clinics occurred in 3 age-based waves. Waves served as Plan-Do-Study-Act (PDSA) cycles. Families completed post-vaccination surveys to determine what CMs were offered and intention for future use with vaccinations. RESULTS Uptake of CMs (PainEase, ShotBlockers, Comfort Positioning, Alternative Focus, Topical Lidocaine, and Breastfeeding/Sucrose) throughout the waves increased and generally remained stable. CMs also seemed to decrease pain/distress with vaccinations (70.5 to 88.7%), and children/caregivers intended to use some combination for future vaccinations (82.5 to 98.5%). CONCLUSIONS Fast-paced mass vaccination clinics provided an ideal opportunity to significantly increase utilization of CMs. Across age groups CMs yielded high satisfaction and interest in future utilization. Clinic nurses returned to their own sub-specialties and became change agents. IMPLICATIONS If all healthcare providers can work together to achieve consensus while incorporating comfort measures into daily practice, sustained change with incorporation of these evidence-based tools can be achieved. Future directions are discussed.
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Affiliation(s)
- Haley J Killian
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | - Amanda Deacy
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | | | - Lucy Raab
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA.
| | - Jennifer V Schurman
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
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Jin F, Wang X, Qi M, Zhang W, Zhang Y. Effectiveness and safety of Buzzy device in needle-related procedures for children under twelve years of age: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37522. [PMID: 38608108 PMCID: PMC11018245 DOI: 10.1097/md.0000000000037522] [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: 09/29/2023] [Accepted: 02/15/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Pain transcends simple physiology, encompassing biological, emotional, psychological, and social facets. Children show pronounced immediate and enduring responses to pain-related procedures. The aim of this meta-analysis is to investigate the efficacy and safety of the Buzzy device for needle-related procedures in children aged twelve years or younger. METHODS PubMed, Web of Science, and Embase were searched from inception to July 2023. Only randomized controlled trials utilizing the Buzzy device for needle-related procedures in children under twelve years old were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Random-effects models were utilized, and analyses were performed using mean differences or standardized mean differences as well as risk ratios. RESULTS A total of 19 studies were included, involving 2846 participants (Buzzy = 1095, Control = 1751). Compared to no intervention, the Buzzy device significantly reduced pain response [self-report SMD = -1.90 (-2.45, -1.36), parental SMD = -3.04 (-4.09, -1.99), observer SMD = -2.88 (-3.75, -2.02)] and anxiety scores [self-report SMD = -1.97 (-3.05, -0.88), parental SMD = -2.01 (-2.93, -1.08), observer SMD = -1.92 (-2.64, -1.19)]. Compared to virtual reality (VR), the Buzzy device reduced self-reported anxiety levels SMD = -0.47 (-0.77, -0.17), and compared to distraction cards, the Buzzy device reduced parental and observer-reported pain [parental SMD = -0.85 (-1.22, -0.48), observer SMD = -0.70 (-1.00, -0.40)] and anxiety [parental SMD = -0.96 (-1.46, -0.47), observer SMD = -0.91 (-1.40, -0.42)]. Subgroup analysis results showed that procedure type, patient age, measurement scales used, and distance of operation were not the reason of heterogeneity. The summarized first puncture attempt success rate did not differ from other interventions. There were no significant adverse events in the included studies. CONCLUSION The Buzzy device reduces pain and anxiety in children during needle procedures, ensuring success and safety. Additionally, the effectiveness of the Buzzy device in reducing pain during venipuncture is superior when compared to its effectiveness during intramuscular injections.
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Affiliation(s)
- Faguang Jin
- Clinical Medical College, Weifang Medical University, Weifang, China
| | - Xiaofang Wang
- Clinical Medical College, Weifang Medical University, Weifang, China
| | - Maomao Qi
- Department of Pediatrics, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Wenhua Zhang
- Department of Pediatrics, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yongfeng Zhang
- Department of Pediatrics, Affiliated Hospital of Weifang Medical University, Weifang, China
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Watanabe M, Kato M, Matsuda YT, Taniguchi K, Itakura S. The infant-doctor relationship: an examination of infants' distress reactions in the presence of a doctor. Sci Rep 2024; 14:7968. [PMID: 38575648 PMCID: PMC10994921 DOI: 10.1038/s41598-024-58677-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
Fear of doctors is a common source of distress among infants; however, the underlying sources of this distress are unknown. To investigate the doctor-infant relationship, the behaviors of 61 healthy infants (176-617 days old) were observed in a simulated examination room. Their behaviors and electrocardiograms were recorded. Two groups of infants were analyzed: those who cried and those who did not. When an experimenter dressed in the doctor's attire entered the room, all 9 infants who were crying (14.8% of all infants) stopped crying, all infants gazed at the experimenter, and their mean heart rate (HR) decreased. After the auscultation started, 29.5% of all infants cried, and the HRs of infants who cried were higher than those of infants who did not cry. During the auscultation, 80.0% of infants who cried averted from the experimenter, while 34.4% of infants who did not cry. Within 5 s of gazing at the stethoscope, the number of infants who cried increased from 3 to 12, and their mean HR also increased. Our findings suggest that the fear of doctors is not due to the appearance of doctors but rather to specific actions performed by doctors, such as auscultation. Infants may regard a doctor's appearance as a source of interest. Furthermore, a stethoscope is a possible trigger for infants' crying. These behavioral observations suggest the potential for patient-centered care for infants.
