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Ceylan E, Gurbuz E. The effect of virtual reality glasses on dental anxiety during scaling and root planing in patients with periodontitis: A randomized controlled clinical trial. Int J Dent Hyg 2024; 22:749-757. [PMID: 38433480 DOI: 10.1111/idh.12788] [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: 08/02/2023] [Revised: 09/10/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients. MATERIALS AND METHODS This randomized controlled split-mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure. RESULTS With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = -0.48, p = 0.01). CONCLUSIONS The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses.
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Affiliation(s)
- Ezgi Ceylan
- Department of Periodontology, Faculty of Dentistry, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ezgi Gurbuz
- Department of Periodontology, Faculty of Dentistry, Kutahya Health Sciences University, Kutahya, Turkey
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MacNeil M, Hundert A, Campbell-Yeo M. Soothing and Distress Behaviors of Infants, Parents, and Clinicians During Childhood Vaccinations. Pain Manag Nurs 2024:S1524-9042(24)00163-2. [PMID: 38991909 DOI: 10.1016/j.pmn.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The purpose of this study was to describe the behaviors of infants who were born preterm, their parents, and clinicians during 2-, 6-, 12-, and 18-month vaccinations. METHODS Vaccination sessions were video recorded for 3-5 minutes. The proportion of 5-second intervals in which distress and soothing behavior by infants, parents, and clinicians was coded using the Measure of Adult and Infant Soothing and Distress. Coding consisted of three phases: baseline/anticipatory (60 seconds prior to first needle), procedure (first needle to removal of final needle), and recovery (up to 180 seconds after removal of final needle). RESULTS A total of 64 infants were included. Distress behavior by infants during the baseline phase ranged from 13% (12-month vaccinations) to 29% (2-month). There was limited anticipatory soothing behavior from parents (10% [12-month] to 50% [2-month]) and clinicians (6% [12-month] to 17% [2-month]). Distress behavior in infants during the procedure ranged from 43% (18-month) to 96% (2-month). There was limited soothing behavior during the procedure from parents (10% [12-month] to 81% [12-month]) and clinicians (13% [12-month] to 71% [2-month]). Few infants received additional pain-reducing interventions, including skin-to-skin contact, 24% oral sucrose, and topical anesthetic. DISCUSSION Despite infant distress, there was limited anticipatory behavior from parents and clinicians. Two-month-old infants displayed the most distress across all time points yet received the least amount of treatment and proximal parent and clinician behavior. Additional implementation efforts are required to increase awareness and practice uptake among parents and clinicians to ensure infants receive equitable and effective pain management.
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Affiliation(s)
- Morgan MacNeil
- School of Nursing, Dalhousie University, Halifax, NS, Canada; Faculty of Health, Dalhousie University, Halifax, NS, Canada; MOM-LINC Lab, IWK Health, Halifax, NS, Canada
| | | | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, NS, Canada; Faculty of Health, Dalhousie University, Halifax, NS, Canada; MOM-LINC Lab, IWK Health, Halifax, NS, Canada; Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
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Mathias N, Huille S, Picci M, Mahoney RP, Pettis RJ, Case B, Helk B, Kang D, Shah R, Ma J, Bhattacharya D, Krishnamachari Y, Doucet D, Maksimovikj N, Babaee S, Garidel P, Esfandiary R, Gandhi R. Towards more tolerable subcutaneous administration: Review of contributing factors for improving combination product design. Adv Drug Deliv Rev 2024; 209:115301. [PMID: 38570141 DOI: 10.1016/j.addr.2024.115301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Subcutaneous (SC) injections can be associated with local pain and discomfort that is subjective and may affect treatment adherence and overall patient experience. With innovations increasingly focused on finding ways to deliver higher doses and volumes (≥2 mL), there is a need to better understand the multiple intertwined factors that influence pain upon SC injection. As a priority for the SC Drug Development & Delivery Consortium, this manuscript provides a comprehensive review of known attributes from published literature that contribute to pain/discomfort upon SC injection from three perspectives: (1) device and delivery factors that cause physical pain, (2) formulation factors that trigger pain responses, and (3) human factors impacting pain perception. Leveraging the Consortium's collective expertise, we provide an assessment of the comparative and interdependent factors likely to impact SC injection pain. In addition, we offer expert insights and future perspectives to fill identified gaps in knowledge to help advance the development of patient-centric and well tolerated high-dose/high-volume SC drug delivery solutions.
