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Plummer K, Adina J, Mitchell AE, Lee-Archer P, Clark J, Keyser J, Kotzur C, Qayum A, Griffin B. Digital health interventions for postoperative recovery in children: a systematic review. Br J Anaesth 2024; 132:886-898. [PMID: 38336513 DOI: 10.1016/j.bja.2024.01.014] [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: 10/31/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Digital health interventions offer a promising approach for monitoring during postoperative recovery. However, the effectiveness of these interventions remains poorly understood, particularly in children. The objective of this study was to assess the efficacy of digital health interventions for postoperative recovery in children. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the use of automation tools for searching and screening. We searched five electronic databases for randomised controlled trials or non-randomised studies of interventions that utilised digital health interventions to monitor postoperative recovery in children. The study quality was assessed using Cochrane Collaboration's Risk of Bias tools. The systematic review protocol was prospectively registered with PROSPERO (CRD42022351492). RESULTS The review included 16 studies involving 2728 participants from six countries. Tonsillectomy was the most common surgery and smartphone apps (WeChat) were the most commonly used digital health interventions. Digital health interventions resulted in significant improvements in parental knowledge about the child's condition and satisfaction regarding perioperative instructions (standard mean difference=2.16, 95% confidence interval 1.45-2.87; z=5.98, P<0.001; I2=88%). However, there was no significant effect on children's pain intensity (standard mean difference=0.09, 95% confidence interval -0.95 to 1.12; z=0.16, P=0.87; I2=98%). CONCLUSIONS Digital health interventions hold promise for improving parental postoperative knowledge and satisfaction. However, more research is needed for child-centric interventions with validated outcome measures. Future work should focus development and testing of user-friendly digital apps and wearables to ease the healthcare burden and improve outcomes for children. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022351492).
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Affiliation(s)
- Karin Plummer
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia; Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia.
| | - Japheth Adina
- Parenting and Family Support Centre, School of Psychology, Brisbane, QLD, Australia
| | - Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, Brisbane, QLD, Australia; Griffith Centre for Mental Health, Griffith University, Brisbane, QLD, Australia; Midwifery and Social Work, School of Nursing, The University of Queensland, Brisbane, QLD, Australia
| | - Paul Lee-Archer
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Janelle Keyser
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Catherine Kotzur
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Abdul Qayum
- Department of Critical Care, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Saigh FI, Saigh ZI. Mothers' Involvement in Pediatric Postoperative Pain Care in a Tertiary Healthcare Setting in Saudi Arabia. Cureus 2023; 15:e34967. [PMID: 36938286 PMCID: PMC10019376 DOI: 10.7759/cureus.34967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Background Many children feel moderate to intense pain in the hospital following surgery. Untreated pain can have deleterious physical and psychological effects. Mothers' involvement in child pain care and management postoperatively has been shown to be important in improving the outcomes and experiences of children, mothers, and health professionals. Aims To explore mothers' involvement in postoperative pain care and management of their children during hospitalization and following discharge and identify approaches to improve management and participation activities. Methods We used a qualitative single case study design with thematic analysis. The analysis included 20 mother-child dyads and 21 nurses, involving observation of participants and semi-structured interviews of mothers and nurses. The analysis also incorporated a review of documents from the pediatric surgical department (hospital policies and forms). Findings The following main themes and sub-themes were generated from the data: (i) provision of pain information (expected type, frequency, and duration of pain after surgery, pain intensity score, pain relief medication, and pain management methods), (ii) communication deficiency (language barrier and breakdown in communication between health professionals), (iii) emotional and physical support (family support, environmental comfort, and sleep and meal requirements), (iv) social and cultural influences (patriarchal society, cultural and religious beliefs, and work status), and (v) hospital facilities, provisions, and services (entertainment, follow-up programs, education courses on pain management for nurses, and materials and services). Conclusions The study examined mothers' participation in postoperative pain care and management in a cohort of children admitted to a tertiary care setting in Saudi Arabia, highlighting key factors that influence involvement and suggesting approaches for improving participation.