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Affiliation(s)
- Motonobu Watanabe
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan.
- Department of Pediatrics, NHO Minami Kyoto Hospital, Joyo, Kyoto, Japan.
| | - Masaharu Kato
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
| | - Yoshi-Taka Matsuda
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
- Department of Child Studies, Shiraume Gakuen University, Kodaira, Tokyo, Japan
| | - Kosuke Taniguchi
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
- Department of Psychology, Kyoto University of Advanced Science, Ukyo-ku, Kyoto, Japan
| | - Shoji Itakura
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
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Rich V, Plummer K, Padhy S, Barratt T, Tran J, Treadgold C, Robertson EG. Captains on call: A qualitative investigation of an intervention to support children with retinoblastoma undergoing regular eye examinations. Psychooncology 2024; 33:e6315. [PMID: 38423988 DOI: 10.1002/pon.6315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Retinoblastoma is a rare childhood ophthalmic cancer that requires frequent eye examinations under anaesthesia and painful or distressing procedures. This can cause significant anxiety for children and their families. OBJECTIVE We evaluated a Starlight Children's Foundation programme, 'Captains on Call', at the Queensland Children's Hospital, which aims to provide positive distraction and reduce stress, anxiety and pain during the perioperative journey for children in the retinoblastoma treatment pathway. This study examined the impact of the programme on the perioperative experience of the children and their families, using a qualitative design. METHODS This study was conducted in a paediatric operating suite at a tertiary-level children's hospital in Australia. We interviewed a parent from 20 families (from a cohort of 40 families, including 44 children), whose children received treatment or screening for retinoblastoma, focusing on the programme's impact on the child and family at various stages during the perioperative journey. We undertook a thematic analysis of transcribed interviews. RESULTS We identified two themes, each with two sub-themes: (1) the programme positively contributed to the overall treatment journey, by addressing different needs at different times, and helping to reframe a traumatic medical experience, and (2), the programme supported the whole family unit by empowering children through play, and adopting a family systems approach which recognised the impact of cancer treatment on the whole family. CONCLUSION This study highlights the value of the Captains on Call programme in supporting children with retinoblastoma and their families during perioperative visits. The Captains, particularly as non-medicalised professionals in a healthcare setting, built trust and rapport with the children through play over repeated episodes of care. The interprofessional collaborative approach with a reflective cycle of practice extended it beyond a programme providing simple distraction. Other retinoblastoma services may benefit from implementing a similar approach.
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Affiliation(s)
- Vanessa Rich
- Department of Anaesthesia, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Karin Plummer
- Department of Anaesthesia, Children's Health Queensland, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Sofia Padhy
- Department of Anaesthesia, Children's Health Queensland, South Brisbane, Queensland, Australia
- Department of Anaesthesia, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Tamsin Barratt
- Department of Anaesthesia, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Johnson Tran
- Department of Anaesthesia, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Claire Treadgold
- Starlight Children's Foundation, New South Wales, New South Wales, Australia
| | - Eden G Robertson
- Starlight Children's Foundation, New South Wales, New South Wales, Australia
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
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Sarman A, Tuncay S. Goldfish or aquatic turtle? Impact of two animal assisted interventions on children's pain, anxiety, and fear during IV catheterization: A randomized controlled trial. J Pediatr Nurs 2024; 75:116-124. [PMID: 38150915 DOI: 10.1016/j.pedn.2023.12.017] [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: 10/21/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to determine the effect of goldfish and aquatic turtle nursing interventions on children's pain, anxiety, and fear during IV catheter insertion. DESIGN AND METHODS The randomized controlled trial included 98 children (control group = 32, goldfish group = 33, aquatic turtle group = 33) aged 5-6 years, attending outpatient clinic for blood sampling and catheterisation procedures. Pain was measured using the Wong Baker Facial Pain Scale, anxiety was measured using the Child Anxiety Scale-State, and child fear was measured using the Child Fear Scale, before, during, and after catheterization. RESULTS When analyzing the pain, anxiety, and fear findings, no statistical difference was found between the scores of the mother, child, and researcher before the procedure. During the catheterization procedure, the pain, anxiety, and fear scores of the children in the fish and turtle groups increased statistically less than those in the control group. When analyzing the post-procedure findings, the pain, anxiety, and fear scores of the control group were similar to those before the procedure. In the fish and turtle groups, anxiety and fear scores were statistically the lowest (p < 0.05). CONCLUSION It can be concluded that animal-assisted practices reduce anxiety and fear during and after the catheterization procedures while diverting attention from pain. PRACTICE IMPLICATIONS Goldfish or aquatic turtle intervention improve children's attitudes toward pain, anxiety, and fear during IV catheter insertion. Pediatric nurses could consider incorporating, such as the animal assisted intervention, into their clinical practice to reduce the pain, anxiety, and fear experienced by children during medical/nursing procedures.
