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Zhong Y, Gong H, Long F, Zhou X, Zhou J, Wang M, Peng T. A bibliometric analysis of research on pediatric preoperative anxiety (2007-2022). Front Pediatr 2024; 12:1327118. [PMID: 38590771 PMCID: PMC10999670 DOI: 10.3389/fped.2024.1327118] [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: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Objective This study aimed to analyze the current state of research on preoperative anxiety in children through CiteSpace, VOSviewer, and the identification of hot spots and frontiers. Method Relevant data were retrieved from the Web of Science Core Collection using the search terms children and preoperative anxiety. Data were analyzed using VOSviewer (version 1.6.18), CiteSpace (5.7. R5) software, and Scimago Graphica. Results A total of 622 articles were published between 2007 and 2022, with an increasing trend over time. Kain, Zeev N. (13; 2.09%) and Dalhousie University (15; 2.41%) were the most influential authors and most prolific institutions, respectively. The United States (121; 19.45%) was the country with the most publications. Pediatric anesthesia (55; 8.84%) had the most publications. High-frequency keywords were categorized into three themes, including nonpharmacologic interventions for preoperative anxiety in children, preoperative medications, and risk factors for anxiety; of these, "predictor" (38; 2016) and "sedative premedication" (20; 2016) were the most studied keywords over the past 6 years. "Distraction" (67; 2019) and "dexmedetomidine" (65; 2019) have been the main areas of interest in recent years. Conclusion Research on preoperative anxiety in children has been the focus of increasing attention over the past fifteen years, with the majority of publications from high-income countries. This review provides a useful perspective for understanding research trends, hot topics, and research gaps in this expanding field.
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Affiliation(s)
- Yue Zhong
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Huishu Gong
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Feiyu Long
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Xingchen Zhou
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Jun Zhou
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Maohua Wang
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Tao Peng
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
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Doğan SSA, Karakan NC, Doğan Ö. Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study. Lasers Med Sci 2024; 39:48. [PMID: 38279075 PMCID: PMC10817992 DOI: 10.1007/s10103-024-03983-7] [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: 06/12/2023] [Accepted: 01/07/2024] [Indexed: 01/28/2024]
Abstract
This study aimed to investigate the effects of 0.6% hyaluronic acid (HA) gel on the healing process and postoperative pain levels after diode laser-assisted labial frenectomy in pediatric patients. Ninety-six pediatric patients (females, 50 and males, 46) aged 8-14 years were randomly divided into four groups as follows: (1) conventional frenectomy with 0.6% topically administered HA (CFH, n = 24); (2) conventional frenectomy with placebo gel (CFP, n = 24); (3) frenectomy performed by diode laser with 0.6% topically administered HA (DLH, n = 24); and (4) frenectomy performed by diode laser with placebo gel (DLP, n = 24). HA application was continued for 1 week thrice daily after the frenectomy. Visual analog scale forms were collected from patients 1 week after the operation. In addition, the plaque index, gingival index, periodontal probing depth, and keratinized tissue width and thickness were recorded. This process was repeated 1 and 3 months after the first visit. The DLH group revealed significant differences in the probing depth, bleeding on probing, keratinized gingiva width, and attached gingiva width according to dual comparisons of the initial, first, and third-month values (p = 0.010, p = 0.007, p<0.001, and p = 0.001, respectively). Significant differences were observed between the CFP and CFH groups according to the initial and initial third-month values with regard to the bleeding on probing (p=0.019 and p = 0.019, respectively). The attached gingival thickness revealed significant differences between the CFP and CFH groups for the initial and initial-third-month comparisons (p = 0.005 and p = 0.007, respectively). The mean values of the initial and initial-third-month differences were significantly higher in the CFH group than those in the CFP group. HA- and laser-assisted labial frenectomies revealed better outcomes in terms of the probing depth, attached gingiva width, keratinized gingiva width, healing process, and postoperative comfort.
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Affiliation(s)
- Suat Serhan Altintepe Doğan
- Department of Periodontology, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Güvenevler Mahallesi, İsmet İnönü St., No. 4, 03030, Afyonkarahisar, Turkey.
| | - Nebi Cansın Karakan
- Department of Periodontology, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Güvenevler Mahallesi, İsmet İnönü St., No. 4, 03030, Afyonkarahisar, Turkey
| | - Özgür Doğan
- Department of Periodontology, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Güvenevler Mahallesi, İsmet İnönü St., No. 4, 03030, Afyonkarahisar, Turkey
- Deparment Of Pediatric Dentistry, Faculty of Dentistry, Afyonarahisar Health Sciences University, Afyonkarahisar, Turkey
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3
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Mounier S, Cambonie G, Baleine J, Le Roux M, Bringuier S, Milési C. Music Therapy During Basic Daily Care in Critically Ill Children: A Randomized Crossover Clinical Trial. J Pediatr 2024; 264:113736. [PMID: 37722559 DOI: 10.1016/j.jpeds.2023.113736] [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: 05/29/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To assess whether music therapy (MT) is effective to reduce pain during daily personal hygiene care (DPHC), a procedure performed in all patients in a pediatric intensive care unit. METHODS Fifty critically ill children were enrolled in a crossover controlled clinical trial with random ordering of the intervention, that is, passive MT, and standard conditions, and blind assessment of pain on film recordings. The primary outcome was variation of the Face Legs Activity Cry Consolability (FLACC) score (range, 0-10) comparing before and during DPHC. Secondary outcomes were changes in heart rate, respiratory rate, and mean arterial blood pressure, and administration of analgesic or sedative drugs during DPHC. Mixed-effects linear model analysis was used to assess effect size (95% CI). RESULTS The median (Q25-Q75) age and weight of the patients were 3.5 years (1.0-7.6 years) and 15.0 kg (10.0-26.8 kg). Consecutive DPHC were assessed on days 3 (2-5) and 4 (3-7) of hospitalization. In standard conditions, FLACC score was 0.0 (0.0-3.0) at baseline and 3.0 (1.0-5.5) during DPHC. With MT, these values were, respectively, 0.0 (0.0-1.0) and 2.0 (0.5-4.0). Rates of FLACC scores of >4 during DPHC, which indicates severe pain, were 42% in standard conditions and 17% with MT (P = .013). Mixed-effects model analysis found smaller increases in FLACC scores (-0.54 [-1.08 to -0.01]; P = .04) and heart rate (-9.00; [-14.53; -3.40]; P = .001) with MT. CONCLUSIONS MT is effective to improve analgesia in critically ill children exposed to DPHC. TRIAL REGISTRATION This study was recorded (April 16, 2019) before patient recruitment on the National Library of Medicine registry (NCT03916835; https://clinicaltrials.gov/ct2/show/NCT03916835).
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Affiliation(s)
- Sophie Mounier
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France; Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France.
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Manon Le Roux
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Sophie Bringuier
- Department of Medical Statistics and Epidemiology, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Christophe Milési
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
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Abdo HMA, Abd Elaziz MS, Elhamid AEEA, Kassem AA, Haiba DM. Effect of Adding Infiltration between The Popliteal Artery and Capsule of The Knee Block (IPACK) to Continuous Adductor Canal Block after Total Knee Arthroplasty. EGYPTIAN JOURNAL OF ANAESTHESIA 2023; 39:680-686. [DOI: 10.1080/11101849.2023.2246732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Hatem Mohammed Ahmed Abdo
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Saeed Abd Elaziz
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Essam Eldin Abd Elhamid
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Ahmed Kassem
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Diaaeldein Mahmoud Haiba
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Vongkiatkajorn K, Brown EA, Donaldson A, Rich V, Paterson R, Kenardy J, Graydon C, Lee-Archer P. The effect of a parental preparation video (Take5) on child and parent anxiety during anaesthetic induction: a protocol for a randomised controlled trial. Trials 2023; 24:446. [PMID: 37422667 DOI: 10.1186/s13063-023-07480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Children undergoing anaesthetic induction experience peri-operative anxiety associated with negative outcomes including emergence delirium, short- and long-term maladaptive behaviour and increased postoperative analgesic requirements. This stems from children's limited ability to communicate, cope, and regulate intense emotions, leading to high dependency on parental emotional regulation. Previous interventions including video modelling, education and distraction techniques before and during anaesthetic induction have demonstrated significant reduction of anxiety levels. No existing interventions combines evidenced-based psychoeducation video with distraction techniques to support parents to moderate peri-operative anxiety. This study aims to test the efficacy of the Take5 video (now referred to as 'Take5'), a short and cost-efficient intervention for child peri-operative anxiety. METHODS A randomised, controlled, superiority trial of Take5 compared to standard care. Take5 was developed by paediatric anaesthetists, child psychologists and a consumer panel of parents of children who had experienced surgery and anaesthesia. Children aged 3-10 years presenting for elective surgery at a quaternary paediatric facility will be randomly allocated to the intervention group or standard care. Intervention group parents will be shown Take5 prior to accompanying their child for anaesthesia induction. Primary outcomes include child and parent anxiety at induction, measured by the Modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF), the Peri-operative Adult-Child Behavior Interaction Scale (PACBIS) and the Induction Compliance Checklist (ICC). Secondary outcomes include post-operative pain, emergence delirium, parental satisfaction, cost-effectiveness, parent and child psychological well-being at 3 months post procedure and video intervention acceptability. DISCUSSION Perioperative anxiety is associated with negative outcome in children including higher pharmacological intervention, delayed procedures, and poor post-recovery outcomes resulting in financial burden on health systems. Current strategies minimising paediatric procedural distress are resource-intensive and have been inconsistent in reducing anxiety and negative postoperative outcomes. The Take5 video is an evidence-driven resource that is designed to prepare and empower parents. The success of Take5 will be evaluated by measuring differences in patient (acute and 3-month), family (satisfaction, acceptability), clinician (feasibility) and health service (cost) outcomes, with each anticipated to benefit children. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN12621001337864) and Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/21/QCHQ/73894).
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Affiliation(s)
- Krittika Vongkiatkajorn
- Anaesthetics Department, Queensland Children's Hospital, Queensland Health, South Brisbane, Australia.
| | - Erin A Brown
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Alexandra Donaldson
- Anaesthetics Department, Queensland Children's Hospital, Queensland Health, South Brisbane, Australia
| | - Vanessa Rich
- Anaesthetics Department, Queensland Children's Hospital, Queensland Health, South Brisbane, Australia
| | - Rebecca Paterson
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Justin Kenardy
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia
| | - Cameron Graydon
- Anaesthetics Department, Queensland Children's Hospital, Queensland Health, South Brisbane, Australia
| | - Paul Lee-Archer
- Anaesthetics Department, Queensland Children's Hospital, Queensland Health, South Brisbane, Australia
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
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6
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Sola C, Devigne J, Bringuier S, Pico J, Coruble L, Capdevila X, Captier G, Dadure C. Hypnosis as an alternative to general anaesthesia for paediatric superficial surgery: a randomised controlled trial. Br J Anaesth 2023; 130:314-321. [PMID: 36690538 DOI: 10.1016/j.bja.2022.11.023] [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: 08/02/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Reducing perioperative anxiety and controlling pain in children are essential to optimise recovery and outcomes for both children and their parents. By acting on sensory and affective modulation of anxiety and pain, hypnosis is widely used in medical care, especially in anaesthesia. This randomised controlled clinical trial was designed to compare general anaesthesia and intraoperative hypnosis support for perioperative management of children undergoing superficial surgery. METHODS Children aged 7-16 yr scheduled for day-case superficial surgery were included and randomly assigned to one of the following two groups: general anaesthesia group or hypnosis group. The primary outcome was length of hospital stay. Child and parent anxiety, child pain, and the occurrence of postoperative negative behavioural changes were also evaluated. RESULTS Sixty children of mean age 10.3 (standard deviation: 2.6) yr were enrolled in the study. Hypnosis was successful in all but one case. The median (25th-75th percentile) length of hospital stay was shorter in the hypnosis group (120 [95-145] vs 240.5 [218-275] min; P<0.001). The general anaesthesia group was associated with a greater incidence of high levels of preoperative anxiety in children (30 vs 11%; P=0.001) and parents (55 vs 30%; P=0.05). Pain scores did not differ between groups. No negative postoperative behavioural changes were reported. CONCLUSIONS In children aged 7-16 yr, hypnosis appears to be feasible and accepted. The quality of the perioperative experience and the rapid recovery support the use of hypnosis as an effective and safe alternative to general anaesthesia for paediatric superficial surgery. CLINICAL TRIAL REGISTRATION NCT02505880.