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Affiliation(s)
- Fatmah I Saigh
- Oncology and Palliative Care, King Abdullah Medical Complex, Jeddah, SAU
| | - Zainab I Saigh
- Clinical Psychology, Mental Health Hospital in Jeddah, Jeddah, SAU
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Wozney L, Vakili N, Chorney J, Clark A, Hong P. The Impact of a Text Messaging Service (Tonsil-Text-To-Me) on Pediatric Perioperative Tonsillectomy Outcomes: Cohort Study With a Historical Control Group. JMIR Perioper Med 2022; 5:e39617. [PMID: 36125849 PMCID: PMC9533209 DOI: 10.2196/39617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Tonsillectomy is a common pediatric surgical procedure performed in North America. Caregivers experience complex challenges in preparing for their child’s surgery and coordinating care at home and, consequently, could benefit from access to educational resources. A previous feasibility study of Tonsil-Text-To-Me, an automated SMS text messaging service that sends 15 time-sensitive activity reminders, links to nutrition and hydration tips, pain management strategies, and guidance on monitoring for complications, showed promising results, with high levels of caregiver satisfaction and engagement. Objective This study aimed to pilot-test Tonsil-Text-To-Me in a real-world context to determine whether and how it might improve perioperative experiences and outcomes for caregivers and patients. Methods Caregivers of children aged 3 to 14 years undergoing tonsillectomy were included. Data from a historical control group and an intervention group with the same study parameters (eg, eligibility criteria and surgery team) were compared. Measures included the Parenting Self-Agency Measure, General Health Questionnaire-12, Parents’ Postoperative Pain Measure, Client Satisfaction Questionnaire-8, and engagement analytics, as well as analgesic consumption, pain, child activity level, and health service use. Data were collected on the day before surgery, 3 days after surgery, and 14 days after surgery. Participants in the intervention group received texts starting 2 weeks before surgery up to the eighth day after surgery. Descriptive and inferential statistics were used. Results In total, 51 caregivers (n=32, 63% control; n=19, 37% intervention) who were predominately women (49/51, 96%), White (48/51, 94%), and employed (42/51, 82%) participated. Intervention group caregivers had a statistically significant positive difference in Parenting Self-Agency Measure scores (P=.001). The mean postoperative pain scores were higher for the control group (mean 10.0, SD 3.1) than for the intervention group (mean 8.5, SD 3.7), both of which were still above the 6/15 threshold for clinically significant pain; however, the difference was not statistically significant (t39=1.446; P=.16). Other positive but nonsignificant trends for the intervention group compared with the control group were observed for the highest level of pain (t39=0.882; P=.38), emergency department visits (χ22=1.3; P=.52; Cramer V=0.19), and other measures. Engagement with resources linked in the texts was moderate, with all but 1 being clicked on for viewing at least once by 79% (15/19) of the participants. Participants rated the intervention as highly satisfactory across all 8 dimensions of the Client Satisfaction Questionnaire (mean 29.4, SD 3.2; out of a possible value of 32.0). Conclusions This cohort study with a historical control group found that Tonsil-Text-To-Me had a positive impact on caregivers’ perioperative care experience. The small sample size and unclear impacts of COVID-19 on the study design should be considered when interpreting the results. Controlled trials with larger sample sizes for evaluating SMS text messaging interventions aimed to support caregivers of children undergoing tonsillectomy surgery are warranted.
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Affiliation(s)
- Lori Wozney
- Mental Health and Addictions, Policy and Planning, Nova Scotia Health, Dartmouth, NS, Canada
| | - Negar Vakili
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Jill Chorney
- Mental Health and Addictions, IWK Health, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Alexander Clark
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Hong
- Division of Otolaryngology, IWK Health, Halifax, NS, Canada
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Forster EM, Kotzur C, Richards J, Gilmour J. Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service. J Child Health Care 2022; 26:394-406. [PMID: 33940942 DOI: 10.1177/13674935211014742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child's pain management and perceptions of support from the NpAPS. Parents completed the Parents' Postoperative Pain Measure-Short Form (PPPM-SF) and factors affecting parents' participation in children's pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.
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Affiliation(s)
| | - Catherine Kotzur
- Department of Anaesthetics, 94273Queensland Children's Hospital, Brisbane
| | - Julianne Richards
- Department of Anaesthetics, 94273Queensland Children's Hospital, Brisbane
| | - John Gilmour
- School of Psychology, University of Southern Queensland, Australia
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van der Perk CJ, van de Riet L, Alsem M, van Goudoever JB, Maaskant J. Prognostic factors influencing parental empowerment after discharge of their hospitalized child: A cross-sectional study. J Pediatr Nurs 2022; 66:e145-e151. [PMID: 35537978 DOI: 10.1016/j.pedn.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE There is a growing number of children with medical complexity (CMC). After hospitalization, care often has to be continued at home, making transitional care very important. However, many parents do not feel empowered in their role as caregiver for the child. To move forward in this field, we explored prognostic factors associated with parental empowerment after discharge of hospitalized children. DESIGN AND METHODS In a cross-sectional study, we collected data on potential prognostic factors found in the literature and on parental empowerment by means of the Family Empowerment Scale (FES). Linear regression analyses were performed to explore the associations between the prognostic factors and the FES. RESULTS Data from 228 patients and their parents were analyzed. Out of twelve factors included in the study, three showed significant associations with parental empowerment. Parents of CMC felt more empowered compared to parents of children with less complex conditions (β = 0.20, p = 0.00). We found a positive association between the age of the child and parental empowerment (β = 0.01, p = 0.00). Employed couples felt more empowered compared to unemployed couples (β = 0.30, p = 0.00). These three variables explained 11% of variance in the FES scores. CONCLUSIONS Parental empowerment is associated with the patient's age, child's medical complexity, and parental employment status. PRACTICE IMPLICATIONS Attention should be paid to the discharge preparation of parents of children with less medical complexity. Awareness is required for parents of younger children and parental employment status, because they are at risk for lower parental empowerment.
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Affiliation(s)
- Cor-Jan van der Perk
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands.
| | - Liz van de Riet
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Mattijs Alsem
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam University Medical Center Department of Rehabilitation Medicine, Amsterdam, the Netherlands
| | - Johannes B van Goudoever
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Jolanda Maaskant
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam University Medical Center, University of Amsterdam Department of Data Science and Epidemiology, Amsterdam, the Netherlands
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Billings KR, Bhushan B, Berkowitz RJ, Stake C, Lavin J. Outcomes of a postoperative day one call to families after adenotonsillectomy in children. Laryngoscope Investig Otolaryngol 2022; 7:1200-1205. [PMID: 36000061 PMCID: PMC9392385 DOI: 10.1002/lio2.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the outcomes of a postoperative day one (POD 1) phone call to families of ambulatory surgical patients, as a means of guiding clinical interventions and quality initiatives, with a focus on children undergoing adenotonsillectomy (T&A). Methods Retrospective analysis of outcomes of a POD 1 questionnaire completed in children <18 years of age undergoing T&A at a tertiary care children's hospital over a 3‐year period (August 14, 2018–August 31, 2021). Results Responses to the questionnaire were obtained for a total of 1428/3464 (41.2%) children undergoing T&A during the study period. There was no difference in gender, age at surgery, race, ethnicity, insurance product, or preoperative diagnosis for those whose caregiver responded to the questionnaire versus those who did not. Parent responses included 84 (5.9%) who reported problems or concerns postdischarge. These included 18 (1.3%) patients unable to take their pain medication, 9 (0.6%) refusing oral intake, 28 (2.0%) with postoperative emesis, 27 (1.9%) with fevers, and 6 (0.4%) with a change in breathing. A total of 75/122 (61.5%) who reported pain were taking their pain medication as directed. Nineteen (1.3%) patients were noted to have bleeding after surgery, including 4 (21.5%) with nosebleeds, and 12 (63.2%) with oral cavity bleeding requiring no interventions. Conclusions The POD 1 questionnaire identified patients with common concerns and complications after T&A. Although most of these concerns were infrequent, it afforded the clinical team the opportunity to provide additional education and instructions on care and management to caregivers after their child's surgical procedure.