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Affiliation(s)
- Abdullah Sarman
- Bingöl University, Faculty of Health Science, Department of Pediatric Nursing, Bingöl, Turkey.
| | - Suat Tuncay
- Bingöl University, Faculty of Health Science, Department of Pediatric Nursing, Bingöl, Turkey
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Taddio A, Coldham J, Logeman C, McMurtry CM, Bucci LM, Gudzak V, MacDonald NE, Little C, Samborn T, Moineddin R. CARD (Comfort Ask Relax Distract) for school-based immunizations in Calgary, Canada: a pragmatic cluster trial. Pain 2024; 165:644-656. [PMID: 37824173 PMCID: PMC10859848 DOI: 10.1097/j.pain.0000000000003050] [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: 03/27/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 10/13/2023]
Abstract
ABSTRACT School-based immunizations are fear-inducing events for many students and contribute to vaccine hesitancy. We developed an immunization delivery framework called the CARD (Comfort Ask Relax Distract) system that incorporates evidence-based interventions to improve the experience (eg, reduce fear, pain, dizziness). We evaluated CARD in grades 6 and 9 students in Calgary, Canada. In this pragmatic, hybrid, effectiveness-implementation, cluster trial, we randomized 8 Community Health Centres providing regional immunization services to CARD or control (usual care). In the CARD group, public health staff educated students about CARD and planned processes to reduce fear cues and support student coping choices during immunization. Students self-reported fear, pain, and dizziness during immunization using a 0-10 numerical rating scale; staff recorded procedure details, including vaccines administered, fainting episodes, and coping strategies used. Staff participated in focus groups afterward. Altogether, 8839 children from 105 schools in the 2019 to 2020 school calendar year were included. Fear was lower for CARD (mean = 3.6 [SD = 3.1] vs control 4.1 [3.2]; mean difference = -0.5; 95% confidence interval = -0.74 to -0.21; P < 0.001). Effectiveness persisted after stratification by student gender (male and female) and grade level (grade 6 and grade 9). Other symptoms did not differ. Compared with control, CARD students used peers, privacy, muscle tension, and topical anesthetics more; verbal distraction, deep breathing, and adult support were used less frequently ( P < 0.05, all analyses). Immunization rate did not differ. Staff reported positive to neutral attitudes about CARD. In summary, this pragmatic trial demonstrated that CARD improved the immunization experiences of students at school.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Charlotte Logeman
- Child Health Evaluative Services, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lucie M. Bucci
- Bucci-Hepworth Health Services Inc., Pincourt, QC, Canada
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Noni E. MacDonald
- Faculty of Medicine, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | | | - Tracy Samborn
- Cochrane Community Health Centre, Alberta Health Services, Cochrane, AL, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Pope N, Jones S, Crellin D, Palmer G, South M, Harrison D. "Seeing the light in the shade of it": primary caregiver and youth perspectives on using an inpatient portal for pain care during hospitalization. Pain 2024; 165:450-460. [PMID: 37638836 DOI: 10.1097/j.pain.0000000000003039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 08/29/2023]
Abstract
ABSTRACT Studies from multiple countries report that most hospitalized children, especially the youngest and sickest, experience pain that is often severe yet inadequately treated. Evidence suggests this can lead to immediate and lifelong consequences affecting children, families, and communities. Partnership and shared decision-making by children, families, and clinicians is the ideal pediatric healthcare model and can improve care quality and safety, including pain care. A growing evidence base demonstrates that inpatient portals (electronic personal health record applications linked to hospital electronic medical or health records) can improve child and family engagement, outcomes, and satisfaction during hospitalization. This study examined the perspectives of caregivers of hospitalized children and of hospitalized youth about using an inpatient portal to support their engagement in pain care while in hospital. A qualitative descriptive study design was used and 20 participants (15 caregivers and 5 youth) with various painful conditions in one pediatric hospital participated in semistructured interviews. The authors applied a reflexive content analysis to the data and developed 3 broad categories: (1) connecting and sharing knowledge about pain, (2) user-centred designs, and (3) preserving roles. These findings outlined caregiver and youth recommendations for portal configurations that deeply engage and empower children and families in pain care through multidirectional knowledge sharing, supporting caregiver and clinicians' roles without burdening, or replacing human interaction implicit in family-centered pain care. Further research should measure the impact of portals on pain-related outcomes and explore the perspectives of clinicians.