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Affiliation(s)
- Chrystelle Sola
- Department of Maternal, Child and Women's Anaesthesiology and Intensive Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France.
| | - Julie Devigne
- Department of Maternal, Child and Women's Anaesthesiology and Intensive Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France
| | - Sophie Bringuier
- Department of Anaesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France
| | - Julien Pico
- Department of Maternal, Child and Women's Anaesthesiology and Intensive Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Lucie Coruble
- Department of Maternal, Child and Women's Anaesthesiology and Intensive Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France; Montpellier Neurosciences Institute, Montpellier University Hospital, Montpellier, France
| | - Guillaume Captier
- Department of Paediatric Plastic Surgery, Montpellier University Hospital, Montpellier, France
| | - Christophe Dadure
- Department of Maternal, Child and Women's Anaesthesiology and Intensive Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
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7
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Walter CM, Lee CS, Moore DL, Abbasian N, Clay SJ, Mecoli MD, Olbrecht VA, Batra M, Ding L, Yang F, Nair M, Huq A, Simpson BE, Brown RL, Garcia VF, Chidambaran V. Retrospective study comparing outcomes of multimodal epidural and erector spinae catheter pain protocols after pectus surgery. J Pediatr Surg 2023; 58:397-404. [PMID: 35907711 DOI: 10.1016/j.jpedsurg.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are no optimal postoperative analgesia regimens for Nuss procedures. We compared the effectiveness of thoracic epidurals (EPI) and novel ambulatory erector spinae plane (ESP) catheters as part of multimodal pain protocols after Nuss surgery. METHODS Data on demographics, comorbidities, perioperative details, length of stay (LOS), in hospital and post discharge pain/opioid use, side effects, and emergency department (ED) visits were collected retrospectively in children who underwent Nuss repair with EPI (N = 114) and ESP protocols (N = 97). Association of the group with length of stay (LOS), in hospital opioid use (intravenous morphine equivalents (MEq)/kg over postoperative day (POD) 0-2), and oral opioid use beyond POD7 was analyzed using inverse probability of treatment weighting (IPTW) with propensity scores, followed by multivariable regression. RESULTS Groups had similar demographics. Compared to EPI, ESP had longer block time and higher rate of ketamine and dexmedetomidine use. LOS for ESP was 2 days IQR (2, 2) compared to 3 days IQR (3, 4) for EPI (p < 0.01). Compared to EPI, ESP group had higher opioid use (in MEq/kg) intraoperatively (0.32 (IQR 0.27, 0.36) vs. 0.28 (0.24, 0.32); p < 0.01) but lower opioid use on POD 0 (0.09 (IQR 0.04, 0.17) vs. 0.11 (0.08, 0.17); p = 0.03) and POD2 (0.00 (IQR 0.00, 0.00) vs. 0.04 (0.00, 0.06) ; p < 0.01). ESP group also had lower total in hospital opioid use (0.57 (IQR 0.42, 0.73) vs.0.82 (0.71, 0.91); p < 0.01), and shorter duration of post discharge opioid use (6 days (IQR 5,8) vs. 9 days (IQR 7,12) (p < 0.01). After IPTW adjustment, ESP continued to be associated with shorter LOS (difference -1.20, 95% CI: -1.38, -1.01, p < 0.01) and decreased odds for opioid use beyond POD7 (OR 0.11, 95% CI: 0.05, 0.24); p < 0.01). However, total in hospital opioid use in MEq/kg (POD0-2) was now similar between groups (difference -0.02 (95% CI: -0.09, -0.04); p = 0.50). The EPI group had higher incidence of emesis (29% v 4%, p < 0.01), while ESP had higher catheter malfunction rates (23% v 0%; p < 0.01) but both groups had comparable ED visits/readmissions. DISCUSSION/CONCLUSION Compared to EPI, multimodal ambulatory ESP protocol decreased LOS and postoperative opioid use, with comparable ED visits/readmissions. Disadvantages included higher postoperative pain scores, longer block times and higher catheter leakage/malfunction. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Charlotte M Walter
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Christopher S Lee
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - David L Moore
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Niekoo Abbasian
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Smokey J Clay
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States.
| | - Marc D Mecoli
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Vanessa A Olbrecht
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Meenu Batra
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, MLC 5041, 3333 Burnet Ave, Cincinnati, OH 45229, United States; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Fang Yang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, MLC 5041, 3333 Burnet Ave, Cincinnati, OH 45229, United States; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Manu Nair
- Summer Undergraduate Research Fellow, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Abraar Huq
- Summer Undergraduate Research Fellow, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Blair E Simpson
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, MLC 3024, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Rebeccah L Brown
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States; Division of Pediatric, General and Thoracic Surgery Department, Cincinnati Children's Hospital Medical Center, MLC 2023, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Victor F Garcia
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States; Division of Pediatric, General and Thoracic Surgery Department, Cincinnati Children's Hospital Medical Center, MLC 2023, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Ave, Cincinnati, OH 45229, United States.
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Yun R, Hess O, Kennedy K, Stricker PA, Blake L, Caruso TJ. Assessing pediatric perioperative affect: A concise review of research and clinically relevant scales. Paediatr Anaesth 2023; 33:243-249. [PMID: 36178764 DOI: 10.1111/pan.14568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 02/07/2023]
Abstract
Perioperative anxiety and distress are common in pediatric patients undergoing general anesthesia and increase the risk for immediate and long-term postoperative complications. This concise review outlines key research and clinically-relevant scales that measure pediatric perioperative affect. Strengths and weaknesses of each scale are highlighted. A literature review identified 11 articles with the following inclusion criteria: patients less than or equal to 18 years, perioperative anxiety or distress, and original studies with reliability or validity data. Although robust research-based assessment tools to measure anxiety have been developed, such as the Modified Yale Preoperative Anxiety Scale, they are too complex and time-consuming to complete by clinicians also providing anesthesia. Clinically-based anxiety measurement scales tend to be easier to use, however they require further testing before widespread standard utilization. The HRAD ± scale (Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation) may be a promising observational anxiety scale that is efficient and includes an assessment of compliance. Further studies are needed to refine a clinically-relevant anxiety assessment tool and appraise interventions that reduce perioperative distress.
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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, California, USA
| | - Olivia Hess
- Stanford School of Medicine, Stanford, California, USA
| | | | - Paul A Stricker
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lindsay Blake
- University of Arkansas for Medical Sciences Library, Little Rock, Arkansas, 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, California, USA
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9
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Wong CL, Choi KC. Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e230001. [PMID: 36795410 PMCID: PMC9936341 DOI: 10.1001/jamanetworkopen.2023.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE Venipuncture is one of the most painful and distressing procedures experienced by pediatric patients. Emerging evidence suggests that providing procedural information and distraction using immersive virtual reality (IVR) may reduce pain and anxiety among children undergoing needle-related procedures. OBJECTIVES To examine the effects of IVR on reducing the pain, anxiety, and stress experienced by pediatric patients undergoing venipuncture. DESIGN, SETTING, AND PARTICIPANTS This 2-group randomized clinical trial recruited pediatric patients aged 4 to 12 years undergoing venipuncture from a public hospital in Hong Kong between January 2019 and January 2020. Data were analyzed from March to May 2022. INTERVENTIONS Participants were randomly allocated to an intervention (an age-appropriate IVR intervention offering distraction and procedural information) or a control (standard care only) group. MAIN OUTCOMES AND MEASURES The primary outcome was child-reported pain. Secondary outcomes included child-reported anxiety, heart rate, salivary cortisol, length of procedure, and satisfaction of health care professionals with the procedure (rated on a 40 point scale, with higher scores indicating greater satisfaction). Outcomes were assessed 10 minutes before, during, immediately after, and 30 minutes after the procedure. RESULTS A total of 149 pediatric patients were recruited, with 86 female patients (57.7%) and 66 patients (44.3%) diagnosed with fever. Compared with the 74 participants in the control group (mean [SD] age, 7.21 [2.49] years), the 75 participants in the IVR group (mean [SD] age, 7.21 [2.43] years) reported significantly less pain (β = -0.78; 95% CI, -1.21 to -0.35; P < .001) and anxiety (β = -0.41; 95% CI, -0.76 to -0.05; P = .03) immediately after the intervention. Health care professional satisfaction in the IVR group (mean [SD] score, 34.5 [4.5]) was significantly higher than that in the control group (mean [SD] score, 32.9 [4.0]; P = .03). Moreover, the length of venipuncture procedure in the IVR group (mean [SD] duration, 4.43 [3.47] minutes) was significantly shorter than that in the control group (mean [SD] duration, 6.56 [7.39] minutes; P = .03). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, integrating procedural information and distraction in an IVR intervention for pediatric patients undergoing venipuncture significantly improved pain and anxiety in the IVR group compared with the control group. The results shed light on the global trends of research on IVR and its clinical development as an intervention for other painful and stressful medical procedures. TRIAL REGISTRATION Chinese Clinical Trial Registry identifier: ChiCTR1800018817.
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Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Le May S, Genest C, Francoeur M, Hung N, Guingo E, Khadra C, Noel M, Paquette J, Roy A. Virtual reality mobility for burn patients (VR-MOBILE): A within-subject-controlled trial protocol. PAEDIATRIC & NEONATAL PAIN 2022; 4:192-198. [PMID: 36618513 PMCID: PMC9798042 DOI: 10.1002/pne2.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
In the acute phase, burn patients undergo several painful procedures. Pediatric burn care procedures conducted in hydrotherapy have been known to generate severe pain intensity and moderate to high levels of anxiety. Hydrotherapy treatments are done with the use of opioids and benzodiazepines for pain and anxiety. Unfortunately, nonpharmacological methods are rarely combined with pharmacological treatments despite evidence showing that distraction can serve as an effective method for pain management and can potentially decrease analgesic requirements in other painful medical procedures. Virtual reality (VR) is a method that uses distraction to interact within a virtual environment. The use of VR is promising for pain reduction in varying settings. Considering the lack of optimal pain and anxiety management during burn wound care and the positive effect of an immersive distraction for painful procedures, using VR for burn wound care procedures may show promising results. This is a within-subject randomized controlled trial design in which each participant will serve as his/her own control. A minimum of 20 participants, aged 7 to 17 years old undergoing a burn care session, will receive both standard and experimental treatments during the same session in a randomized order. The experimental treatment will consist of combining VR distraction using the video game Dreamland® to the current standard pharmacological care as per unit protocol. The control group will only receive the unit's standard pharmacological care. The mean difference in both pain intensity scores and in anxiety between the two different sequences will be the primary outcomes of this study. This study evaluates the effect of VR on burn wound care. If results from this study show a positive effect of VR compared to standard care, this protocol may provide guidance on how to implement this type of immersive care as part of the tools available for distraction of painful procedures for acute burn victims.
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Affiliation(s)
- Sylvie Le May
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada,Faculty of NursingUniversité de MontréalMontréalQuébecCanada,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CRIUSMM)MontréalQuébecCanada
| | - Christine Genest
- Faculty of NursingUniversité de MontréalMontréalQuébecCanada,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CRIUSMM)MontréalQuébecCanada
| | - Maxime Francoeur
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada
| | - Nicole Hung
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada,Faculty of MedicineUniversité de MontréalMontréalQuébecCanada
| | - Estelle Guingo
- Department of Creation and NEW MediaUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaQuébecCanada
| | | | - Melanie Noel
- Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Julie Paquette
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada
| | - Andrée‐Anne Roy
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada
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11
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Nemetski SM, Berman DI, Khine H, Fein DM. Virtual Reality as Anxiolysis During Laceration Repair in the Pediatric Emergency Department. J Emerg Med 2022; 63:72-82. [PMID: 35934650 DOI: 10.1016/j.jemermed.2022.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although procedural pain is effectively treated with analgesics, managing anxiety during laceration repair is more challenging. OBJECTIVES We examined the feasibility of using immersive virtual reality (VR) as anxiolysis during laceration repair in the pediatric emergency department (ED). METHODS We conducted a non-blinded, observational, pilot study in an urban pediatric ED that enrolled a convenience sample of children aged 5-13 years undergoing sutured repair of non-facial lacerations. Subjects played an immersive VR game while undergoing laceration repair. Parents assessed their child's anxiety on a 100-mm visual analogue scale at enrollment and during laceration repair. The primary outcome measure was the percentage of children whose anxiety score did not increase by ≥ 20 mm from enrollment to the first stitch. RESULTS Forty patients completed the study. Mean initial anxiety score was 54 mm (standard deviation 33 mm). Thirty-seven of forty patients (93%; 95% confidence interval [CI] 83-99%) had anxiety scores that did not increase by 20 mm or more from enrollment to the first stitch. Eighty percent (95% CI 64-91%) of patients' anxiety scores decreased between enrollment and first stitch. The mean change in anxiety score at first stitch was -39 mm (95% CI -51 mm to -27 mm; p < 0.001). Similar downward trends in anxiety scores were noted throughout the procedure. All laceration repairs were successfully completed without sedation or restraints. There were no adverse events noted, and the main barriers identified with VR use involved easily correctable technical difficulties with the equipment. CONCLUSION Immersive VR is a safe and effective distractive technique to reduce procedural anxiety during laceration repair in the pediatric ED.