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Affiliation(s)
- Kathleen R. Billings
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Otolaryngology‐Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Bharat Bhushan
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Otolaryngology‐Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Rachel J. Berkowitz
- Data Analytics and Reporting Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Christine Stake
- Department of Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jennifer Lavin
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Otolaryngology‐Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
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The effect of telephone counseling and internet-based support on pain and recovery after tonsil surgery in children – a systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Lagrange C, Jepp C, Slevin L, Drake-Brockman TFE, Bumbak P, Herbert H, von Ungern-Sternberg BS, Sommerfield D. Impact of a revised postoperative care plan on pain and recovery trajectory following pediatric tonsillectomy. Paediatr Anaesth 2021; 31:778-786. [PMID: 33788340 DOI: 10.1111/pan.14187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/03/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A previous cohort of adenotonsillectomy patients at our institution demonstrated moderate-severe post-tonsillectomy pain scores lasting a median (range) duration of 6 (0-23) days and postdischarge nausea and vomiting affecting 8% of children on day 1 following surgery. In this subsequent cohort, we evaluate the impact of changes to our discharge medication and parental education on post-tonsillectomy pain and recovery profile. METHODS In this follow-on, prospective observational cohort study, all patients undergoing tonsillectomy at our institution during the study period were discharged with standardized analgesia. Parents received a revised education package and a medication diary which were not provided to the previous cohort. Pain scores, rates of nausea and vomiting, medication usage and unplanned representation rates were collected by telephone from parents. RESULTS Sixty-nine patients were recruited. Moderate-severe pain lasted a median (range) of 5 (0-12) days. Twenty-nine (42%) had pain scores ≥4/10 beyond postoperative day 7. By postoperative day 5, only 37 (53%) parents continued to administer regular analgesia. The median number of oxycodone doses used was 5 (0-22), and only 28 (41%) parents had disposed of leftover oxycodone within 1 month of surgery. Twenty-four (35%) patients experienced nausea or vomiting postdischarge. The median (range) time for return to normal activities was 6 (0-14) days. Thirty-two/sixty-nine (46%) patients had unplanned medical representations. Most occurred between postoperative day 5 and 7. Pain contributed to 16 (35%) representations. CONCLUSIONS Despite extensive changes to our discharge protocols parents continued to report a prolonged period of pain, post operative nausea and vomiting, and behavioral changes. Further work is required to examine barriers to compliance with simple analgesia and education in appropriate methods of opioid disposal.
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Affiliation(s)
- Claudia Lagrange
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Catherine Jepp
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Lliana Slevin
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - Paul Bumbak
- Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, Perth, WA, Australia
| | - Haley Herbert
- Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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Billings KR, Stake C, Arzu J, Lavin J. Outcomes of a Postoperative Data-Extraction Questionnaire After Adenotonsillectomy in Children. Laryngoscope 2021; 131:E2821-E2826. [PMID: 34014559 DOI: 10.1002/lary.29626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate outcomes of a postoperative telephone questionnaire for children who underwent adenotonsillectomy (T&A). To determine whether episodes of postoperative hemorrhage were not captured until the call, and whether this impacted knowledge of physician rates of hemorrhage. STUDY DESIGN Retrospective database analysis. METHODS Retrospective analysis of outcomes of an 11-question data extraction tool utilized at a tertiary care children's hospital for follow-up in T&A patients <18 years of age over a 2-year period. Sub-analysis of positive responses to the question asking about incidence of postoperative hemorrhage. RESULTS During the study period, 1,068/3,142 (34.0%) parents responded to the phone call. Median age was 6.0 years (interquartile range [IQR] 4.0-8.2), and 566 (53.0%) were male. Ninety (8.4%) noted that the child was still snoring, but only 9 (0.84%) reported signs of obstructed breathing. A total of 402 (37.6%) reported a voice change after surgery. Most children (n = 885, 82.9%) did not receive opioid analgesics, and 252 (23.6%) received acetaminophen/ibuprofen 7 days postoperatively. Return visits to the emergency department were reported in 149 patients; primarily for hemorrhage in 46 (30.8%). In 7 (15.2%) patients, the hemorrhage event was not recorded until the call. The majority-of respondents (n = 1,031, 96.5%) were satisfied with the outcome of the procedure. CONCLUSIONS The postoperative T&A tool provided a means of gathering information on success and satisfaction with surgical outcomes. Children were able to be managed primarily with acetaminophen and ibuprofen. Most complications were captured in the electronic record, although some episodes of hemorrhage were not noted until the call, emphasizing the importance of follow-up. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Kathleen R Billings
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Christine Stake
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Jennifer Arzu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jennifer Lavin
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Kelley-Quon LI, Kirkpatrick MG, Ricca RL, Baird R, Harbaugh CM, Brady A, Garrett P, Wills H, Argo J, Diefenbach KA, Henry MCW, Sola JE, Mahdi EM, Goldin AB, St Peter SD, Downard CD, Azarow KS, Shields T, Kim E. Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion. JAMA Surg 2021; 156:76-90. [PMID: 33175130 PMCID: PMC8995055 DOI: 10.1001/jamasurg.2020.5045] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
IMPORTANCE Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery. EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique. FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery. CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.