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Affiliation(s)
- Nicole Pope
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Sophie Jones
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Dianne Crellin
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Greta Palmer
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Mike South
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Denise Harrison
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
- The University of Melbourne, Australia. Faculty of Medicine, Dentistry and Health Sciences, Department Paediatrics
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Le May S, Wu W, Francoeur M, Dodin P, Doyon-Trottier E, Hung N, Guingo E, Vu AK, Sylfra A, Lessard L, Cara-Slavich S, DeKoven K. Topical anesthetics for needle-related pain in adults and children (TOPIC): a mini-review. FRONTIERS IN PAIN RESEARCH 2024; 4:1350578. [PMID: 38259980 PMCID: PMC10800406 DOI: 10.3389/fpain.2023.1350578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Healthcare professionals (HCP) perform various needle procedures that can be distressing and painful for children and adults. Even though many strategies have been proven effective in reducing distress and pain, topical anesthetic use before needle procedures is uncommon. However, there are limited studies in the existing literature comparing specifically liposomal lidocaine and tetracaine hydrochloride topical creams. Source This systematic review analyzed studies on the use of two anesthetic creams, Liposomal Lidocaine (Maxilene®) and Tetracaine hydrochloride (Ametop™), in children and adults undergoing a needle-related procedure. Databases searched: PubMed, CINAHL, ClinicalTrials. Only randomized controlled trials (RCT) and Controlled Clinical Trials (CCT) studies were included. Cochrane Collaboration's Risk of Bias assessment tool was used. Strictly minimally invasive procedures were included to standardize different skin needle interventions. Principal findings Only one study with 60 participants was available to be included in this review. No statistically significant difference was found in the mean pain score among both interventions. The outcomes of self-reported distress during cannulation and on HCP satisfaction were not reported. However, physiological characteristics associated with stress/anxiety and on cannulation success rate were reported and did not show statistical significance. Conclusion Little to no evidence regarding the most efficient cream between liposomal lidocaine and tetracaine hydrochloride for pain management during needle-related procedures was found. Further studies, particularly RCT with larger sample sizes and standardized outcome measures, are needed to confirm the relative efficacy of either anesthetic cream.
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Affiliation(s)
- Sylvie Le May
- Institut TransMedTech, CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, QC, Canada
| | - Wenjia Wu
- Institut TransMedTech, CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, QC, Canada
- Department of Dental Medicine, CHU Sainte-Justine, Montreal, QC, Canada
| | - Maxime Francoeur
- Institut TransMedTech, CHU Sainte-Justine Research Center, Montreal, QC, Canada
| | - Philippe Dodin
- Medical Librairies, Direction de l’enseignement, CHU Sainte-Justine, Montreal, QC, Canada
| | - Evelyne Doyon-Trottier
- Emergency Department, CHU Sainte-Justine, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Nicole Hung
- Institut TransMedTech, CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Estelle Guingo
- Institut TransMedTech, CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Creation and New Medias, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, QC, Canada
| | - An Kateri Vu
- Faculty of Dental Medicine, University of Montreal, Montreal, QC, Canada
| | - Annie Sylfra
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Laurence Lessard
- Institut TransMedTech, CHU Sainte-Justine Research Center, Montreal, QC, Canada
| | - Stephany Cara-Slavich
- Institut TransMedTech, CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Kathryn DeKoven
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Anesthesiology, CHU Sainte-Justine, Montreal, QC, Canada
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Suleman SK, Yahya NB, Nilsson S, Enskär K. Comparison of trace image colors for kids-book with two active distractions in reducing pain and fear of children during the venipuncture procedure. Eur J Pediatr 2024; 183:113-122. [PMID: 37837462 PMCID: PMC10857977 DOI: 10.1007/s00431-023-05271-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023]
Abstract