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Affiliation(s)
| | - Danielle I Berman
- Department of Pediatrics, Albert Einstein College of Medicine - Children's Hospital at Montefiore, Bronx, New York
| | - Hnin Khine
- Division of Pediatric Emergency Medicine, Department of Pediatrics
| | - Daniel M Fein
- Division of Pediatric Emergency Medicine, Department of Pediatrics
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12
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Follow up of pain reported by children undergoing outpatient surgery using a smartphone application: AlgoDARPEF multicenter descriptive prospective study. Pain 2022; 163:2224-2231. [PMID: 35239543 DOI: 10.1097/j.pain.0000000000002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
ABSTRACT In pediatric patients, pain remains the most common complaint after surgery. This French multicenter epidemiological study (AlgoDARPEF) aimed to evaluate the use of a smartphone application (App) to assess the duration and severity of pain experienced by children undergoing outpatient surgery. Children below 18 years of age scheduled for an elective outpatient procedure in one of the participating centers were eligible. Parents were invited to provide daily information for 10 days regarding their child's pain and comfort via a smartphone App using the Parents' Postoperative Pain Measure - Short Form (PPPM-SF). Children over 6 years old could also provide self-assessments of pain using a Numerical Rating Scale (NRS-11). Data regarding pain medication, preoperative anxiety, postoperative nausea and vomiting, and parent satisfaction were also analyzed. Repeated-measures analyses of variance (ANOVAs) were used to compare the self- and hetero-assessments of pain. Eleven centers participated in the study, and 1,573 patients were recruited. Forty-nine percent of parents (n = 772) actually used the App at least once. In all surgeries, the average pain rating on the PPPM-SF scale did not exceed 3/10 throughout the follow-up period, as well as for the four main surgical specialties. Age, visceral surgery, and preoperative anxiety ≥ 4/10 were identified as independent risk factors for experiencing at least one episode of pain ≥ 4/10 during the first 48 postoperative hours. While these findings indicated that postoperative pain management appears to be satisfactory in the families who used the App, some improvements in anxiety management are suggested. This study shows that inviting parents to use a smartphone App to assess and report the quality of postoperative management in pediatric patients, provides useful information. A continuous report is possible, regarding pain and adverse events, over a postoperative ten days period, by a self-reporting or a parent's contribution. Future studies should investigate the ability of live data collection using an App to ensure fast, efficient interactions between patients and physicians.
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Mathias EG, Pai MS. Anxiety and Pain in Children Undergoing Surgery: A Scoping Review. J Perianesth Nurs 2022; 37:545-550. [DOI: 10.1016/j.jopan.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 01/17/2023]
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Berchio C, Micali N. Cognitive assessment using ERP in child and adolescent psychiatry: Difficulties and opportunities. Psychiatry Res Neuroimaging 2022; 319:111424. [PMID: 34883368 DOI: 10.1016/j.pscychresns.2021.111424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
Event related potentials (ERPs) represent powerful tools to investigate cognitive functioning in child and adolescent psychiatry. So far, the available body of research has largely focused on advancements in analysis methods, with little attention given to the perspective of assessment. The aim of this brief report is to provide recommendations for cognitive ERPs assessment that can be applied across diagnostic categories in child and adolescent psychiatry research. First, we discuss major issues for ERPs testing using examples from common psychiatric disorders. We conclude by summing up our recommendations for methodological standards and highlighting the potential role of ERPs in the field.
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Affiliation(s)
- Cristina Berchio
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Child and Adolescent Psychiatry, Department of Child and Adolescent Health, Geneva University Hospital, Geneva, Switzerland; Great Ormond Street Institute of Child Health, University College London, London, UK
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15
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Le May S, Genest C, Hung N, Francoeur M, Guingo E, Paquette J, Fortin O, Guay S. The Effect of Virtual Reality Game Preparation for Children scheduled for MRI (IMAGINE): a Randomized Controlled Trial Protocol (Preprint). JMIR Res Protoc 2021; 11:e30616. [PMID: 35700000 PMCID: PMC9237773 DOI: 10.2196/30616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/06/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background It is known that magnetic resonance imaging (MRI) procedures generate fear and anxiety. Children may become restless during scanning, which results in movement artifacts requiring the MRI procedure to be repeated with sedation. Few studies seem to have looked at the effect of immersive virtual reality (IVR) on anxiety in children scheduled for MRI scans and how to identify which children are more responsive. Objective The aims of this study are 3-fold: develop an algorithm of predictability based on biofeedback, address feasibility and acceptability of preprocedural IVR game preparation for anxiety management during MRI procedures, and examine the efficacy of IVR game preparation compared with usual care for the management of procedural anxiety during MRI scans. Methods This study will have 2 phases. We will first conduct a field test with 10 participants aged 7 to 17 years to develop a predictive algorithm for biofeedback solution and to address the feasibility and acceptability of the research. After the field test, a randomized controlled trial will be completed using a parallel design with 2 groups: an experimental group (preprocedural IVR game preparation) and a usual care group (standard care as per the radiology department’s protocol) in an equal ratio of 49 participants per group for 98 participants. Recruitment will be carried out at a hospital in Quebec, Canada. The experimental group will receive a preprocedural IVR game preparation (IMAGINE) that offers an immersive simulation of the MRI scan. Participants will complete a questionnaire to assess the acceptability, feasibility, and incidence of side effects related to the intervention and the biofeedback device. Data collected will include sociodemographic and clinical characteristics as well as measures of procedure-related anxiety with the French-Canadian version of the State-Trait Anxiety Inventory for Children (score 1-3) and the Children’s Fear Scale (score 0-4). Physiological signs will be noted and include heart rate, skin conductance, hand temperature, and muscle tension. Measures of the level of satisfaction of health care professionals, parents, and participants will also be collected. Analyses will be carried out according to the intention-to-treat principle, with a Cronbach α significance level of .05. Results As of May 10, 2022, no participant was enrolled in the clinical trial. The data collection time frame is projected to be between April 1, 2022, and March 31, 2023. Findings will be disseminated through peer-reviewed publications. Conclusions Our study provides an alternative method for anxiety management to better prepare patients for an awake MRI procedure. The biofeedback will help predict which children are more responsive to this type of intervention. This study will guide future medical practice by providing evidence-based knowledge on a nonpharmacological therapeutic modality for anxiety management in children scheduled for an MRI scan. Trial Registration ClinicalTrials.gov NCT04988516; https://clinicaltrials.gov/ct2/show/NCT04988516 International Registered Report Identifier (IRRID) PRR1-10.2196/30616
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Affiliation(s)
- Sylvie Le May
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Christine Genest
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île de Montréal, Montreal, QC, Canada
| | - Nicole Hung
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Maxime Francoeur
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Estelle Guingo
- Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Julie Paquette
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Olivier Fortin
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Stéphane Guay
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île de Montréal, Montreal, QC, Canada
- School of Criminology, Université de Montréal, Montreal, QC, Canada
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Gold JI, SooHoo M, Laikin AM, Lane AS, Klein MJ. Effect of an Immersive Virtual Reality Intervention on Pain and Anxiety Associated With Peripheral Intravenous Catheter Placement in the Pediatric Setting: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2122569. [PMID: 34432011 PMCID: PMC8387848 DOI: 10.1001/jamanetworkopen.2021.22569] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE The inclusion of digital therapeutics (eg, virtual reality [VR] systems) for the management of pain and anxiety associated with routine acutely painful medical procedures may have a substantial impact on treatment adherence and improve long-term health outcomes among young patients. OBJECTIVE To determine whether a VR intervention decreases pain and anxiety among patients undergoing peripheral intravenous catheter (PIVC) placement compared with standard care in the pediatric setting. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from April 12, 2017, to July 24, 2019, among 107 patients aged 10 to 21 years who were undergoing PIVC placement in 2 clinical settings (a radiology department and an infusion center) at an urban pediatric academic medical center in the US. Patients, caregivers, and clinicians completed pre-PIVC and post-PIVC placement questionnaires measuring patient pain, anxiety, and anxiety sensitivity; only participants with complete data from before and after PIVC placment were included in the analyses. INTERVENTIONS Patients were randomized to receive standard care (simple distraction techniques [eg, music, coloring, singing, and talking] and the application of numbing cream) or a VR intervention using a balanced computer-generated randomization scheme stratified by sex. All patients who received the VR intervention were offered concurrent standard care; however, VR plus standard care was not specifically examined. MAIN OUTCOMES AND MEASURES Primary outcomes were patient pain (measured by the Faces Pain Scale-Revised) and anxiety (measured by a visual analogue scale) reported by the patient, caregiver, and clinician after PIVC placement. Outcomes were analyzed using generalized linear modeling with backward stepwise selection for final model building. RESULTS A total of 107 patients (median age, 14.7 years [interquartile range, 12.8-16.9 years]; 63 male participants [58.9%]) completed the clinical trial; 54 patients received standard care, and 53 patients also received the VR intervention. Patients who received the VR intervention compared with standard care had significantly lower mean post-PIVC anxiety scores when patient-reported (1.85 points [95% CI, 1.28-2.41 points] vs 3.14 points [95% CI, 2.59-3.68 points]; P < .001) and clinician-reported (2.04 points [95% CI, 1.37-2.71 points] vs 3.34 points [95% CI, 2.69-3.99 points]; P = .002). Patients in the VR group vs the standard care group also had significantly lower mean post-PIVC pain scores when patient-reported (1.34 points [95% CI, 0.63-2.05 points] vs 2.54 points [95% CI, 1.78-3.30 points]; P = .002), caregiver-reported (1.87 points [95% CI, 0.99-2.76 points] vs 3.01 points [95% CI. 1.98-4.03 points]; P = .04), and clinician-reported (2.05 points [95% CI, 1.47-2.63 points] vs 3.59 points [95% CI, 2.97-4.22 points]; P < .001). Aside from lower levels of baseline pain and anxiety, no demographic variables among patients in the VR group were associated with lower levels of post-PIVC pain and anxiety. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, patients undergoing PIVC placement who received a VR intervention experienced significantly less anxiety and pain compared with those who received standard care. The use of patient, caregiver, and clinician data provided a variety of subjective information, as well as observable and objective data regarding perceived pain and anxiety beyond patient reporting alone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: CHLA-15-00549.
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Affiliation(s)
- Jeffrey I. Gold
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles
- University Center of Excellence in Developmental Disabilities, University of Southern California, Los Angeles
- Department of Anesthesiology Critical Care Medicine, Saban Research Institute at Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Michelle SooHoo
- University Center of Excellence in Developmental Disabilities, University of Southern California, Los Angeles
| | - Andrea M. Laikin
- University Center of Excellence in Developmental Disabilities, University of Southern California, Los Angeles
| | - Arianna S. Lane
- Department of Anesthesiology Critical Care Medicine, Saban Research Institute at Children’s Hospital Los Angeles, Los Angeles, California
| | - Margaret J. Klein
- Department of Anesthesiology Critical Care Medicine, Saban Research Institute at Children’s Hospital Los Angeles, Los Angeles, California
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Moïse-Richard A, Ménard L, Bouchard S, Leclercq AL. Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter. JOURNAL OF FLUENCY DISORDERS 2021; 68:105830. [PMID: 33662867 DOI: 10.1016/j.jfludis.2021.105830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Many school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter. METHODS Ten children and adolescents who stutter (aged 9-17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions. RESULTS Results show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment. CONCLUSION Our results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking.
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Affiliation(s)
- Anne Moïse-Richard
- Marie Enfant Rehabilitation Centre of Sainte-Justine University Hospital Centre, Montreal, Canada; University of Montreal, Canada
| | - Lucie Ménard
- Marie Enfant Rehabilitation Centre of Sainte-Justine University Hospital Centre, Montreal, Canada; Laboratoire de Phonétique, Université du Québec à Montréal, Canada
| | - Stéphane Bouchard
- Université du Québec en Outaouais et Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Canada
| | - Anne-Lise Leclercq
- Research Unit on Childhood, Speech and Language Therapy Department, and Clinique Psychologique et Logopédique de l'Université de Liège, Belgium.
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Abstract
Young pediatric patients who undergo venipuncture or capillary blood sampling often experience high levels of pain and anxiety. This often results in distressed young patients and their parents, increased treatment times, and a higher workload for healthcare professionals. Social robots are a new and promising tool to mitigate children’s pain and anxiety. This study aims to purposefully design and test a social robot for mitigating stress and anxiety during blood draw of children. We first programmed a social robot based on the requirements expressed by experienced healthcare professionals during focus group sessions. Next, we designed a randomized controlled experiment in which the social robot was applied as a distraction method to measure its capacity to mitigate pain and anxiety in children during blood draw in a children’s hospital setting. Children who interacted with the robot showed significantly lower levels of anxiety before actual blood collection, compared to children who received regular medical treatment. Children in the middle classes of primary school (aged 6–9) seemed especially sensitive to the robot’s ability to mitigate pain and anxiety before blood draw. Children’s parents overall expressed strong positive attitudes toward the use and effectiveness of the social robot for mitigating pain and anxiety. The results of this study demonstrate that social robots can be considered a new and effective tool for lowering children’s anxiety prior to the distressing medical procedure of blood collection.
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Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study. CHILDREN-BASEL 2021; 8:children8050368. [PMID: 34063034 PMCID: PMC8147916 DOI: 10.3390/children8050368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023]
Abstract
The aim of this pilot study was to assess: (1) the feasibility and acceptability of a Mindfulness-Based Virtual Reality (MBVR) intervention among children and young adults with Inflammatory Bowel Disease (IBD), and (2) the preliminary efficacy of MBVR on key psychological (anxiety) and physical (pain) outcomes. Participants were 62 children to young adults with IBD (M = 15.6 years; 69.4% Crohn's disease; 58% male) recruited from an outpatient pediatric IBD clinic. Participants completed a baseline assessment, underwent the 6-min MBVR intervention, completed a post-intervention assessment and study satisfaction survey, and provided qualitative feedback. Results suggest strong feasibility and acceptability. Participants reported high levels of satisfaction with MBVR including high levels of enjoyment (M = 4.38; range 1-5) and relaxation (M = 4.35; range 1-5). Qualitative data revealed several key themes including participants interest in using MBVR in IBD medical settings (e.g., hospitalizations, IBD procedures, IBD treatments), as well as in their daily lives to support stress and symptom management. Preliminary analyses demonstrated improvements in anxiety (t = 4.79, p = 0.001) and pain (t = 3.72, p < 0.001) following MBVR. These findings provide initial support for the feasibility and acceptability of MBVR among children and young adults with IBD. Results also suggest MBVR may improve key IBD outcomes (e.g., anxiety, pain) and highlight the importance of conducting a randomized controlled trial and more rigorous research to determine intervention efficacy.