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Affiliation(s)
- Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Department of Preventive Medicine, University of Southern California, Los Angeles
- Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles
| | | | - Robert L Ricca
- Department of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Robert Baird
- Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ashley Brady
- Department of Pediatric Surgery, University of Michigan, Ann Arbor
| | - Paula Garrett
- Department of Pediatric Surgery, University of Michigan, Ann Arbor
| | - Hale Wills
- Division of Pediatric Surgery, Hasbro Children's Hospital, Providence, Rhode Island
- Department of Surgery, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jonathan Argo
- Department of Pediatric Anesthesiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Marion C W Henry
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Juan E Sola
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Elaa M Mahdi
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Kenneth S Azarow
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland
| | - Tracy Shields
- Division of Library Services, Naval Medical Center, Portsmouth, Virginia
| | - Eugene Kim
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
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Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 76:947-961. [PMID: 33201518 PMCID: PMC8247026 DOI: 10.1111/anae.15299] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure‐specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta‐analysis guidelines with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol; non‐steroidal anti‐inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra‐operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first‐line analgesics are contra‐indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.
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Affiliation(s)
- N Aldamluji
- Department of Adult Anaesthesiology, Sidra Medicine, Qatar
| | - A Burgess
- Department of Otolaryngology Head and Neck Surgery, Com Maillot-Hartmann Private Hospital, Neuilly sur Seine, France
| | - E Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H Beloeil
- Department of Anaesthesiology and Critical Care, Université Rennes, Rennes, France
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A comprehensive examination of the immediate recovery of children following tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 2020; 135:110106. [PMID: 32422367 PMCID: PMC7308207 DOI: 10.1016/j.ijporl.2020.110106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first two weeks following surgery. STUDY DESIGN Observational, longitudinal study. SETTING Four major pediatric hospitals in the U.S. consisting of Children's Hospital of Orange County, Children's Hospital of Los Angeles, Lucile Packard Children's Hospital, and Children's Hospital Colorado. SUBJECTS and Methods: Participants included 827 patients between 2 and 15 years of age who underwent tonsillectomy with or without adenoidectomy surgery. Baseline and demographic information were gathered prior to surgery, and measures of clinical, behavioral, and physical recovery were recorded immediately following and up through two weeks after surgery. RESULTS Pain following T&A was clinically significant through the first post-operative week and nearly resolved by the end of the second week. Negative behavioral changes were highly prevalent after surgery (75.6% of children at Day 0) through the first week (63.9% at Week 1), and over 20% of children continued to evidence new onset negative behavioral changes at two weeks post-operatively. Children were rated as experiencing significant functional impairment in the immediate three days following surgery and most children returned to baseline functioning by the end of the second week. CONCLUSIONS Results of this study suggest that children show immediate impairment in functioning and experience clinically significant pain throughout the first week following T&A, and new onset maladaptive behavioral changes persisting even up to the two-week assessment period.
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Harbaugh CM, Vargas G, Sloss KR, Bohm LA, Cooper KA, Thatcher AL, Zopf DA, Chua KP, Waljee JF, Gadepalli SK. Association of Opioid Quantity and Caregiver Education with Pain Control after Pediatric Tonsillectomy. Otolaryngol Head Neck Surg 2020; 162:746-753. [DOI: 10.1177/0194599820912033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective To examine whether a service guideline reducing postoperative opioid prescription quantities and caregiver-reported education to use nonopioid analgesics first are associated with caregiver-reported pain control after pediatric tonsillectomy. Study Design Prospective cohort study (July 2018–April 2019). Setting Pediatric otolaryngology service at a tertiary academic children’s hospital. Subjects and Methods Caregivers of patients aged 1 to 11 years undergoing tonsillectomy (N = 764) were surveyed 7 to 21 days after surgery regarding pain control, education to use nonopioid analgesics first, and opioid use. Respondents who were not prescribed opioids or had missing data were excluded. Logistic regression modeled caregiver-reported pain control as a function of service guideline implementation (December 2018) recommending 20 rather than 30 doses for postoperative opioid prescriptions and caregiver-reported analgesic education, adjusting for patient demographics. Results Among 430 respondents (56% response), 387 patients were included. The sample was 43% female with a mean age of 5.0 years (SD, 2.5). Pain control was reported as good (226 respondents, 58%) or adequate/poor (161 respondents, 42%). Mean opioid prescription quantity was 27 doses (SD, 7.9) before and 21 doses (SD, 6.1) after guideline implementation ( P < .001). Education to use nonopioids first was reported by 308 respondents (80%). In regression, prescribing guideline implementation was not associated with pain control (adjusted odds ratio, 1.3; 95% CI, 0.9-2.0; P = .22), but caregiver-reported education to use nonopioids first was associated with a higher odds of good pain control (adjusted odds ratio, 1.9; 95% CI, 1.1-3.2; P = .02). Conclusion Caregiver education to use nonopioid analgesics first may be a modifiable health care practice to improve pain control as postoperative opioid prescription quantities are reduced.