This study investigated the effectiveness of trace image and coloring for kids-book (TICK-B), cough trick, and balloon inflation techniques in reducing pain and fear in children during venipuncture. The current study is a prospective, controlled, and randomized trial (RCT). School-aged children who required venipuncture were involved in the study. Pediatric patients were randomly assigned to four groups: the TICK-B group, the cough trick group, the inflation of balloons, and the control groups. Before and after the procedure, the children and their parents were interviewed. Wong-Baker (FACES) Pain Rating Scale was applied to measure the severity of pain. Children's Fear Scale was applied to measure children's fear. This study involved the 160 children (mean age, 8.39-2.18 years). The severity of pain and fear levels among the children during and after the procedure were significantly different (p = 0.001). Pain and fear were significantly decreased in children in the intervention groups compared with those in the control group (p < 0.05). In the TICK-B group, participants reported significantly less pain and fear during the venipuncture procedure than in the cough trick, balloon inflation, and control groups (P = 0.001, p = 0.001, p = 0.001) and after the procedure (p = 0.001, p = 0.002, p = 0.002). There was a similar significance found in the level of fear during the procedure (p = 0.001, p = 0.002, p = 0.006), and after the procedure (p = 0.001, p = 0.008, p = 0.015). Conclusion: TICK-B was the most effective method for decreasing the pain and fear of children associated with venipuncture procedures. Furthermore, the distraction technique of coughing and inflating balloons also proved efficacious in decreasing the pain and fear of children during venipuncture. Trial registration: The study has been registered with ClinicalTrials.org under the number NCT04983303. It was retrospectively registered on July 26, 2021. What is Known: • Venipuncture, one of the most painful and uncomfortable procedures for children, caused great fear and discomfort during the procedure. What is New: • The TICK-B technique, music listening, and cartoon watching techniques are effective, simple, and safe ways to reduce children's fear and pain. These interventions provide a good way for children and their parents to collaborate during painful medical procedures. • No studies have compared the impact of TICK-B during venipuncture.
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Affiliation(s)
- Sherzad Khudeida Suleman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Psychiatric and Pediatric Nursing Unit, College of Nursing, University of Duhok, Duhok, Kurdistan Region, Iraq.
| | - Nizer Bakir Yahya
- Pediatric Medicine Unit, College of Medicine, Duhok University, Duhok, Kurdistan Region, Iraq
| | - Stefan Nilsson
- Institute of Health and Caring Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Karin Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mabbott AP, Bedford H. Pain management in infant immunisation: A cross-sectional survey of UK primary care nurses. Prim Health Care Res Dev 2023; 24:e71. [PMID: 38126393 PMCID: PMC10790675 DOI: 10.1017/s146342362300066x] [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: 03/29/2023] [Revised: 09/26/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Childhood immunisation is a critically important public health initiative. However, since most vaccines are administered by injection, it is associated with considerable pain and distress. Despite evidence demonstrating the efficacy of various pain management strategies, the frequency with which these are used during routine infant vaccinations in UK practice is unknown. AIM This study aimed to explore primary care practice nurses' (PNs) use of evidence-based pain management strategies during infant immunisation, as well as barriers to evidence-based practice. METHODS A questionnaire was developed and distributed to nurses throughout the UK via convenience sampling in paper and online formats. Questions assessed the frequency of pain management intervention use during infant immunisation and barriers to their use. FINDINGS A total of 255 questionnaire responses were received. Over 90% (n = 226) of respondents never used topical anaesthetics or sweet solutions during immunisations, while 41.9% advised breastfeeding occasionally (n = 103). Parent-/caregiver-led distraction was the most frequently used intervention, with most nurses using it occasionally (47.9%, n = 116) or often (30.6%, n = 74). Most practices had no immunisation pain management policy (81.1%, n = 184), and most PNs' previous training had not included pain management (86.9%, n = 186). Barriers to intervention use included lack of time, knowledge and resources. Excluding distraction, pain management strategies were infrequently or never used during infant immunisation. Key barriers to using evidence-based strategies were lack of time, knowledge and resources.