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Gold JI, Annick ET, Lane AS, Ho K, Marty RT, Espinoza JC. "Doc McStuffins: Doctor for a Day" Virtual Reality (DocVR) for Pediatric Preoperative Anxiety and Satisfaction: Pediatric Medical Technology Feasibility Study. J Med Internet Res 2021; 23:e25504. [PMID: 33730687 PMCID: PMC8094020 DOI: 10.2196/25504] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/06/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background Preoperative anxiety is a common occurrence among children and is associated with a host of maladaptive postoperative behaviors. Consequently, increased attention has been placed on interventions to reduce preoperative anxiety and its associated outcomes. Child Life preparation prior to surgery includes evidence-based practices such as age-appropriate distraction and therapeutic play. Virtual reality (VR) is a promising addition to the Child Life toolbox to address anxiety prior to surgery. The current study evaluates the implementation and feasibility of a VR experience, “Doc McStuffins: Doctor for a Day Virtual Reality Experience” (DocVR), developed by Disney Junior in collaboration with Children’s Hospital Los Angeles, to target pediatric preoperative anxiety. Objective The primary aim of this study was to examine the feasibility and efficacy of DocVR for preoperative anxiety. A secondary aim was to improve patient, caregiver, and health care provider satisfaction with the preoperative experience. Methods In this study, 51 patients (age 6-14 years) scheduled for surgery in the ambulatory surgery center and the main operating room at Children’s Hospital Los Angeles were approached to participate in Disney’s DocVR experience. The patients played the DocVR experience for an average of 18 minutes (3-55 minutes). Irrespective of surgical procedure, patients and their families were eligible, as long as they had no known marked cognitive or visual impairments that would interfere with completing the survey and engaging in the DocVR experience. Results Patients who tried the DocVR experience (n=51) responded overwhelmingly positively to both the VR technology and to the game itself. Patients experienced a statistically significant decrease in anxiety following DocVR game play (Z=–3.26, P=.001). On the Facial Affective Scale, the percentage of patients who chose the face with the most positive facial expression to represent their affect increased from 23% (12/51) pre-VR to 49% (25/47) post-VR. Furthermore, 97% (38/39) of patients reported feeling more comfortable at the hospital, and 74% (28/38) reported feeling less scared at the hospital after playing the game. The game was enjoyed by 94% (46/49) of patients, and 88% (30/34) of patients reported feeling both “Interested” and “Involved” in the game. Conclusions DocVR is a feasible and beneficial VR experience to relieve pediatric preoperative anxiety and improve satisfaction in the preoperative area. The VR experience resulted in a decrease in overall anxiety and an increase in overall positive affect during the preoperative time. Patients also responded positively to the game, confirming their interest in the content and affirming the quality of the DocVR experience. The positive response to the game indicates that DocVR has the potential to make the overall preoperative experience less anxiety-producing and more comfortable, which leads to improved patient satisfaction. Naturally, improved patient outcomes lead to improved caregiver and health care provider satisfaction.
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Affiliation(s)
- Jeffrey I Gold
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Erin T Annick
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Arianna S Lane
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Katherine Ho
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Ryan T Marty
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Juan C Espinoza
- Division of General Pediatrics, Department of Pediatrics, The Saban Research Institute at Children's Hospital Los Angeles, The West Coast Consortium for Technology & Innovation Pediatrics, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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21
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Mednick L, O'Connell B, Graber K, Roussin C, Weinstock P. "Ready SIM Go": An Adapted Simulation "Service Line" for Patients and Caregivers. Simul Healthc 2021; 16:120-127. [PMID: 32218091 DOI: 10.1097/sih.0000000000000448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY STATEMENT Changing healthcare systems and efforts to decrease medical costs have resulted in many more patients and caregivers (PCs) needing to manage life-sustaining therapies on their own. Given the potential for underpreparedness to result in increased morbidity and mortality, developing safe and efficient homecare training methods for PCs is essential. Medical simulation with PCs is an underused tool, which has the potential to decrease anxiety and increase preparedness through opportunities for repeated practice of medical procedures within a safe, controlled environment. This article describes the development of a hospital-based simulation service line for PCs, leveraging lessons learned from training for 250 patients and 450 caregivers in 14 different departments and subspecialties, and explains adaptations of standard simulation methods necessary for safe and effective use of simulation with this unique population. Process blueprint, examples of specific programs, as well as feedback from participants and clinicians are included.
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Affiliation(s)
- Lauren Mednick
- From the Boston Children's Hospital Simulator Program (L.M., B.O., K.G., P.W.); Department of Psychiatry (L.M.), Boston Children's Hospital; Department of Anesthesia (P.W.), Critical Care and Pain Medicine, Boston Children's Hospital; Department of Child Life (B.O.), Boston Children's Hospital; Harvard Medical School (L.M., C.R., P.W.); Center for Medical Simulation (C.R.); and Department of Anesthesia (C.R.), Massachusetts General Hospital, Boston, MA
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22
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Rodrigues JRG, de Avila MAG, Jamas MT, Siqueira FPC, Daniel LG, Nilsson S. Transcultural adaptation of the children's anxiety questionnaire in Brazil. Nurs Open 2021; 8:1652-1659. [PMID: 33611862 PMCID: PMC8186675 DOI: 10.1002/nop2.794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/17/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Aim To describe the transcultural adaptation process of the Children's Anxiety Questionnaire (CAQ) for the Brazilian culture. Design This is a methodological study of cross‐cultural adaptation. Methods Study conducted in Brazil and Sweden involved the following steps: preparation, translation, synthesis of translations, back‐translation and review, and harmonization of the translations by a committee of 13 healthcare professionals using the content validity index (CVI). Cognitive debriefing, using children between 4–10 years old, was completed by 15 children to determine if the images corresponded with their meanings and 17 children to determine if they could understand the Global CAQ after listening. Results Convergences and discrepancies between the original instrument in Swedish, the English version and the Brazilian translation were compared. The process of culturally adapting the CAQ to Brazilian Portuguese was validated, as demonstrated by a satisfactory S‐CVI (0.94) among professionals and an agreement of 95% and above by children.
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Affiliation(s)
| | | | | | | | | | - Stefan Nilsson
- Institute of Health and Care Sciences, and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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23
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Bringuier S, Macioce V, Boulhais M, Dadure C, Capdevila X. Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score. Eur J Pain 2021; 25:1081-1090. [PMID: 33428820 DOI: 10.1002/ejp.1729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Behavioural pain scales are recommended to assess postoperative pain for children who are too young to use self-report tools. Their main limitation is underestimation of pain in the days following an intervention. Although relevant, facial expression is not used in daily clinical practice. This prospective study aimed to assess the validity and reliability of the Facial Action Summary Score (FASS), a five-item scale, to assess postoperative pain until hospital discharge in children <7 years. METHODS Assessments of pain and anxiety of 123 children using FASS and validated scales were used to study the psychometric validity of the FASS in clinical practice. RESULTS The content validity was previously investigated in a development study. The internal validity of the FASS was high with excellent reliability (intraclass coefficient = 0.94) and a high Cronbach α (0.89). Convergent validity with pain scales (FLACC [Face, Legs, Activity, Cry, Consoling] and FPS-R [Faces Pain Scale - Revised]) was high (r > 0.8). Sensitivity to change was verified by a significant decrease in the score after rescue analgesia. For a threshold of 2/5, the FASS shows excellent specificity (97%) and sensitivity (82%). The low number of false negatives is the main strength of this tool. CONCLUSIONS This work highlights the interest in using facial expression in daily clinical practice to manage postoperative pain. The FASS is easy to use with excellent psychometric properties and is particularly sensitive to measure pain in the days following surgery. SIGNIFICANCE The aim of this study was to prove that facial expression of pain can be used in clinical practice to measure postoperative pain in children. The reduced number of false negatives is the main strength of this tool.
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Affiliation(s)
- Sophie Bringuier
- Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France.,Clinical Research and Epidemiology Unit, La Colombière University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Valerie Macioce
- Clinical Research and Epidemiology Unit, La Colombière University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Myriam Boulhais
- Clinical Research and Epidemiology Unit, La Colombière University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Christophe Dadure
- Department of Paediatric and Gynaecology Anaesthesia, Lapeyronie University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France.,Inserm Unit Functional Genomics Institute, University of Montpellier, Montpellier, France
| | - Xavier Capdevila
- Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France.,Inserm Unit Montpellier NeuroSciences Institute, University of Montpellier, Montpellier, France
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24
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Romero-Acosta K, Gómez-de-Regil L, Lowe GA, Lipps GE, Gibson RC. Parenting Styles, Anxiety and Depressive Symptoms in Child/Adolescent. Int J Psychol Res (Medellin) 2021; 14:12-32. [PMID: 34306576 PMCID: PMC8297574 DOI: 10.21500/20112084.4704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/31/2020] [Accepted: 02/10/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To analyse the possible direct and interactive associations of sex, age and parenting styles with symptoms of depression and anxiety. METHODS In this cross-sectional study, 710 students ranging from 8 to 13 years (mean age 10.8 years [ 0.75]), the most of them males (n = 422, 59.4%), completed three screening instruments: a parenting practices scale and two self-reports for evaluating anxiety and depressive symptoms. Two hierarchical multiple regression analyses were performed. RESULTS Authoritative (38.6%) and neglectful (38%) parenting styles were predominant. Symptoms of depression -F (3, 706) = 3.12, p = .03- and anxiety -F (3, 706) = 2.83, p = .4- differed by parenting styles. Students with a neglectful parenting style reported significant lower generalized anxiety symptoms than those whose parents used authoritative parenting. CLINICAL IMPLICATIONS Children ages 8 to 13 years-old with authoritative parenting style should be evaluated for possible presence of generalized anxiety symptoms.
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Affiliation(s)
- Kelly Romero-Acosta
- Grupo de investigación Dimensiones Humanas. Departamento de investigación psicológica, Facultad de humanidades y educación. Corporación Universitaria del Caribe CECAR. Sincelejo, Colombia.Corporación Universitaria del CaribeCorporación Universitaria del Caribe CECARSincelejoColombia
| | - Lizzette Gómez-de-Regil
- Hospital Regional de Alta Especialidad de la Península de Yucatán. Fraccionamiento Altabrisa. Mérida, Yucatán, México.MéridaYucatánMéxico
| | - Gillian A. Lowe
- Department of Community Health and Psychiatry. The University of the West Indies Mona. Kingston, Jamaica.The University of the West Indies MonaKingstonJamaica
| | - Garth E. Lipps
- Department of Sociology, Psychology and Social Work. The University of the West Indies Mona. Kingston, Jamaica.The University of the West Indies MonaKingstonJamaica
| | - Roger C. Gibson
- Department of Community Health and Psychiatry. The University of the West Indies Mona. Kingston, Jamaica.The University of the West Indies MonaKingstonJamaica
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25
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Potthoff LM, Glotzbecker MP, O’Connell B, O’Neill NP, Graber KM, Byrne CA, Tremmel JM, Weinstock P, Mednick L. SIMDiscovery: a simulation-based preparation program for adolescents undergoing spinal fusion surgery. Spine Deform 2021; 9:1363-1370. [PMID: 33689156 PMCID: PMC7943935 DOI: 10.1007/s43390-021-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022]
Abstract
PURPOSE Spinal fusion surgery is associated with high levels of stress and anxiety for patients and their caregivers. Medical simulation has demonstrated efficacy in improving preparedness, knowledge, and overall experience prior to other medical procedures. The current study examines the utility of a multi-faceted preparation program (SIMDiscovery) using simulation techniques to reduce anxiety and increase preparedness among patients undergoing spinal fusion surgery and their caregivers. METHODS Participants attended SIMDiscovery where they received hands-on preparation about what to expect before, during, and after their surgery. Anxiety, preparedness, and knowledge about the procedure were assessed pre- and post-participation using self-report measures. Participants also completed a questionnaire at their first post-operative medical appointment. Differences from pre to post and between patients and caregivers were calculated with paired and independent sample t-tests. RESULTS Participants included 22 patients and 29 caregivers. Post-SIMDiscovery, both groups demonstrated increased knowledge for the surgical process and lower state anxiety. Patients reported increased feelings of preparedness in all areas while caregivers reported increased feelings of preparedness in most areas. Families continued to report positive impact of the program 30 days after surgery; however, they also identified areas where they desired increased preparation. CONCLUSIONS SIMDiscovery increased patients' and caregivers' knowledge regarding spinal fusion surgery and helped them feel less anxious and more prepared regarding most aspects of the surgical process. These changes were generally maintained throughout the post-operative period. Participants identified areas for increased preparation, highlighting the importance of continuing to adapt programs based on patient and family feedback. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Lauren M. Potthoff
- grid.2515.30000 0004 0378 8438Department of Psychiatry, Boston Children’s Hospital, Boston, MA US ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA US ,grid.413808.60000 0004 0388 2248Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Michael P. Glotzbecker
- grid.2515.30000 0004 0378 8438Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA US ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA US
| | - Brianna O’Connell
- grid.2515.30000 0004 0378 8438Boston Children’s Hospital Simulator Program, Boston, MA US ,grid.2515.30000 0004 0378 8438Department of Child Life, Boston Children’s Hospital, Boston, MA US
| | - Nora P. O’Neill
- grid.2515.30000 0004 0378 8438Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA US
| | - Kelsey M. Graber
- grid.2515.30000 0004 0378 8438Boston Children’s Hospital Simulator Program, Boston, MA US
| | - Carrie A. Byrne
- grid.2515.30000 0004 0378 8438Department of Child Life, Boston Children’s Hospital, Boston, MA US ,grid.2515.30000 0004 0378 8438Boston Children’s Hospital Perioperative Program, Boston, MA US
| | - Joseph M. Tremmel
- grid.2515.30000 0004 0378 8438Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA US
| | - Peter Weinstock
- grid.2515.30000 0004 0378 8438Boston Children’s Hospital Simulator Program, Boston, MA US ,grid.2515.30000 0004 0378 8438Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA US ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA US
| | - Lauren Mednick
- grid.2515.30000 0004 0378 8438Department of Psychiatry, Boston Children’s Hospital, Boston, MA US ,grid.2515.30000 0004 0378 8438Boston Children’s Hospital Simulator Program, Boston, MA US ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA US
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26
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Zhang Y, Yan F, Li S, Wang Y, Ma Y. Effectiveness of animal-assisted therapy on pain in children: A systematic review and meta-analysis. Int J Nurs Sci 2020; 8:30-37. [PMID: 33575442 PMCID: PMC7859554 DOI: 10.1016/j.ijnss.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Aims Animal-assisted therapy (AAT) relieves pain by creating a relaxed and comfortable environment to reduce anxiety in children. Yet little is known about its effects on pain in children. This study aims to systematically evaluate the effects of AAT on pain in children. Methods Eight databases including PubMed, Cochrane Library, Web of Science, CINAHL Complete, Chinese Biomedical Database (CBM), Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI) and Wanfang Database were retrieved, and all randomized controlled trials or controlled clinical trial using AAT on children’s pain were recruited from inception to October 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. RevMan 5.3 software was employed for meta-analysis. Results Seven published studies containing 4 RCTs and 3 CCTs were included for the systematic review. The results of meta-analysis showed that AAT could reduce children’s pain when compared with the control group [MD = −0.53, 95% CI (−0.77, −0.30), P < 0.00001]. Conclusion Current evidence shows that AAT can relieve pain in children to some extent. Considering the limited quality and quantity of the available studies, more high quality studies should be performed to verify the above conclusion.