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Affiliation(s)
- Calista M. Harbaugh
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Gracia Vargas
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth R. Sloss
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren A. Bohm
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Karen A. Cooper
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aaron L. Thatcher
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - David A. Zopf
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kao-Ping Chua
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer F. Waljee
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Samir K. Gadepalli
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Boztepe H, Ay A, Akyüz C. Maternal Pain Management at Home in Children with Cancer: A Turkish Sample. J Pediatr Nurs 2020; 50:e99-e106. [PMID: 31434636 DOI: 10.1016/j.pedn.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the present study was to examine maternal pain management in children with cancer and the associated factors. DESIGN AND METHODS The present work is a descriptive and cross-sectional study. Data for the study were obtained from mothers of children in the age group of 0 to 18 years undergoing treatment for solid tumors in Pediatric Oncology Service and Outpatient Clinics (n = 112). We used a questionnaire on parental pain management practices at home, the knowledge about pain and analgesic drugs, Spielberger State-Trait Anxiety Inventory (STAI), and Pain Catastrophizing Scale (PCS) to collect the data. RESULTS Several mothers taking part in the study reported various misconceptions about the assessment of children's pain, analgesic drugs, and usage of limited non-pharmacological methods for managing pain in children with cancer. No significant relationships were found between mothers' pain management practices, knowledge of pain assessment and analgesic drugs, and mothers' and children's sociodemographic characteristics or mothers' pain catastrophizing and anxiety about their own pain. CONCLUSIONS The findings of the study revealed that the majority of mothers of children with cancer had misconceptions regarding knowledge of pain assessment and analgesic drugs; these misconceptions potentially lead to manage children's pain associated with cancer ineffectively. Findings indicate mothers' information and support needs for children's cancer pain management in the home settings. PRACTICE IMPLICATIONS A further understanding of barriers to parental pain management in children with cancer in the home setting will contribute immensely in developing appropriate management practices.
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Affiliation(s)
- Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atılım University, İncek, Ankara, Turkey
| | - Ayşe Ay
- Pediatric Nursing Department, Faculty of Nursing, Hacettepe University, Sıhhiye, Ankara, Turkey.
| | - Canan Akyüz
- Professor Pediatric Oncology Department, Hacettepe University Institute of Oncology, Hacettepe University, Sıhhiye, Ankara, Turkey
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Yu KE, Kim JS. Effects of a posttonsillectomy management program using a mobile instant messenger on parents' knowledge and anxiety, and their children's compliance, bleeding, and pain. J SPEC PEDIATR NURS 2019; 24:e12270. [PMID: 31468682 DOI: 10.1111/jspn.12270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 07/08/2019] [Accepted: 08/01/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Pediatric tonsillectomy is a highly common surgery for children. The inclusion of tonsillectomy in the diagnosis-related group payment system in Korea has resulted in a shorter hospital stay for patients who undergo tonsillectomy. This, in turn, provides parents with additional caregiver roles in the home. OBJECTIVES This study aimed to investigate the effects of a postdischarge management program (PDMP) using Mobile Instant Messenger (MIM) on parents' knowledge and state anxiety about postoperative care, and their children's compliance with care instructions at home, frequency of bleeding, and pain intensity after tonsillectomy. DESIGN AND METHODS A nonequivalent control group nonsynchronized design. SETTINGS AND PARTICIPANTS Participants were 52 tonsillectomy children aged 3-7 years and their 52 parents (27 for the experimental group and 25 for the control group) from a hospital, in Korea. The control group received a routine written and oral predischarge education, while the experimental group received a predischarge education and a daily MIM for 7 days. For the experimental group, bidirectional communication between the nurse and parent when necessary using MIM are available during the intervention period. RESULTS Parents in the experimental group reported a significantly higher knowledge about postdischarge management and lower state anxiety than the control group. Children in the experimental group showed a significantly greater improvement in compliance with the care instructions at home than the control group. However, bleeding frequency and pain intensity were not significantly lower in the experimental group than that in the control group. PRACTICAL IMPLICATIONS Nurses play a critical role in preventing and managing the complications of tonsillectomy. Providing proper parental education about pediatric posttonsillectomy care at home is critical for a successful recovery. With the explosion of smartphone technology, the MIM-based PDMP is a useful and effective strategy in helping parents and children in posttonsillectomy care at home.
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Affiliation(s)
- Kyoung Eun Yu
- Department of Nursing, Donggang University, Gwangju, Korea
| | - Jin Sun Kim
- Department of Nursing, Chosun University, Gwangju, Korea
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Li C, Huang S, Su X, Zhang T, Jiang K. Monitoring of home recovery using the 317-nursing mobile application following day-case surgery in children: Perspectives from both nurses and patients. Medicine (Baltimore) 2019; 98:e16639. [PMID: 31374033 PMCID: PMC6708974 DOI: 10.1097/md.0000000000016639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The number of elective day-case surgeries has considerably increased in recent years, especially in China. Few studies have investigated the ability of mobile applications to assist recovery for patients having undergone day-surgery; however, these studies have indicated that the use of mobile applications is cost-efficient and has a positive effect on recovery after surgery. This study aimed to evaluate the utility and efficacy of using the 317-nursing mobile application program (317NAPP) for monitoring home recovery following day-surgery involving high ligation of the hernial sac in pediatric patients.Prospective clinical study involving 2 parallel groups.Patients were randomly divided into the "intervention 317NAPP group" (n = 64) and the control group (n = 63). Patients were followed-up using the 317NAPP in the intervention group and via telephonic consultations in the control group. All patients were enrolled after being provided sufficient guidance with respect to discharge and health education. The health index, including the physiological function, ability to perform daily activities, and the injury response, was evaluated before and 24 hours after surgery. The time duration of each follow-up session was also evaluated in both groups.The preoperative (T1) health index scores were significantly higher than the postoperative (T0) ones in both groups (P = .00). The quality of recovery (T1-T0) of the intervention group (10.75 ± 5.28) was better than that of the control group (11.78 ± 5.16), but the differences were not significant (P = .27). In the intervention group, the follow-up time duration was significantly lower in comparison to that in the control group (P = .00).This study demonstrated that 317NAPP had a positive effect on recovery following day-surgery, and the time-duration for follow-up was shorter than that performed using telephonic consultation. Monitoring recovery using 317NAPP was safe, efficient, inexpensive, and relatively easy; therefore, it may help improve the recovery of patients having undergone day-surgery.