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Affiliation(s)
- Annie P. Mabbott
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Helen Bedford
- University College London Great Ormond Street Institute of Child Health, London, UK
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Kantor J, Vanderslott S, Morrison M, Pollard AJ, Carlisle RC. The Oxford Needle Experience (ONE) scale: a UK-based and US-based online mixed-methods psychometric development and validation study of an instrument to assess needle fear, attitudes and expectations in the general public. BMJ Open 2023; 13:e074466. [PMID: 38097240 PMCID: PMC10729041 DOI: 10.1136/bmjopen-2023-074466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To develop and validate the Oxford Needle Experience (ONE) scale, an instrument to assess needle fear, attitudes and expectations in the general population. DESIGN Cross-sectional validation study. SETTING Internet-based with participants in the UK and USA. PARTICIPANTS UK and US representative samples stratified by age, sex, and ethnicity using the Prolific Academic platform. MAIN OUTCOME MEASURES Exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation on the UK sample for the ONE scale. Confirmatory factor analysis (CFA) with a Satorra-Bentler scaled test statistic evaluating the root mean squared error of approximation (RMSEA), standardised root mean squared residual (SRMR) and comparative fit index (CFI) on the US sample. Reliability as internal consistency using McDonald's omega. Convergent validity using the Pearson correlation coefficient. Predictive and discriminant validity using logistic regression ORs of association (OR). RESULTS The population included 1000 respondents, 500 in the UK and 500 in the USA. Minimum average partial correlation and a scree plot suggested four factors should be retained: injection hesitancy, blood-related hesitancy, recalled negative experiences and perceived benefits, yielding a 19-question scale. On CFA, the RMSEA was 0.070 (90% CI, 0.064 to 0.077), SRMR 0.053 and CFI 0.925. McDonald's omega was 0.92 and 0.93 in the UK and US samples, respectively. Convergent validity with the four-item Oxford Coronavirus Explanations, Attitudes and Narratives Survey (OCEANS) needle fear scale demonstrated a strong correlation (r=0.83). Predictive validity with a single-question COVID-19 vaccination status question demonstrated a strong association, OR (95% CI) 0.97 (0.96 to 0.98), p<0.0001 in the US sample. Discriminant validity with a question regarding the importance of controlling what enters the body confirmed the ONE score does not predict this unrelated outcome, OR 1.00 (0.99, 1.01), p=0.996 in the US sample. CONCLUSIONS The ONE scale is a reliable and valid multidimensional scale that may be useful in predicting vaccine hesitancy, designing public health interventions to improve vaccine uptake and exploring alternatives to needles for medical procedures.
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Affiliation(s)
- Jonathan Kantor
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- Biomedical Ultrasonics, Biotherapy, and Biopharmaceuticals Laboratory (BUBBL), Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Department of Dermatology, Center for Global Health, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Michael Morrison
- Centre for Health, Law, and Emerging Technologies (HeLEX), University of Oxford, Oxford, UK
| | | | - Robert C Carlisle
- Biomedical Ultrasonics, Biotherapy, and Biopharmaceuticals Laboratory (BUBBL), Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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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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Thull-Freedman J, Noel M. We Can End the Harm Caused by Preventable Needle Pain: The Promise of Quality Improvement. Hosp Pediatr 2023; 13:e384-e386. [PMID: 37981874 DOI: 10.1542/hpeds.2023-007524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, University of Calgary
- Alberta Children's Hospital Research Institute
| | - Melanie Noel
- Alberta Children's Hospital Research Institute
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Owerko Centre, Calgary, Alberta, Canada
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Einarsdóttir Egeland S, Lie HC, Woldseth EM, Korsvold L, Ruud E, Larsen MH, Viktoria Mellblom A. Exploring reported distress before and pain during needle insertion into a venous access port in children with cancer. Scand J Caring Sci 2023; 37:927-937. [PMID: 35076943 DOI: 10.1111/scs.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Venous access port is commonly used during cancer treatment in children, yet little is known about how children experience such needle insertion procedures. AIM To study distress before and pain after venous access port needle insertion among children and adolescents with cancer. A second aim was to explore associations between their self-report of procedure-related distress and pain with proxy reports by parents and nurses. METHOD The sample included 43 children/adolescents, aged 1-16 years with cancer, treated at two Norwegian university hospitals. The patient, parent(s), and the nurse performing the procedure completed developmentally appropriate 11-point distress and pain scales before and immediately after the venous access port procedure. Data were analysed using descriptive statistics and non-parametric correlations. ETHICAL ISSUES The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Regional Committee for Medicine and Health Research and the data protector officer at the hospitals. RESULTS For the youngest children (1-5 years), the median distress proxy score was 8 (range 0-9) and pain proxy score 4 (range 0-10). Median distress and pain scores for children aged 6-12 years were 3 (range 0-9) and 1 (range 0-10), respectively, and for the adolescents (age 13-16) 0 (range 0-6) and 1 (range 0-5), respectively. Patients' self-reported distress and pain correlated highly with parents' (distress: rho = 0.83, p < 0.001, pain: rho = 0.92, p < 0.001) and with nurses' proxy ratings (distress: rho = 0.89, p < 0.001, pain: rho = 0.88, p < 0.001). CONCLUSION There were individual age differences in experienced distress/pain associated with venous access port needle insertion, with a trend for younger children to experience higher levels of distress/ pain than the older children. Children's self-report of distress/ pain concurred with both parental and nurse proxy reports.