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Affiliation(s)
- Yuanyuan Zhang
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, Gansu, China
| | - Fanghong Yan
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, Gansu, China
| | - Sijun Li
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, Gansu, China
| | - Yutan Wang
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, Gansu, China
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27
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Le May S, Tsimicalis A, Noel M, Rainville P, Khadra C, Ballard A, Guingo E, Cotes-Turpin C, Addab S, Chougui K, Francoeur M, Hung N, Bernstein M, Bouchard S, Parent S, Hupin Debeurme M. Immersive virtual reality vs. non-immersive distraction for pain management of children during bone pins and sutures removal: A randomized clinical trial protocol. J Adv Nurs 2020; 77:439-447. [PMID: 33098330 DOI: 10.1111/jan.14607] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
AIMS To examine the efficacy of an immersive virtual reality distraction compared with an active non-immersive distraction, such as video games on a tablet, for pain and anxiety management and memory of pain and anxiety in children requiring percutaneous bone pins and/or suture removal procedures. DESIGN Three-centre randomized clinical trial using a parallel design with two groups: experimental and control. METHODS Study to take place in the orthopaedic department of three children hospital of the Montreal region starting in 2019. Children, from 7-17 years old, requiring bone pins and/or suture removal procedures will be recruited. The intervention group (N = 94) will receive a virtual reality game (Dreamland), whereas the control group (N = 94) will receive a tablet with video games. The primary outcomes will be both the mean self-reported pain score measured by the Numerical Rating Scale and mean anxiety score, measured by the Child Fear Scale. Recalls of pain and anxiety will be measured 1 week after the procedure using the same scales. We aim to recruit 188 children to achieve a power of 80% with a significance level (alpha) of 5%. DISCUSSION While multiple pharmacological methods have previously been tested for children, no studies have evaluated the impact of immersive virtual reality distraction for pain and anxiety management in the orthopaedic setting. IMPACT Improved pain management can be achieved using virtual reality during medical procedures for children. This method is innovative, non-pharmacological, adapted to the hospital setting, and user-friendly. TRIAL REGISTRATION NCT03680625, registered on clinicaltrials.gov.
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Affiliation(s)
- Sylvie Le May
- Research Center, CHU Sainte-Justine, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Shriners' Hospital for children in Montreal, Montreal, QC, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Pierre Rainville
- Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Ariane Ballard
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Estelle Guingo
- UQAT Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Casey Cotes-Turpin
- UQAT Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Sofia Addab
- Shriners' Hospital for children in Montreal, Montreal, QC, Canada
| | - Khadidja Chougui
- Shriners' Hospital for children in Montreal, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | | | - Nicole Hung
- Research Center, CHU Sainte-Justine, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mitchell Bernstein
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | | | - Stefan Parent
- Department of Surgery, CHU Sainte-Justine, Montreal, QC, Canada
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28
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Asbrand J, Schmitz J, Krämer M, Nitschke K, Heinrichs N, Tuschen-Caffier B. Effects of Group-Based CBT on Post-Event Processing in Children with Social Anxiety Disorder Following an Experimental Social Stressor. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1945-1956. [PMID: 31073879 DOI: 10.1007/s10802-019-00558-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Theoretical models and previous research suggest that post-event processing (PEP) after social situations maintains social anxiety disorder (SAD). To date, little is known about PEP in childhood, a critical period for disorder development, or about possible positive effects of cognitive behavioral therapy (CBT) on PEP in children. Children with SAD (n = 71; aged 9-13 years) and healthy controls (n = 55) participated in a social stress task (Trier Social Stress Test for Children, TSST-C), which was repeated in children with SAD after either 12 sessions of CBT or a waiting period. PEP was assessed daily with regard to both valence and frequency, as well as in more detail regarding specific negative and positive ruminative thoughts 1 week after each TSST-C. Daily PEP after the TSST-C was more frequent and more negative in children with SAD compared to healthy controls, in particular during the first 2 days after the TSST-C. After CBT treatment, children with SAD reported more positive PEP but not less negative PEP compared to children in the waitlist control group. The current study suggests that negative PEP in children with SAD is most pronounced in the first days following social stress. Group-based CBT seems to be effective in building up positive cognitions after social stress in children, but developing specific interventions targeting negative PEP immediately after a social stressor may be necessary to further increase treatment efficacy.
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Affiliation(s)
- Julia Asbrand
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Julian Schmitz
- Department for Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Martina Krämer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Nitschke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nina Heinrichs
- Institute of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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29
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Nguyen CV, Alvin M, Lee C, George D, Gilmore A, Tripi PA, Liu RW. A prospective randomised study on efficacy of music for decreasing preoperative anxiety in children. J Perioper Pract 2020; 31:268-273. [PMID: 32648838 DOI: 10.1177/1750458920939780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The operating room can be a frightening environment for paediatric patients. This study investigated whether music medicine can mitigate preoperative anxiety in children. MATERIALS AND METHODS One hundred and fifty children undergoing general anaesthesia were randomised to listen to music of the child's choice, lullaby music or no music before induction. Heart rates were measured in the waiting room, upon first entry into the operating room and just prior to induction. RESULTS There was no significant difference in average heart rate change from the waiting room to induction in the patient choice, lullaby and control groups. Older age was associated with higher heart rate changes between baseline and entering the operating room. Pharmacologic sedation showed a significant beneficial effect on heart rate change at induction. CONCLUSION Use of music medicine in the operating room does not show efficacy to reduce anxiety in children based on heart rate changes.
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Affiliation(s)
- Cynthia V Nguyen
- Division of Pediatric Orthopaedic Surgery, Shriners for Children Medical Center - Pasadena, Pasadena, USA
| | - Madeleine Alvin
- Department of Anesthesiology and Critical Care Medicine, The 1501Johns Hopkins Hospital, Baltimore, USA
| | - Carol Lee
- Division of Pediatric Orthopaedic Surgery, 2546Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, USA
| | - Darrell George
- Division of Pediatric Orthopaedic Surgery, 2546Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, USA
| | - Allison Gilmore
- Division of Pediatric Orthopaedic Surgery, 2546Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, USA
| | - Paul A Tripi
- Division of Pediatric Anesthesia, 2546Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, USA
| | - Raymond W Liu
- Division of Pediatric Orthopaedic Surgery, 2546Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, USA
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30
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Koç Özkan T, Balcı S. The Effect of Acupressure on Acute Pain During Venipuncture in Children: Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2020; 17:221-228. [PMID: 32320139 DOI: 10.1111/wvn.12437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2018] [Indexed: 11/30/2022]
Abstract
AIMS The study was conducted as a randomized controlled trial in order to determine the effects of acupressure on acute pain during venipuncture in children. METHODS The population of the study consisted of children, aged between 9 and 12 years, who received venipuncture between September 2015 and June 2016 at a university hospital in Istanbul. The sample consisted of a total of 90 children, including 45 children in the acupressure group and 45 children in the control group, who met the sample inclusion criteria. The results of the study were obtained by using an information form, the State Anxiety Inventory for Children (STAIC), the visual analog scale (VAS), and the Faces Pain Scale-Revised (FPS-R). Acupressure was applied to the children in the acupressure group for 10 min before the venipuncture procedure. Pain, heart rate, and oxygen saturation levels of the children in the acupressure and control groups were evaluated both before and after the venipuncture procedure. RESULTS The children in the acupressure and control groups were found to be similar in terms of age, gender, parents' educational levels and working status, number of venipuncture procedures, and mean anxiety scores. In the evaluation that was conducted before the venipuncture procedure, no statistically significant differences were observed between the heat rates, oxygen saturation levels, and expected pain scores from the venipuncture procedure in the children in the acupressure and control groups. On the other hand, it was observed that the children in the acupressure group (VAS: 19.51 ± 4.98; FPS-R: 2.08 ± 0.41) experienced less pain than the children in the control group (VAS: 47.37 ± 9.89; FPS-R: 4.84 ± 1.08), and there was a significant difference between the two groups (p< .000). LINKING EVIDENCE TO ACTION Acupressure administration is effective in reducing the pain that is experienced by children during a venipuncture procedure.
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Affiliation(s)
- Tuba Koç Özkan
- Midwifery Department, Adiyaman University Faculty of Health Sciences, Adiyaman, Turkey
| | - Serap Balcı
- Department of Child Health and Diseases Nursing, Florence Nightingale Faculty of Nursing, Istanbul University, Istanbul, Turkey
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Finkelstein JB, Cahill D, Graber K, Tulley K, O'Connell B, Mednick L, Rosoff JS, Bauer SB, Weinstock P, Estrada CR. Anxiety, distress, and pain in pediatric urodynamics. Neurourol Urodyn 2020; 39:1178-1184. [PMID: 32203630 DOI: 10.1002/nau.24339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/12/2020] [Indexed: 11/07/2022]
Abstract
AIMS No one has assessed urodynamic studies (UDS) to determine those steps that elicit the greatest anxiety, distress, and pain in children. We sought to systematically evaluate a child's UDS experience to mollify these reactions. METHODS Prospective study involving children aged ≥5 undergoing UDS over a 6-month period (from 10 December 2018 to 22 May 2019). Upon arrival, patients completed a visual analog scale for anxiety (VAS-A, 0-10) about the upcoming procedure. A research assistant assessed the patient's behavior during each major step of UDS using a validated brief behavioral distress scale. Nursing staff also obtained patients' pain ratings (0-10) for these key elements. Immediately after UDS, each child completed a posttest VAS-A along with a survey about the UDS experience. RESULTS A total of 76 UDS were observed; almost half included sphincter needle electromyography (EMG). Mean patient VAS-A scores were 2.3 before UDS, compared to 0.8 afterward (P < .001). The highest proportion of distressful behaviors were observed during EMG needle (31%) and urethral catheter (29%) insertion, in agreement with the highest mean pain scores of 3.2 and 2.7, respectively. Fifty-four percent of children reported not being completely aware of what was going to happen before the procedure and 50% of those patients exhibited at least one interfering or potentially interfering behavior. Similarly, 60% of children with no prior history of UDS exhibited at least one interfering or potentially interfering behavior. CONCLUSIONS EMG needle and urethral catheter placement, initial urodynamic testing and not knowing what to expect were associated with greater pain and distress during pediatric UDS.