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Affiliation(s)
| | | | | | | | - Kewen Jiang
- Department of Neurology
- Department of Laboratory, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
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17
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Xin Y, Li X, Du J, Cheng J, Yi C, Mao H. Efficacy of Telephone Follow-Up in Children Tonsillectomy with Day Surgery. Indian J Pediatr 2019; 86:263-266. [PMID: 30547424 DOI: 10.1007/s12098-018-2813-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Day surgery for tonsillectomy has become more and more popular in China. However, many parents face difficulties to cope up with the pain and side effects after surgery. The present study was aimed to examine the efficacy of telephone follow-up on children's post-discharge recovery after tonsillectomy. METHODS In this prospective study, the sample consisted of 863 children randomly assigned to receive clinic visit after discharge or 1 to 14 d' telephone follow-up after discharge. During the follow-up, the research nurse or parents assessed each child's status, identified problems, and provided needed follow-up care. Key outcomes were pain intensity, postoperative complication, and unanticipated contact with the health care system. RESULTS Compared with clinical visit, children in telephone follow-up group presented with less pain in early stage after surgery and better food and drink intake. The prevalence of hemorrhage, nausea, vomiting, fever and dizziness had no difference between the groups. Telephone follow-up also reduced unanticipated healthcare services. CONCLUSIONS The present study suggested that a follow-up telephone call is a safe and cost-effective method of postoperative management for pediatric patients who have undergone tonsillectomy.
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Affiliation(s)
- Yan Xin
- Department of ENT, Affiliated Renhe Hospital of China, Three Gorges University, Second Clinical Medical College of China, No. 410 Yiling Road, Yi Chang, Hubei, China
| | - Xin Li
- Department of ENT, Affiliated Renhe Hospital of China, Three Gorges University, Second Clinical Medical College of China, No. 410 Yiling Road, Yi Chang, Hubei, China.
| | - JinDong Du
- Department of ENT, Affiliated Renhe Hospital of China, Three Gorges University, Second Clinical Medical College of China, No. 410 Yiling Road, Yi Chang, Hubei, China
| | - Jie Cheng
- Department of ENT, Affiliated Renhe Hospital of China, Three Gorges University, Second Clinical Medical College of China, No. 410 Yiling Road, Yi Chang, Hubei, China
| | - ChunYan Yi
- Department of ENT, Affiliated Renhe Hospital of China, Three Gorges University, Second Clinical Medical College of China, No. 410 Yiling Road, Yi Chang, Hubei, China
| | - HuaDong Mao
- Department of ENT, Affiliated Renhe Hospital of China, Three Gorges University, Second Clinical Medical College of China, No. 410 Yiling Road, Yi Chang, Hubei, China
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18
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Keefe KR, Byrne KJ, Levi JR. Treating pediatric post-tonsillectomy pain and nausea with complementary and alternative medicine. Laryngoscope 2018; 128:2625-2634. [PMID: 29729030 DOI: 10.1002/lary.27231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/15/2018] [Accepted: 03/21/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Although tonsillectomy is a common and largely safe procedure, pain management in children remains a controversial topic. In addition to the challenge of choosing appropriate analgesia, there is often low parent and child adherence. This article presents a review, and evaluates the potential role, of a range of complementary and alternative therapies that may be sought out by parents. METHODS A literature review of complementary and alternative interventions performed using PubMed, Cochrane Library, and EMBASE, supplemented by searches from Google and hand searches of cross-references of selected articles, yielded 32 studies for qualitative analysis. RESULTS The studies included for analysis investigated a wide variety of alternative treatment modalities: acupuncture and related therapies, aromatherapy, homeopathy, honey, intravenous fluid, speech therapy, hyaluronic acid, behavioral therapies, ice/cold, hydrogen peroxide rinse, and chewing gum. CONCLUSION At this time, stronger conclusions cannot be made about the therapies investigated because there are many methodology limitations of the studies analyzed. However, our results suggest merit for these treatments as adjuvant therapies that can enhance analgesia and decrease requirements of controversial medications. Honey and acupuncture have the greatest amount of evidence for postoperative pain and nausea; however, all interventions examined were cost-effective and safe. We recommend against hydrogen peroxide rinses and chewing gum. Laryngoscope, 2625-2634, 2018.