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Affiliation(s)
- Steinunn Einarsdóttir Egeland
- Department of Paediatric Oncology and Haematology, Division for Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Martha Woldseth
- Department of Pediatric Oncology Medicine and Haematology, Division for Pediatric and Adolescent Medicine, St.Olav's Hospital, University Hospital of Trondheim, Norway
| | | | - Ellen Ruud
- Department of Paediatric Oncology and Haematology, Division for Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Anneli Viktoria Mellblom
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (RBUP), Oslo, Norway
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Forsner M, Cyrén M, Gerdin A, Rullander A. It hurts to get forced: Children's narratives about restraint during medical procedures. PAEDIATRIC & NEONATAL PAIN 2023; 5:110-118. [PMID: 38149218 PMCID: PMC10749400 DOI: 10.1002/pne2.12093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 12/28/2023]
Abstract
According to the UN Convention on the Rights of the Child (UNCRC), children have the right to be involved in decisions about medical procedures affecting them. However, research has shown that healthcare professionals sometimes find this difficult to achieve and those procedures then are performed against the will of the child. The aim was to illuminate restraint from the perspective of children's and young people's experiences of feeling forced during medical procedures. Following the phenomenological hermeneutic method, a secondary qualitative analysis of narrative data from four datasets collected between 2001 and 2020 was performed. Twelve children and young people aged 6-19 years (three male, nine female) from central and northern Sweden narrated their experiences of restraint related to medical procedures in nine narrative interviews and three short written narratives. The analysis revealed that it hurts to get forced, this being illustrated in six themes: bodily misery, emotional rebellion, feeling disregarded, physically limited, desiring escape, and leaving deep traces. From the perspective of children and young people, restraint was interpreted with inspiration from the philosopher Michel Foucault, as being overpowered - not voluntary submission but offering resistance - and according to the theory of caring and uncaring, a relationship in which the healthcare professional is perceived as indifferent to the patient as a person. In conclusion restraint hurts and means powerlessness to the child, leaving deep traces that remain for a long time. The findings call the healthcare profession to take action to support children's self-determination, participation, and integrity in healthcare. How children experience restraint in healthcare merits further investigation from the children's own perspective.
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Signorelli C, Robertson EG, Valentin C, Alchin JE, Treadgold C. A Review of Creative Play Interventions to Improve Children's Hospital Experience and Wellbeing. Hosp Pediatr 2023; 13:e355-e364. [PMID: 37830155 DOI: 10.1542/hpeds.2022-006994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
CONTEXT Being in the hospital can be stressful for children and caregivers. Evidence-based play interventions to reduce this stress, such as play therapy or Child Life services, have been introduced in hospitals globally, with growing awareness of potential benefits. OBJECTIVES To evaluate the impact of nonmedical/illness-specific creative or play-based programs in hospital settings on children's (<18 years) and their caregivers' hospital experiences, wellbeing, and other health outcomes. DATA SOURCES PubMed, CINAHL, Google Scholar. METHODS We conducted a systematic review of original articles published since 2011, screening 2701 de-duplicated articles. RESULTS We identified 25 eligible articles, representing 1629 children (57% male), 422 caregivers, and 128 health professionals. Included studies most commonly evaluated professional children's entertainers (n = 8 studies), music therapy (n = 4), unstructured play (n = 3), and humanoid/animal robots (n = 3). Most studies evaluated the impact on the child's level of anxiety (n = 14/25), mostly supporting a reduction (n = 13/14 studies). Several studies provided evidence for a reduction in children's pain (n = 4/6), and negative emotional/behavioral outcomes (eg, sadness, anger, irritability; n = 5/6 studies). There was mixed evidence for the impact of the included interventions on physiologic outcomes (eg, systolic pressure, heart frequency; n = 3/5 studies) and fatigue (n = 1/2 studies). Evidence on caregiver outcomes and the impact on health care services was limited. CONCLUSIONS The findings of our review generally supported the value of play-based interventions on children's' wellbeing while in the hospital, particularly reducing anxiety and pain. Further evaluation of their impact on caregivers' outcomes and the health care system is needed.