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Affiliation(s)
| | - Dylan Cahill
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
| | - Kelsey Graber
- Simulator Program, Boston Children's Hospital, Boston, Massachusetts
| | - Kelsey Tulley
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts.,Child Life Services, Boston Children's Hospital, Boston, Massachusetts
| | - Brianna O'Connell
- Simulator Program, Boston Children's Hospital, Boston, Massachusetts.,Child Life Services, Boston Children's Hospital, Boston, Massachusetts
| | - Lauren Mednick
- Simulator Program, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
| | - James S Rosoff
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
| | - Peter Weinstock
- Child Life Services, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Connecticut
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
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32
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Yayan EH, Zengin M, Düken ME, Suna Dağ Y. Reducing Children's Pain and Parents' Anxiety in the Postoperative Period: A Therapeutic Model in Turkish Sample. J Pediatr Nurs 2020; 51:e33-e38. [PMID: 31324415 DOI: 10.1016/j.pedn.2019.07.004] [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: 11/19/2018] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE This study was conducted to determine the effect of a new therapeutic model (a therapeutic play/play therapy (TP/PT) program) on alleviating pain in children receiving inpatient treatment in paediatric surgery units and parents' anxiety levels in the post-operative period. DESIGN AND METHODS The study was designed as a semi-experimental model using the TP/PT program. Four measurements (pre-test, two interim tests and post-test) for children and two measurements (pre-test and post-test) for parents were performed. The data were collected using the Child and Parent Information Form, the Wong-Baker Faces Pain (WBFP) Rating Scale and the State-Trait Anxiety Inventory (STAI). RESULTS The mean pain score for children after TP/PT decreased in each measurement, and a significant difference was found between these measurements. The mean state anxiety score for parents significantly decreased after the TP/PT program, and a statistically significant difference was found between these measurements (p = 0.000). CONCLUSIONS This study determined that the post-operative TP/PT program was an effective method to reduce acute post-operative pain in children. Parental anxiety levels were found to correlate with levels of pre- and post-operative pain in children. PRACTICE IMPLICATIONS The findings of this study provide a basis for using a new therapeutic model that is easy to apply and effective for reducing children's pain and parents' anxiety.
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Affiliation(s)
- Emriye Hilal Yayan
- İnönü University, Faculty of Nursing, Pediatric Nursing Department, Malatya, Turkey
| | - Mürşide Zengin
- Adıyaman University, School of Health, Nursing Department, Adıyaman, Turkey.
| | - Mehmet Emin Düken
- Harran University, Faculty of Health Science, Pediatric Nursing Department, Şanlıurfa, Turkey
| | - Yeliz Suna Dağ
- İnönü University, Faculty of Nursing, Pediatric Nursing Department, Malatya, Turkey
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33
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Simić D, Vlajković A, Stević M. Postoperative analgesia in children. ABC: ČASOPIS URGENTNE MEDICINE 2020. [DOI: 10.5937/abc2001001s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Labaste F, Ferré F, Combelles H, Rey V, Foissac J, Senechal A, Conil J, Minville V. Validation of a visual analogue scale for the evaluation of the postoperative anxiety: A prospective observational study. Nurs Open 2019; 6:1323-1330. [PMID: 31660159 PMCID: PMC6805714 DOI: 10.1002/nop2.330] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/18/2019] [Accepted: 05/21/2019] [Indexed: 11/11/2022] Open
Abstract
AIM Anxiety affects the perception of pain during the postoperative period. A simple evaluation scale could improve the management of this component. The objective of this study was to evaluate the reproducibility and the consistency of a visual analogue scale for anxiety compared with the reference method, the State-Trait Anxiety Inventory (STAI). DESIGN Observational, prospective, monocentric study of 500 patients in the post-anaesthetist care unit. Anxiety was evaluated using both the visual analogue scale for anxiety and the STAI in perioperative patients. Consistency between the visual analogue scale for anxiety and the STAI, detection thresholds and factors predicting anxiety were researched. RESULTS A correlation was found between the visual analogue scale for anxiety and the STAI. There was also a correlation between pain and anxiety. Analysis of receiver operating characteristic (ROC) curves showed a visual analogue scale for anxiety threshold of 34/100 allowing the identification of patients with or without anxiety. Predictive factors for anxiety are female gender, use of benzodiazepine in premedication, emergency surgery and significant pain in the post-anaesthetist care unit. In summary, visual analogue scale for anxiety is a useful tool for detecting the anxiety component of postoperative pain. It could be used in association with covariates of interest to improve anxiety management during the postoperative period.
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Affiliation(s)
- François Labaste
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U1048Université de Toulouse, UPSToulouseFrance
| | - Fabrice Ferré
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
| | - Hélène Combelles
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
| | - Valentin Rey
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
| | - Jean‐Christophe Foissac
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
| | - Anne Senechal
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
| | - Jean‐Marie Conil
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
| | - Vincent Minville
- Department of Anesthesiology and Intensive CareUniversity Hospital of ToulouseToulouseFrance
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U1048Université de Toulouse, UPSToulouseFrance
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Newman N, Kogan S, Stavsky M, Pintov S, Lior Y. The impact of medical clowns exposure over postoperative pain and anxiety in children and caregivers: An Israeli experience. Pediatr Rep 2019; 11:8165. [PMID: 31579203 PMCID: PMC6769359 DOI: 10.4081/pr.2019.8165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 12/27/2022] Open
Abstract
While postoperative pain management was shown to reduce unwanted physiological and emotional outcomes, pediatric postoperative pain management remains suboptimal. Medical-clowns were shown to be beneficial in many medical contexts including reduction of stress, anxiety and pain. This study was set to assess the effectiveness of medical-clowns on pediatric postoperative pain reduction. Children age 4 or above, planned for elective hernia repair surgery were recruited. Children were randomly divided to a control or medicalclown escorted groups. Demographical and clinical data were collected using questionnaires and electronic sheets. Children escorted by clowns reported lower levels of pain upon admittance, discharge and 12- hours post-surgery. Statistically significant reduction of parental distress and significantly higher serum cortisol levels were observed in the clown-therapy group. Although small, our study supports the possibility that preoperative medical-clown therapy might be a cheap, safe and yet beneficial method for postoperative pain reduction.
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Affiliation(s)
- Nitza Newman
- Pediatric Surgery Department, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva
| | - Slava Kogan
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva.,Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva
| | - Moshe Stavsky
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva.,Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva
| | - Shay Pintov
- The Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Lior
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva.,Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva
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Taghizadeh N, Heard G, Davidson A, Williams K, Story D. The experiences of children with autism spectrum disorder, their caregivers and health care providers during day procedure: A mixed methods study. Paediatr Anaesth 2019; 29:927-937. [PMID: 31448870 DOI: 10.1111/pan.13689] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 04/25/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autism Spectrum Disorder is now diagnosed in more than 1% of children in Australia and USA. Children with autism spectrum disorder may have additional health care needs, require more specialized services for their health care, or experience more difficulties during hospital attendance. Customized care for these children may assist in decreasing potentially challenging behaviours during hospitalization. The purpose of this study was to explore the experiences of children with autism spectrum disorder and their caregivers during attendance for day procedures in two hospitals in Melbourne, Australia. Further, the perceptions of their health care providers were explored. METHODS Twenty-nine participants, including 14 health care providers and 15 caregivers of children with autism spectrum disorder, were interviewed within 72 hours of their day procedure attendance at the Royal Children's Hospital and the Royal Dental Hospital in Melbourne, Australia. Interviews were recorded digitally, then transcribed and coded. Mixed quantitative and qualitative methods (content analysis) were used. RESULTS Hospital attendance was often stressful. Participants identified a number of facilitating factors including good communication, clear explanations, and friendly attitudes of staff. Flexibility and individualized care of patients (such as avoiding unnecessary blood pressure measurements, and not changing into hospital gowns) were valued. Supportive aids (such as computers or special interest objects), use of social stories, and giving premedication were all considered helpful. Perceived barriers to care included prolonged waiting times for operation date as well as waiting on the day of operation, lack of private space, lack of noninvasive equipment such as cutaneous infrared thermometers, poor communication, and inadequate training of staff about autism spectrum disorder. CONCLUSION Providing optimal care for children with autism spectrum disorder requires a multifaceted approach that may require changes to hospital work flow, staff training, better use of aids (such as tablet computers and social stories), and premedication. Good communication and flexibility are key areas of importance.
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Affiliation(s)
- Neda Taghizadeh
- Anesthesia Trial Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Anesthesia, Royal Dental Hospital, Carlton, Victoria, Australia
| | - Gaylene Heard
- Department of Anesthesia, Royal Dental Hospital, Carlton, Victoria, Australia.,Department of Anesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Parkville, Victoria, Australia.,Department of Anesthesia and Acute Pain Medicine, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Andrew Davidson
- Anesthesia Trial Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Anesthesia and Pain Management, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katrina Williams
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Neurodevelopment and Disability Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Developmental Disability and Rehabilitation Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David Story
- Department of Anesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Parkville, Victoria, Australia
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Hoffman HG, Rodriguez RA, Gonzalez M, Bernardy M, Peña R, Beck W, Patterson DR, Meyer WJ. Immersive Virtual Reality as an Adjunctive Non-opioid Analgesic for Pre-dominantly Latin American Children With Large Severe Burn Wounds During Burn Wound Cleaning in the Intensive Care Unit: A Pilot Study. Front Hum Neurosci 2019; 13:262. [PMID: 31440148 PMCID: PMC6694842 DOI: 10.3389/fnhum.2019.00262] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background/Aim: Using a within-subjects, within-wound care design, this pilot study tested for the first time, whether immersive virtual reality (VR) can serve as an adjunctive non-opioid analgesic for children with large severe burn wounds during burn wound cleaning in the ICU, in a regional burn center in the United States, between 2014–2016. Methods: Participants included 48 children from 6 years old to 17 years of age with >10% TBSA burn injuries reporting moderate or higher worst pain during no VR on Day 1. Forty-four of the 48 children were from developing Latin American countries. Patients played adjunctive SnowWorld, an interactive 3D snowy canyon in virtual reality during some portions of wound care, vs. No VR during comparable portions of the same wound care session (initial treatment condition randomized). Using Graphic Rating scales, children's worst pain ratings during “No VR” (treatment as usual pain medications) vs. their worst pain during “Yes VR” was measured during at least 1 day of wound care, and was measured for up to 10 study days the patient used VR. Results: VR significantly reduced children's “worst pain” ratings during burn wound cleaning procedures in the ICU on Day 1. Worst pain during No VR = 8.52 (SD = 1.75) vs. during Yes VR = 5.10 (SD = 3.27), t(47) = 7.11, p < 0.001, SD = 3.33, CI = 2.45–4.38, Cohen's d = 1.03 (indicating large effect size). Patients continued to report the predicted pattern of lower pain and more fun during VR, during multiple sessions. Conclusion: Immersive virtual reality can help reduce the pain of children with large severe burn wounds during burn wound cleaning in the Intensive Care Unit. Additional research and development is recommended.
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Affiliation(s)
- Hunter G Hoffman
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, WA, United States
| | - Robert A Rodriguez
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
| | - Miriam Gonzalez
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
| | - Mary Bernardy
- Shriners Hospitals for Children, Galveston, TX, United States
| | - Raquel Peña
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
| | - Wanda Beck
- Shriners Hospitals for Children, Galveston, TX, United States
| | - David R Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Walter J Meyer
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
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Brown EA, De Young A, Kimble R, Kenardy J. The role of parental acute psychological distress in paediatric burn re-epithelialization. Br J Health Psychol 2019; 24:876-895. [PMID: 31389153 DOI: 10.1111/bjhp.12384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/24/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Following a paediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re-epithelialization, after controlling for child procedural distress. DESIGN A prospective observational study with longitudinal outcome. METHODS Eighty-three parents of children 1-6 years old reported acute psychological distress (post-traumatic stress symptoms [PTSS], guilt, pre-procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent-child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre-, peak-, and post-procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re-epithelialization. Date of re-epithelialization was determined by the treating consultant. RESULTS Days to re-epithelialization ranged from 3 to 35 days post-injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re-epithelialization. In Block 2, child peak-procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance. CONCLUSIONS Parental PTSS appears to be an important but under-recognized factor that may influence their child's burn re-epithelialization. Further investigation is required to understand the mechanisms contributing to this association. Statement of contribution What is already known on this subject? Psychological stress delays wound healing, and this relationship has been found in paediatric burn populations with procedural pain. Parental psychological stress is often present after a child's burn and is related to the child's procedural coping and distress. What does this study add? Parental post-traumatic stress is related to delayed child burn re-epithelialization. This association is in addition to procedural pain delaying re-epithelialization.
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Affiliation(s)
- Erin A Brown
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia.,School of Psychology, The University of Queensland, St Lucia, Qld, Australia
| | - Alexandra De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Children's Health Queensland, South Brisbane, Qld, Australia
| | - Justin Kenardy
- School of Psychology, The University of Queensland, St Lucia, Qld, Australia
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Logan DE, Breazeal C, Goodwin MS, Jeong S, O'Connell B, Smith-Freedman D, Heathers J, Weinstock P. Social Robots for Hospitalized Children. Pediatrics 2019; 144:peds.2018-1511. [PMID: 31243158 DOI: 10.1542/peds.2018-1511] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Social robots (SRs) are increasingly present in medical and educational contexts, but their use in inpatient pediatric settings has not been demonstrated in studies. In this study, we aimed to (1) describe the introduction of SR technology into the pediatric inpatient setting through an innovative partnership among a pediatric teaching hospital, robotics development, and computational behavioral science laboratories and (2) present feasibility and acceptability data. METHODS Fifty-four children ages 3 to 10 years were randomly exposed to 1 of 3 interventions: (1) interactive SR teddy bear; (2) tablet-based avatar version of the bear; or (3) plush teddy bear with human presence. We monitored intervention enrollment and completion patterns, obtained qualitative feedback on acceptability of SR use from child life-specialist stakeholders, and assessed children's positive and negative affect, anxiety, and pain intensity pre- and postintervention. RESULTS The intervention was well received and appeared feasible, with 93% of those enrolled completing the study (with 80% complete parent data). Children exposed to the SR reported more positive affect relative to those who received a plush animal. SR interactions were characterized by greater levels of joyfulness and agreeableness than comparison interventions. Child life specialist stakeholders reported numerous potential benefits of SR technology in the pediatric setting. CONCLUSIONS The SR appears to be an engaging tool that may provide new ways to address the emotional needs of hospitalized children, potentially increasing access to emotionally targeted interventions. Rigorous development and validation of SR technology in pediatrics could ultimately lead to scalable and cost-effective tools to improve the patient care experience.