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Affiliation(s)
| | - Kevin J Byrne
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, U.S.A.,Boston Medical Center, Boston, Massachusetts, U.S.A
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Parker R, McKeever S, Wiseman T, Twycross A. An Integrative Review of Interventions to Support Parents When Managing Their Child's Pain at Home. Pain Manag Nurs 2018; 19:139-156. [DOI: 10.1016/j.pmn.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 01/24/2023]
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Yu KE, Kim JS. An Integrative Review of Korean Nursing Studies on Pediatric Tonsillectomy. CHILD HEALTH NURSING RESEARCH 2017. [DOI: 10.4094/chnr.2017.23.4.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Özalp Gerçeker G, Karayağız Muslu G, Yardimci F. Children's postoperative symptoms at home through nurse-led telephone counseling and its effects on parents' anxiety: A randomized controlled trial. J SPEC PEDIATR NURS 2016; 21:189-199. [PMID: 27596004 DOI: 10.1111/jspn.12155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE The objective of this study was to evaluate children's postoperative symptoms at home after outpatient surgery through nurse-led telephone counseling and the effects of the nurse-led telephone counseling on parents' state-trait anxiety scores. DESIGN AND METHODS In this prospective randomized controlled study, nurse-led telephone counseling was provided every day to parents in the intervention group until they came for the follow-up visit. Parents of children (n = 54) ages 3-17 years who had undergone outpatient surgery for appendicitis, cholecystectomy, or ovarian cysts were eligible to participate in the study. On the first postoperative day and at the follow-up visit, the Spielberger State-Trait-Anxiety Inventory (STAI) was administered to parents who were randomly allocated to the intervention (n = 24) and control groups (n = 30). RESULTS The parents reported on postoperative symptoms such as pain, activity levels, excretion, sleep, nutrition, and wound infection. While there was no difference in STAI scores for parents between the groups at the first postoperative day, there was a significant decrease in STAI scores in the intervention group versus the control group, with parents in the intervention group reporting lower anxiety scores. PRACTICE IMPLICATIONS Our results suggest that nurse-led telephone counseling is effective at reducing anxiety in parents of children after outpatient surgery.
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Affiliation(s)
| | - Gonca Karayağız Muslu
- Assistant Professor, Muğla Sıtkı Koçman University Fethiye Health School, Muğla, Turkey
| | - Figen Yardimci
- Assistant Professor, Ege University Nursing Faculty, Bornova, Izmir, Turkey
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Yang JY, Lee H, Zhang Y, Lee JU, Park JH, Yun EK. The Effects of Tonsillectomy Education Using Smartphone Text Message for Mothers and Children Undergoing Tonsillectomy: A Randomized Controlled Trial. Telemed J E Health 2016; 22:921-928. [PMID: 27192359 DOI: 10.1089/tmj.2016.0019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tonsillectomy is the most common type of surgical procedure performed in preschool children. Due to short period of hospitalization, mothers are expected to manage their children's care at home. However, they are rarely provided with sufficient information about postoperative management. This study aims to determine the effectiveness of providing caregivers with information on tonsillectomy care by smartphone text messaging in increasing their mothers' knowledge, reducing the anxiety, and improving the sick-role behavior of pediatric tonsillectomy patients. MATERIALS AND METHODS A sample of 61 pediatric patients and their mothers was recruited. Participants were randomly assigned into either the experimental group (n = 27) or the control group (n = 34). The control group was given information about the tonsillectomy by conventional textual and verbal means, whereas the experimental group received the same information in the form of 10 text messages during the period from hospitalization to their first follow-up visits. RESULTS Results of mixed design, two-way analysis of variance indicated significant interaction effects between time points and groups for mothers' knowledge (F = 4.26, p = 0.043) and children's anxiety (F = 3.32; p = 0.037). Thus, the results do support the effectiveness of tonsillectomy education using smartphone text messaging in increasing mothers' knowledge and reducing children's anxiety. CONCLUSIONS These results can be applied to preoperative and postoperative interventions for children not only for tonsillectomy but also for many other operations. The development of various educational programs using smartphone text messaging for postoperative patient management would also be valuable.
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Affiliation(s)
- Ji Yeon Yang
- 1 Graduate School of Public Administration, Kyung Hee University , Seoul, Korea
| | - Hanna Lee
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Yongai Zhang
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Ji Uhn Lee
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jun Hee Park
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Eun Kyoung Yun
- 3 College of Nursing Science, Kyung Hee University, Seoul, Korea
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Williams G, Bell G, Buys J, Moriarty T, Patel A, Sunderland R, Shepherd L, Brooks P, Polhill S. The prevalence of pain at home and its consequences in children following two types of short stay surgery: a multicenter observational cohort study. Paediatr Anaesth 2015; 25:1254-63. [PMID: 26406603 DOI: 10.1111/pan.12749] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The potential for pain at home in children following day case surgery has long been recognized. Pain has also been associated with behavioral disturbances and sleep disruption in children following surgery and may also impact negatively on recovery, parental and patient satisfaction, family life, healthcare use, and have an economic cost. AIM To investigate the prevalence of pain at home, and its consequences, in children following two types of short stay surgery across eight pediatric centers in the UK in an observational cohort study. Reporting of the study was done in adherence with STROBE guidelines. METHOD Two hundred and forty-one children undergoing either Tonsillectomy with or without Adenoidectomy (T's ± A's) or Orchidopexy surgery (either by Open or Laparoscopic) were recruited. Data collection was via three structured telephone interviews [Day (D) 2, 7 and 14] conducted from a clinical research facility. The normal clinical practices of the centers involved in the study were not altered in any way. Outcomes studied were (i) Pain incidence and severity; (ii) Associated consequences-incidence of psychological disturbances, unplanned use of healthcare services, and social/economic cost to families; and (iii) Comparative pain and associated outcomes for two types of surgery (T's ± A's vs Orchidopexy). RESULTS The incidence of pain following both operative models was high though it differed between the two groups. In the T's ± A's group, the incidence of pain was high throughout the study period (D2 90.1%, D3-7 88.1%, D8-14 61.8%). The Orchidopexy group demonstrated a similar pattern, though with decreased rates (D2 70.4%, D3-7 34.7%, D8-14 17.1%). Both groups showed similar patterns for the rates of behavioral disturbances (T's & A's: D2 76%, D3-7 73%, D8-14 30% and Orchidopexy: D2 37%, D3-7 20%, D8-14 10%). Seventy percent of the families reported unplanned healthcare use with pain the primary reason in 79% of these. CONCLUSIONS The prevalence of pain at home, and its potential associated consequences, is high following short stay surgery in children in the UK. In both groups, high incidences were seen for longer periods than is commonly perceived. These findings were consistent between the centers involved suggesting that this is a significant national healthcare issue with potential short- and long-term consequences for the child, their family, and health services.