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Affiliation(s)
- Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Eden G Robertson
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
- Starlight Children's Foundation, Naremburn, NSW, Australia
| | - Chelsea Valentin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Joseph E Alchin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Claire Treadgold
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
- Starlight Children's Foundation, Naremburn, NSW, Australia
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Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children's pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs 2023; 73:e27-e35. [PMID: 37455147 DOI: 10.1016/j.pedn.2023.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study was conducted to determine the effects of visual and/or auditory distraction techniques applied to children aged 7-12 during invasive procedures on pain, anxiety, and medical fear. METHODS This single-blinded, randomized controlled trial was carried out in the pediatric emergency department of a public hospital between November 2021 and March 2022. In the study, 144 children were assigned to three different intervention groups, in which a kaleidoscope, music, and virtual reality were applied during invasive procedures, and the control group in which the standard invasive procedure was applied, by using the stratified block randomization method. The data were collected using a Personal Information Form, Wong-Baker Faces Pain Rating Scale, Children's Anxiety Meter-State, and Child Medical Fear Scale. RESULTS In the study, the levels of pain, anxiety, and medical fear after the invasive procedure were lower in the intervention groups than in the control group. In addition, there was no difference between the three different distraction techniques in terms of reducing pain and medical fear, but the virtual reality application was more effective in reducing the level of anxiety. CONCLUSION Visual and/or auditory distraction techniques are effective methods that can be used by nurses in pediatric healthcare to reduce invasive procedure-related pain, anxiety, and medical fear. IMPLICATIONS FOR PRACTICE This study provides evidence that can guide the use of non-pharmacological methods such as distraction to prevent the traumatic effects of invasive procedures in children.
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Affiliation(s)
- Nursen Goktas
- Mehmet Akif Ersoy State Hospital, Child Monitoring Center, Canakkale, Turkey
| | - Dilek Avci
- Bandirma Onyedi Eylul University, Faculty of Health Sciences, Balikesir, Turkey.
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Volinn E. When Patients' Assessments of Treatment for Subjective Symptoms are At Odds with Authoritative Assessments in the Biomedical Literature: The Case of Patients Treated with Acupuncture for Low Back Pain in a Traditional Chinese Medicine Clinic in China (and Story of a Bewildered Chicken). J Eval Clin Pract 2023; 29:1073-1082. [PMID: 36647197 DOI: 10.1111/jep.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/27/2022] [Accepted: 10/04/2022] [Indexed: 01/18/2023]
Abstract
Assessments of treatments for 'subjective symptoms' are problematic and potentially contentious. These are symptoms without ascertainable pathophysiology, also referred to as 'medically unexplained.' Treatments of them may be assessed from different perspectives, and an assessment as seen from one perspective may be discrepant with an assessment as seen from another perspective. The observational study described in the paper represents one perspective. Patients in the study were treated with acupuncture for the subjective symptom of low back pain in a Traditional Chinese Medicine Clinic in China; acupuncture is a form of TCM, which is indigenous to China. Shortly after treatment began and six months afterward, patients reported 'clinically important improvements' on a variety of standard, cross-culturally validated outcome measures, including pain intensity, physical functioning, and emotional functioning; this assessment is consistent with numerous assessments of acupuncture in China and other Southeastern Asian countries. On the other hand, clinical trials represent another perspective from which to assess acupuncture. Although assessments based on trials are not uniform, several assessments based on them, including those published in journals such as Lancet and New England Journal of Medicine, conclude that acupuncture is not effective. These trials, however, were mainly situated in the U.S., western European countries, and other WEIRD (Western, Educated, Industrialized, Rich, Democratic) countries. This is notable, because the population of China, the indigenous context of acupuncture, is greater than populations of WEIRD countries combined. Patients' expectations of a treatment such as acupuncture and their prior familiarity with it vary among contexts, and patients' experiences of treatment outcomes may vary accordingly. In short, although clinical trials constitute a test of truth in biomedicine and inform authoritative assessments in WEIRD countries, they do not necessarily represent the truth from the perspective of those experiencing outcomes of especially indigenous treatments for subjective symptoms in non-WEIRD contexts.
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Arıkan A, Esenay FI. The Effect of Distraction Methods During Venous Blood Sampling on Pain Levels in School-Age Children: A Systematic Review. Pain Manag Nurs 2023; 24:e109-e114. [PMID: 37479642 DOI: 10.1016/j.pmn.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES This systematic review was conducted to examine the available evidence on the effects of distraction methods during venous blood sampling on pain levels in school-age children. DESIGN A systematic review. DATA SOURCES Pubmed, Web of Science, Scopus, Science Direct were searched using search terms. REVIEW/ANALYSIS METHODS A systematic review of all relevant articles published between June 2017 and June 2022, was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS The applied search strategy identified 612 articles in four databases. A total of 2,032 school-age children in the 15 studies who met the study inclusion criteria were included in the review. Four studies used active distraction, eight studies used passive distraction, and three studies used both distraction methods. CONCLUSIONS Active and passive distractions are efficacious interventions during venous blood sampling in reducing pain in school-age children. However, more studies are needed to determine the superiority between these two methods.
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Affiliation(s)
- Aylin Arıkan
- From the Graduate Schools of Health Sciences at Ankara University, Ankara, Turkey.
| | - Figen Işık Esenay
- Assistant Professor, Department of Pediatric Nursing, Faculty of Nursing, Ankara University, Ankara, Turkey
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