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Affiliation(s)
- Deirdre E Logan
- Departments of Anesthesia, Critical Care and Pain Medicine and.,Departments of Psychiatry and
| | - Cynthia Breazeal
- Media Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts; and
| | - Matthew S Goodwin
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Sooyeon Jeong
- Media Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts; and
| | - Brianna O'Connell
- Boston Children's Hospital Simulator Program and.,Child Life Services, Boston Children's Hospital, Boston, Massachusetts
| | | | - James Heathers
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Peter Weinstock
- Departments of Anesthesia, Critical Care and Pain Medicine and.,Boston Children's Hospital Simulator Program and.,Anesthesia, Harvard Medical School, Boston, Massachusetts
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Wong CL, Lui MMW, Choi KC. Effects of immersive virtual reality intervention on pain and anxiety among pediatric patients undergoing venipuncture: a study protocol for a randomized controlled trial. Trials 2019; 20:369. [PMID: 31221208 PMCID: PMC6585051 DOI: 10.1186/s13063-019-3443-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/13/2019] [Indexed: 12/22/2022] Open
Abstract
Background Venipuncture is one of the most painful and distressing procedure experienced by pediatric patients. Evidence suggests that distraction combined with age-appropriate procedural information can effectively decrease procedural pain and anxiety in pediatric patients. Immersive virtual reality (IVR) can simultaneously provide complete distraction and procedural information to patients. Methods Guided by the gate control theory and Lazarus and Folkman’s theory, this study aims to examine the effects of IVR intervention on reducing the pain, anxiety and stress, the duration of venipuncture, and the satisfaction of healthcare providers for the procedure. A randomized controlled trial with repeated assessments will be conducted. A total of 200 pediatric patients aged 4–12 years will be recruited from a regional public hospital and randomly assigned to either the intervention or control group. The study will use two age-appropriate IVR modules that consist of procedural information. The intervention group will receive IVR intervention, whereas the control group will receive standard care only. The cost-effectiveness of IVR intervention will be compared with that of standard care. Outcome evaluation will be conducted at four time points: 10 min before, during, immediately after, and 30 min after the procedure. Intention to treat and generalized estimating equation model will be used to analyze the data. Discussion This study is the first of its kind to adopt IVR intervention with age-appropriate procedural information for pediatric patients undergoing venipuncture. Findings of the proposed study may: (1) provide a novel, facile, and cost-effective intervention that can be used virtually at any time and place to manage pain and anxiety; and (2) shed light on the global trends of research and clinical development of IVR as an intervention for other painful and stressful medical procedures. Trial registration Chinese Clinical Trial Registry, ChiCTR1800018817. Registered on 11 October 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3443-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 824, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.
| | - Miranda Mei Wa Lui
- Paediatrics & Adolescent Medicine, Tseung Kwan O Hospital, Hospital Authority, Hong Kong, People's Republic of China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 824, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China
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Houx L, Dubois A, Brochard S, Pons C. Do clowns attenuate pain and anxiety undergoing botulinum toxin injections in children? Ann Phys Rehabil Med 2019; 63:393-399. [PMID: 30708069 DOI: 10.1016/j.rehab.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Botulinum toxin injection (BTI) is the primary treatment for spasticity in children. Anxiety and pain are important concerns to address to attenuate the discomfort of BTI. The aim of this study was to compare the effectiveness of medical clowns and usual distractions, both added to nitrous oxide (N2O) and analgesic cream, on pain and anxiety during BTI sessions in children. METHODS The primary outcome was pain evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Secondary criteria were pain rated on a Visual Analog Scale (VAS) by the child and parent, anxiety rated on a VAS before and during BTIs by the child and parent(s), rating of the success of the sessions on a 4-point Likert scale by the physician and parent(s), and rating of the benefits of the distraction by the parent(s). Non-parametric tests were used for between-group comparisons. RESULTS Baseline group characteristics of the clown and control groups did not differ. During 88 BTI sessions (40 with clown distraction and 48 with control distraction) in 59 children (35 boys; 52 with cerebral palsy, 12 with moderate to severe cognitive disorders), median maximal FLACC score was 2.5 (interquartile range [IQR]: 1-4) in the clown group and 3 (IQR: 1-4.3) in the control group. VAS self-reported pain score was 2.5 (IQR: 0-5) and 3 (IQR: 1-6.3) in the clown and control groups (P=0.56), and VAS proxy-reported pain score was 2.5 (IQR: 0.3-3.4) and 3 (IQR: 1-4.5) (P=0.25). After BTI sessions, the 2 groups did not differ in VAS self- and proxy-reported anxiety (P=0.83 and P=0.81). Physician and parent ratings of the success of sessions were similar between the groups (P=0.89 and P=0.11). Parent ratings of the perceived benefits of distraction were higher in the clown than control group (P=0.004). CONCLUSIONS Although clown distraction was particularly appreciated by parents, it did not significantly reduce pain or anxiety in children as compared with usual distraction. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03149263.
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Affiliation(s)
- Laetitia Houx
- Department of physical and medical rehabilitation, CHRU MORVAN, 29602 Brest, Bretagne, France; Department of pediatric physical and medical rehabilitation, fondation ILDYS, 29200 Brest, Bretagne, France; Laboratory of medical information processing, Inserm U1101, 29200 Brest, Bretagne, France.
| | - Amandine Dubois
- Department of psychology, university of occidental Brittany, 29200 Brest, Bretagne, France; LP3C, EA 1285, Rennes 2, 35000 Rennes, Bretagne, France
| | - Sylvain Brochard
- Department of physical and medical rehabilitation, CHRU MORVAN, 29602 Brest, Bretagne, France; Department of pediatric physical and medical rehabilitation, fondation ILDYS, 29200 Brest, Bretagne, France; Laboratory of medical information processing, Inserm U1101, 29200 Brest, Bretagne, France
| | - Christelle Pons
- Department of pediatric physical and medical rehabilitation, fondation ILDYS, 29200 Brest, Bretagne, France; Laboratory of medical information processing, Inserm U1101, 29200 Brest, Bretagne, France
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Chidambaran V, Zhang X, Geisler K, Stubbeman BL, Chen X, Weirauch MT, Meller J, Ji H. Enrichment of Genomic Pathways Based on Differential DNA Methylation Associated With Chronic Postsurgical Pain and Anxiety in Children: A Prospective, Pilot Study. THE JOURNAL OF PAIN 2019; 20:771-785. [PMID: 30639570 DOI: 10.1016/j.jpain.2018.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/23/2018] [Accepted: 12/14/2018] [Indexed: 12/13/2022]
Abstract
We have reported child anxiety sensitivity (Child Anxiety Sensitivity Index [CASI]) predicts chronic postsurgical pain (CPSP). Herein, we evaluated DNA methylation profiles to understand the gene-environment interactions underlying CPSP and CASI, to identify shared, enriched, genomic pathways. In 73 prospectively recruited adolescents undergoing spine fusion, preoperative CASI and pain data over 12 months after surgery were collected. DNA from the peripheral blood of evaluable subjects with (n = 16) and without CPSP (n = 40) were analyzed using MethylationEPIC arrays. We identified 637 and 2,445 differentially DNA methylated positions (DMPs) associated with CPSP and CASI, respectively (P ≤ .05). Ingenuity pathway analysis of 39 genes with DMPs for both CPSP and CASI revealed enrichment of several canonical pathways, including GABA receptor (P = .00016 for CPSP; P =.0008 for CASI) and dopamine-DARPP32 feedback in cyclic adenosine monophosphate (P = .004 for CPSP and P =.00003 for CASI) signaling. Gene-gene interaction network enrichment analysis revealed participation of pathways in cell signaling, molecular transport, metabolism, and neurologic diseases (P < 10-8). Bioinformatic approaches to identify histone marks and transcription factor (TF) binding events underlying DMPs, showed their location in active regulatory regions in pain pathway relevant brain cells. Using Enrichr/Pinet enrichment and Library of Integrated Network-Based Cellular Signatures knockdown signatures, we identified TFs regulating genes with DMPs in association with CPSP and CASI. In conclusion, we identified epigenetically enriched pathways associated with CPSP and anxiety sensitivity in children undergoing surgery. Our findings support GABA hypofunction and the roles of the dopamine-DARPP32 pathway in emotion/reward and pain. This pilot study provides new epigenetic insights into the pathophysiology of CPSP and a basis for future studies in biomarker development and targetable interventions. PERSPECTIVE: Differential DNA methylation in regulatory genomic regions enriching shared neural pathways were associated with CPSP and CASI in adolescents undergoing spine surgery. Our findings support GABA hypofunction and the roles of the dopamine-DARPP32 pathway in emotion/reward contributing to behavioral maintenance of pain 10 to 12 months after surgery.
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Affiliation(s)
- Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Xue Zhang
- Pyrosequencing core for genomic and epigenomic research, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Kristie Geisler
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Bobbie L Stubbeman
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Xiaoting Chen
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew T Weirauch
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Divisions of Biomedical Informatics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jarek Meller
- Divisions of Biomedical Informatics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hong Ji
- Department of Environmental Health, University of Cincinnati; Division of Asthma Research, Cincinnati Children's Hospital, Cincinnati, Ohio
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Baghele A, Dave N, Dias R, Shah H. Effect of preoperative education on anxiety in children undergoing day-care surgery. Indian J Anaesth 2019; 63:565-570. [PMID: 31391620 PMCID: PMC6644192 DOI: 10.4103/ija.ija_37_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background and Aims: There have been various methods tested for reducing preoperative anxiety in children, but very limited literature is available in the Indian scenario. Our aim was to analyse the effect of an informative video about the anaesthetic technique on preoperative anxiety in children. Methods: In all, 94 children were randomly allotted into two groups. Children in the study group were shown a peer modelling video depicting induction of general anaesthesia and recovery during the preanaesthetic check (PAC). Patients in the control group were given only verbal information during PAC. Anxiety was assessed on visual analog scale (VAS) for anxiety at two times. Baseline VAS score was recorded during PAC and preoperative VAS score was assessed prior to induction of anaesthesia. The VAS score was represented as median value. Data were analysed using the Mann–Whitney U-test for ordinal data and skewed quantitative data. Categorical data was analysed by using Chi-square test and t-test was applied for quantitative data. The significance threshold of P value was set at <0.05. Results: The median (interquartile range) preoperative VAS score was significantly lower in the study group [1 (0–1.3)] when compared with the control group [5 (3–5)] (P < 0.001). The mean preoperative pulse rate, mean preoperative systolic blood pressure and mean preoperative diastolic blood pressure were significantly lower in the study group when compared with the control group (P < 0.001). Conclusion: Multimedia information in the form of a peer modelling video helped reduce preoperative anxiety in children between 7 and 12 years of age.
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Affiliation(s)
- Aarti Baghele
- Department of Paediatric Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nandini Dave
- Department of Paediatric Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Raylene Dias
- Department of Paediatric Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Harick Shah
- Department of Paediatric Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Delivet H, Beauvais D, Mialot A, Vacher T, Marsac L, Brasher C, Michelet D, Dahmani S. Description of typical personality factors and events that lead to anxiety at induction of anesthesia in French children. Paediatr Anaesth 2018; 28:987-998. [PMID: 30251353 DOI: 10.1111/pan.13492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/02/2018] [Accepted: 08/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Preventive strategies are available to reduce preoperative anxiety in children, the ideal time for implementing such strategies remains poorly determined. AIMS The aim of this study was to determine psychological factors and events involved in the development of preoperative anxiety in children. METHODS This study consisted of prospective evaluations of anxiety trait and state during the preoperative period. Attendance at a preanesthetic consultation is obligatory for all patients undergoing surgery in France. Anxiety trait and state assessments were quantified in mothers and children before and after the preanesthetic consultation using visual analog and faces numerical scales. Preoperative anxiety in children was assessed immediately before induction of anesthesia using an analog scale. Other data recorded included demographic and medical data and type of hospital stay. Univariate and multivariate logistic regression analyses were used. RESULTS Overall 111 consecutive patients were included. The following factors emerged leading to anxiety state at induction of anesthesia: maternal anxiety state before the preanesthetic consultation, a feeling of not being reassured by the anesthesiologist, maternal anxiety state after the consultation, and anxiety trait in the child. Logistic regression found this combination of factors (OR = 4 [1.4 -12]) and inpatient stay (OR = 3 [1.4-7]), predicting anxiety with an accuracy of 69%. CONCLUSION The present study identified a combination of psychological factors and events associated with the development of anxiety at induction of anesthesia in children. Parental anxiety impacts upon children and occurs before the preanesthetic consultation. This result may assist clinicians to prescribe personalized preventive strategies against anxiety.