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Affiliation(s)
- Glyn Williams
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Graham Bell
- Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, UK
| | - Justin Buys
- Surgical Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tony Moriarty
- Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, UK
| | - Anil Patel
- Department of Anaesthesia, Royal National Throat Nose & Ear Hospital, University College Hospital, London, UK
| | - Robin Sunderland
- Department of Anaesthesia, St Georges Healthcare NHS Trust, London, UK
| | - Liz Shepherd
- Department of Anaesthesia, Sheffield Children's Hospital, Sheffield, UK
| | - Peter Brooks
- Department of Anaesthesia, Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Sara Polhill
- Department of Anaesthesia, University College Hospital London, London, UK
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Twycross AM, Williams AM, Bolland RE, Sunderland R. Parental attitudes to children's pain and analgesic drugs in the United Kingdom. J Child Health Care 2015; 19:402-11. [PMID: 24459102 DOI: 10.1177/1367493513517305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Many children experience treatable moderate to severe pain following surgery. Increasingly, children undergo surgery as day cases, and, as such, parents are more likely to be responsible for managing pain post-operatively. Research in the United States and Finland has found parents fear the side effects of analgesics; think they are addictive; and that children should receive as little analgesia as possible. Little is known about parental attitudes in this context in the United Kingdom. This study set out to explore parental attitudes towards children's pain and analgesic drugs to contribute to existing knowledge about parental attitudes elsewhere so that the information provided to parents can be tailored effectively. A convenience sample of parents (n = 108) at one hospital in South West London completed the Parental Pain Expression Perceptions and the Medication Attitudes Questionnaires. Although many parents have a good understanding of the ways in which children express pain, a substantial proportion of parents hold misconceptions regarding how children express pain and concerns in relation to analgesic drugs. This may impact on the quality of the pain management provided to children post-operatively and needs taking into account when preparing parents in this context.
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Affiliation(s)
| | | | - Rachael E Bolland
- London South Bank University, UKGreat Ormond Street Hospital, UKSt George's Healthcare Trust, UK
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Twycross A, Parker R, Williams A, Gibson F. Cancer-Related Pain and Pain Management: Sources, Prevalence, and the Experiences of Children and Parents. J Pediatr Oncol Nurs 2015; 32:369-84. [PMID: 25736032 DOI: 10.1177/1043454214563751] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advances in treatment mean children are increasingly cared for by their parents at home, leading to a shift in responsibility from health care professionals to parents. Little is known about parents' pain management experiences and the etiology of pain experienced by children with cancer especially when at home. A rapid review of the literature was undertaken investigating children's cancer-related pain, with emphasis on the management of pain outside the health care setting. Electronic databases were searched and a quality assessment was conducted. Forty-two articles were included. Despite advances in pain management techniques, children with cancer regularly cite pain as the most prevalent symptom throughout the cancer trajectory. The source of pain is usually treatment side effects or painful procedures. Parents find dealing with their child's pain distressing and demanding and may hold misconceptions about pain management. Findings indicate a need for more robust research into parental pain management leading to the development of effective pain management resources for parents.
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Affiliation(s)
| | | | - Anna Williams
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- London South Bank University, London, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Chorney JM, Twycross A, Mifflin K, Archibald K. Can we improve parents' management of their children's postoperative pain at home? Pain Res Manag 2014; 19:e115-23. [PMID: 25106030 PMCID: PMC4158941 DOI: 10.1155/2014/938352] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thousands of children undergo surgery each year, and a shift toward same-day surgeries and decreased lengths of hospital stay results in parents being increasingly responsible for their child's postoperative care. Recent studies have tested interventions designed to improve parent management of their children's postoperative pain at home, but progress in this area has been limited by a lack of synthesis of these findings. OBJECTIVE To conduct a systematic review of interventions to improve parent management of children's postoperative pain at home. METHODS Articles evaluating interventions to improve management of their children's postoperative pain were identified using a library scientist-designed search strategy applied in EMBASE, PubMed, CINAHL and PsycINFO. Two independent raters assessed each study for eligibility and extracted data. RESULTS Of the 147 articles identified for the review, eight met the inclusion criteria. Interventions included pain education, training in pain assessment, education on distraction, instruction in around-the-clock dosing and nurse coaching. Overall, results of comparisons of pain intensity and analgesic administration were modest. The intervention with the largest effect size was instruction in around-the-clock dosing, either alone or in combination with nurse coaching. Results of studies investigating pain assessment, pain education and distraction trials revealed small to medium effect sizes. CONCLUSIONS Results of trials investigating interventions to improve parent management of their children's postoperative pain at home were modest. Future studies should further examine barriers and facilitators to pain management to design more effective interventions.
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Affiliation(s)
- Jill MacLaren Chorney
- Departments of Anesthesia, Pain Management and Perioperative Medicine, and Psychology, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia
| | - Alison Twycross
- Department of Children’s Nursing, London South Bank University, London, United Kingdom
| | - Katherine Mifflin
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia
| | - Karen Archibald
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia
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Comparison of Two Analgesic Protocols for Post-tonsillectomy Pain Control in Outpatient Adults. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.otoeng.2013.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Comparación de 2 protocolos analgésicos en el control del dolor postamigdalectomía en pacientes adultos ambulatorios. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 65:102-8. [DOI: 10.1016/j.otorri.2013.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 11/18/2022]
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