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Affiliation(s)
- Honorine Delivet
- Department of Pain Management, Robert Debré University Hospital, Paris Sorbonne Cité, Paris Diderot University, Paris, France.,René Descarte University, Boulogne-Billancourt Cedex, France
| | - Delphine Beauvais
- Department of Anaesthesia and Intensive Care, RobertDebré University Hospital, Paris Sorbonne Cité, Paris Diderot University, Paris, France.,Denis Diderot University, Paris, France
| | - Adelaide Mialot
- Department of Anaesthesia and Intensive Care, RobertDebré University Hospital, Paris Sorbonne Cité, Paris Diderot University, Paris, France.,Denis Diderot University, Paris, France
| | - Thomas Vacher
- Department of Anaesthesia and Intensive Care, RobertDebré University Hospital, Paris Sorbonne Cité, Paris Diderot University, Paris, France.,Denis Diderot University, Paris, France
| | - Lucile Marsac
- Department of Anaesthesia and Intensive Care, RobertDebré University Hospital, Paris Sorbonne Cité, Paris Diderot University, Paris, France.,Denis Diderot University, Paris, France
| | - Christopher Brasher
- Department of Anesthesia and Pain Management, Royal Children's Hospital, Melbourne, VIC, Australia.,Anesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Daphné Michelet
- Department of Anaesthesia and Intensive Care, RobertDebré University Hospital, Paris Sorbonne Cité, Paris Diderot University, Paris, France.,Denis Diderot University, Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia and Intensive Care, RobertDebré University Hospital, Paris Sorbonne Cité, Paris Diderot University, Paris, France.,Denis Diderot University, Paris, France.,DHU PROTECT INSERM U 1141, Robert Debré University Hospital, Paris, France
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Development and validity of the Burns-Child Adult Medical Procedure Interaction Scale (B-CAMPIS) for young children. Burns 2018; 45:76-87. [PMID: 30274811 DOI: 10.1016/j.burns.2018.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Young children are at increased risk of burn injury and of procedural distress during the subsequent wound care. There are currently few observational measures validated for use with young children during medical procedures. The aim of this research was to adapt the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) to assess parent-young child interactions during burn wound care by including nonverbal behavioral coding. METHOD Eighty-seven families of children (1-6years old) were recruited at their first burn dressing change. Potential behaviors were identified through a literature review, consulting health professionals, and direct observation of parents and children during burn wound care. Nonverbal behaviors were coded live, and verbal behaviors were audio recorded for later assessment. RESULTS Inter-coder reliability was good to excellent for the Burns-CAMPIS (B-CAMPIS). The additional behaviors were correlated with the hypothesized coping, distress, coping-promoting and distress-promoting categories of the CAMPIS-R. Some behaviors differed in frequency across child age groups, with older children demonstrating more verbal behaviors. Convergent validity was demonstrated through correlations with previously validated observational parent-child behavior measures, and parent- and nurse- reported measures of child pain and anxiety. Univariate regression analyses demonstrated the child categories of the B-CAMPIS accounted for equal or more of the variance of parent- and nurse- reported child pain and anxiety, compared to the CAMPIS-R. CONCLUSIONS The B-CAMPIS is a reliable and valid measure, for assessing coping and distress relationships in young children and their families. Pending further validation, the B-CAMPIS assists researchers and clinicians to recognize and target important behaviors to improve young child coping during pediatric burn wound care.
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Wantanakorn P, Harintajinda S, Chuthapisith J, Anurathapan U, Rattanatamrong P. A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures. Hosp Pediatr 2018; 8:643-650. [PMID: 30213798 DOI: 10.1542/hpeds.2018-0073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Insufficient preparation for children who are undergoing bone marrow aspiration can cause anxiety and negative outcomes. Nonpharmacological therapies have been proven to reduce fear in children who are undergoing painful procedures. We have therefore developed a mobile application to help reduce these patients' anxiety by providing them with procedural information and coping skills. METHODS This single-blinded, randomized controlled trial included 60 patients age 5 to 12 years old who were undergoing bone marrow aspiration procedures in Thailand that were conducted between May 2015 and May 2016. Sixty participants were randomly assigned to the intervention group (mobile application added to usual care) or the control group (usual care only). Preprocedural anxiety levels were evaluated by visual analog scales (child anxiety visual analog scale); this was repeated in the intervention group immediately after patients used the mobile application. On the day of the procedure, the patients' cooperation levels were assessed by using the modified Yale Preoperative Anxiety Scale. The total amount of sedative drugs that were used was also recorded. The paired t test and the Wilcoxon signed rank test were used to analyze within-person change, whereas the t test and the Wilcoxon rank sum test were used for group comparisons. RESULTS The child anxiety visual analog scale score of patients in the intervention group decreased significantly after they used the mobile application (P < .0012). The modified Yale Preoperative Anxiety Scale score of patients in the intervention group was significantly lower than that in the control group (P < .01). There was no difference in sedative use between the 2 groups. CONCLUSIONS This mobile application possibly had effectiveness in routine use for reducing anxiety and increasing patients' cooperation in bone marrow aspiration procedures.
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Affiliation(s)
- Pornchanok Wantanakorn
- Chakri Naruebodindra Medical Institute, and .,Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and
| | - Supamas Harintajinda
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and
| | - Jariya Chuthapisith
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and
| | - Usanarat Anurathapan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and
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Berghmans JM, Poley MJ, van der Ende J, Veyckemans F, Poels S, Weber F, Schmelzer B, Himpe D, Verhulst FC, Utens E. Association between children's emotional/behavioral problems before adenotonsillectomy and postoperative pain scores at home. Paediatr Anaesth 2018; 28:803-812. [PMID: 30079454 DOI: 10.1111/pan.13450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children undergoing adenotonsillectomy are at risk of severe postoperative pain and sleep problems. Little is known about the specific child risk factors for these problems. AIMS The aim of this study was to assess the occurrence of postoperative pain, sleep problems, and medication adherence, and assess the influence of internalizing and externalizing problems on postoperative pain. METHODS This prospective cohort study included 160 children, aged 1.5-5 years undergoing day-care adenotonsillectomy. Parents rated their child's pain with the Parents' Postoperative Pain Measure and their child's sleep problems with Vernon's Post Hospital Behavioral Questionnaire during the first 3 days and at day 10 postoperatively. Emotional/behavioral problems (ie, internalizing and externalizing behaviors) during the past 2 months were assessed using the Child Behavior Checklist. Regression analysis was used to assess whether children's pain intensity at home was associated with internalizing/externalizing problems, after controlling for age, preoperative child state anxiety, parental state anxiety, parental need for information, and socioeconomic status. RESULTS Applying a threshold of ≥6 on the Parents' Postoperative Pain Measure, the incidence of moderate to severe pain was 57.6% at day 1, 53.5% at day 2, 35.4% at day 3, and 4.8% at day 10. During the first three postoperative nights, 37.1% of the children woke up. Internalizing problems (β = 0.343; P = 0.001) and parental need for information (β = 0.207; P = 0.011) were independently associated with higher pain scores at home during the first 3 days (R2 = 0.225). CONCLUSION Following adenotonsillectomy, children often experienced moderate to severe pain and sleep problems during the first 3 days at home. Preoperative internalizing problems and parental need for information were independently associated with increased pain at home. Screening for these problems can help to identify vulnerable children and adapt the perioperative analgesic strategy accordingly (which includes preparation, information, and prescription of pain analgesics).
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Affiliation(s)
- Johan M Berghmans
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Anesthesia, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marten J Poley
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Francis Veyckemans
- Department of Anesthesiology, Hôpital Jeanne de Flandre, University Hospital Lille, Lille, France
| | - Stephanie Poels
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Frank Weber
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bert Schmelzer
- Department of Ear, Nose and Throat surgery, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Dirk Himpe
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, Academic Center for Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam/de Bascule, Amsterdam, The Netherlands
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Abstract
OBJECTIVES The objective of this study was to evaluate the agreement between the State Trait Anxiety Inventory (STAI) and other anxiety scales to determine whether these shorter to administer scales could replace the STAI. METHODS This was a prospective cohort study on a convenience sample of children, aged 9 to 17 years, presenting to a pediatric emergency department. Patients were divided into 2 groups: preteens (PT) (aged 9-12 years) completed the pediatric STAI and teens (T) (aged 13-17 years) completed the adult STAI. Participants also completed a visual analog scale (0-100 mm), a Likert scale (1-5), and a short version of the STAI. Intraclass correlation (2-way mixed model, average measures) was used to evaluate agreement between the STAI and the other scales. A sample size of 100 patients per group was estimated as sufficient. RESULTS The median (interquartile range) STAI state anxiety scores were 33 (28.25-36.75) and 37.5 (32-44), in the PT (n = 100) and T (n = 100) groups, respectively. The median (interquartile range) STAI trait anxiety scores were 33.5 (28-38.75) and 36 (31-44), in the PT and T groups, respectively. Agreements between the STAI and the other scales were poor for all scales. At best, the intraclass correlation was 0.71 for the agreement between the STAI and the short version of the STAI. CONCLUSIONS There appears to be poor agreement between the STAI and the other scales designed to measure anxiety in children 9 to 17 years presenting to the pediatric emergency department.
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Wong CL, Ip WY, Kwok BMC, Choi KC, Ng BKW, Chan CWH. Effects of therapeutic play on children undergoing cast-removal procedures: a randomised controlled trial. BMJ Open 2018; 8:e021071. [PMID: 29980545 PMCID: PMC6042539 DOI: 10.1136/bmjopen-2017-021071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine (1) the effectiveness of therapeutic play in reducing anxiety and negative emotional manifestations among children undergoing cast-removal procedures and (2) the satisfaction of parents and cast technicians with cast-removal procedures. DESIGN A randomised controlled trial. SETTING An orthopaedic outpatient department of a regional teaching hospital in Hong Kong. PARTICIPANTS Children (n=208) aged 3-12 undergoing cast-removal procedure were invited to participate. INTERVENTIONS Eligible children were randomly allocated to either the intervention (n=103) or control group (n=105) and stratified by the two age groups (3-7 and 8-12 years). The intervention group received therapeutic play intervention, whereas the control group received standard care only. Participants were assessed on three occasions: before, during and after completion of the cast-removal procedure. OUTCOME MEASURES Children's anxiety level, emotional manifestation and heart rate. The satisfaction ratings of parents and cast technicians with respect to therapeutic play intervention were also examined. RESULTS Findings suggested that therapeutic play assists children aged 3-7 to reduce anxiety levels with mean differences between the intervention and control group was -20.1 (95% CI -35.3 to -4.9; p=0.01). Overall, children (aged 3-7 and 8-12) in the intervention groups exhibited fewer negative emotional manifestations than the control group with a mean score difference -2.2 (95% CI -3.1 to -1.4; p<0.001). Parents and technicians in the intervention group also reported a higher level of satisfaction with the procedures than the control group with a mean score difference of 4.0 (95% CI -5.6 to 2.3; p<0.001) and 2.6 (95% CI 3.7 to 1.6; p<0.001), respectively. CONCLUSION Therapeutic play effectively reduces anxiety and negative emotional manifestations among children undergoing cast-removal procedures. The findings highlight the importance of integrating therapeutic play into standard care, in particular for children in younger age. TRIAL REGISTRATION NUMBER ChiCTR-IOR-15006822; Pre-results.
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Affiliation(s)
- Cho Lee Wong
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Wan Yim Ip
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Kai Chow Choi
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Bobby King Wah Ng
- Faculty of Medicine, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Carmen Wing Han Chan
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Kang Y, Rahrig H, Eichel K, Niles HF, Rocha T, Lepp NE, Gold J, Britton WB. Gender differences in response to a school-based mindfulness training intervention for early adolescents. J Sch Psychol 2018; 68:163-176. [PMID: 29861026 PMCID: PMC6174072 DOI: 10.1016/j.jsp.2018.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 12/30/2017] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
Mindfulness training has been used to improve emotional wellbeing in early adolescents. However, little is known about treatment outcome moderators, or individual differences that may differentially impact responses to treatment. The current study focused on gender as a potential moderator for affective outcomes in response to school-based mindfulness training. Sixth grade students (N = 100) were randomly assigned to either the six weeks of mindfulness meditation or the active control group as part of a history class curriculum. Participants in the mindfulness meditation group completed short mindfulness meditation sessions four to five times per week, in addition to didactic instruction (Asian history). The control group received matched experiential activity in addition to didactic instruction (African history) from the same teacher with no meditation component. Self-reported measures of emotional wellbeing/affect, mindfulness, and self-compassion were obtained at pre and post intervention. Meditators reported greater improvement in emotional wellbeing compared to those in the control group. Importantly, gender differences were detected, such that female meditators reported greater increases in positive affect compared to females in the control group, whereas male meditators and control males displayed equivalent gains. Uniquely among females but not males, increases in self-reported self-compassion were associated with improvements in affect. These findings support the efficacy of school-based mindfulness interventions, and interventions tailored to accommodate distinct developmental needs of female and male adolescents.
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Affiliation(s)
- Yoona Kang
- Annenberg School for Communication, University of Pennsylvania, United States.
| | - Hadley Rahrig
- Brown University Contemplative Studies Initiative, United States
| | - Kristina Eichel
- Department of Psychiatry and Human Behavior, Brown University Medical School, United States
| | - Halsey F Niles
- Brown University Contemplative Studies Initiative, United States; Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, United States
| | - Tomas Rocha
- Philasophy and Education, Columbia University, United States
| | - Nathaniel E Lepp
- Brown University Contemplative Studies Initiative, United States
| | - Jonathan Gold
- Brown University Contemplative Studies Initiative, United States; Moses Brown School, United States
| | - Willoughby B Britton
- Brown University Contemplative Studies Initiative, United States; Department of Psychiatry and Human Behavior, Brown University Medical School, United States.
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