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Affiliation(s)
- Neil Mathias
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Sylvain Huille
- Sanofi, 13 quai Jules Guesde, 94400 Vitry-Sur-Seine, France.
| | - Marie Picci
- Novartis Pharma AG, Fabrikstrasse 4, CH-4056 Basel, Switzerland
| | - Robert P Mahoney
- Comera Life Sciences, 12 Gill St, Suite 4650, Woburn, MA 01801 USA
| | - Ronald J Pettis
- Becton-Dickinson, 21 Davis Drive, Research Triangle Park, NC 27513 USA
| | - Brian Case
- KORU Medical Systems, 100 Corporate Dr, Mahwah, NJ 07430 USA
| | - Bernhard Helk
- Novartis Pharma AG, Werk Klybeck, WKL-681.4.42, CH-4057 Basel, Switzerland
| | - David Kang
- Halozyme Therapeutics, Inc., 12390 El Camino Real, San Diego, CA 92130 USA
| | - Ronak Shah
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Junchi Ma
- Johnson & Johnson Innovative Medicine, 200 Great Valley Pkwy, Malvern, PA 19355 USA
| | | | | | - Dany Doucet
- GSK, 1250 South Collegeville Road, Collegeville, PA 19426 USA
| | | | - Sahab Babaee
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065 USA
| | - Patrick Garidel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Straße 65, 88397 Biberach/Riss, Germany
| | | | - Rajesh Gandhi
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
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Killian HJ, Deacy A, Edmundson E, Raab L, Schurman JV. If we know better, why don't we do better? A rapid quality improvement project to increase utilization of comfort measures to reduce pain and distress in children in a COVID-19 mass vaccination clinic. J Pediatr Nurs 2024; 76:e93-e100. [PMID: 38307756 DOI: 10.1016/j.pedn.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Many evidence-based tools exist to address pain and distress associated with injections; however, there remains a large gap between the knowledge of these tools and their utilization. Our hospital began a quality improvement (QI) project prior to COVID-19, with the goal of increasing the utilization of Comfort Promise measures during needle procedures. When COVID-19 vaccinations were approved, our mass vaccination clinics provided an opportunity to rapidly increase utilization across the institution. The primary aim was to increase the percentage of comfort measures (CM) offered with COVID-19 vaccinations. METHODS Through this QI project, nurses and other professionals implemented CMs during COVID mass vaccination clinics. Clinics occurred in 3 age-based waves. Waves served as Plan-Do-Study-Act (PDSA) cycles. Families completed post-vaccination surveys to determine what CMs were offered and intention for future use with vaccinations. RESULTS Uptake of CMs (PainEase, ShotBlockers, Comfort Positioning, Alternative Focus, Topical Lidocaine, and Breastfeeding/Sucrose) throughout the waves increased and generally remained stable. CMs also seemed to decrease pain/distress with vaccinations (70.5 to 88.7%), and children/caregivers intended to use some combination for future vaccinations (82.5 to 98.5%). CONCLUSIONS Fast-paced mass vaccination clinics provided an ideal opportunity to significantly increase utilization of CMs. Across age groups CMs yielded high satisfaction and interest in future utilization. Clinic nurses returned to their own sub-specialties and became change agents. IMPLICATIONS If all healthcare providers can work together to achieve consensus while incorporating comfort measures into daily practice, sustained change with incorporation of these evidence-based tools can be achieved. Future directions are discussed.
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Affiliation(s)
- Haley J Killian
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | - Amanda Deacy
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | | | - Lucy Raab
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA.
| | - Jennifer V Schurman
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
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Ong N, Brogan D, Lucien A, Wolman S, Campbell D, Deng L, Koirala A, Garg P, Sharma K. The development and evaluation of a vaccination pathway for children with intellectual and developmental disability and needle fear. PAEDIATRIC & NEONATAL PAIN 2024; 6:1-9. [PMID: 38504870 PMCID: PMC10946674 DOI: 10.1002/pne2.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/21/2024]
Abstract
This qualitative study describes the development and evaluation of a clinical pathway to facilitate the implementation of catch-up vaccinations for children with significant needle fear, particularly in children with developmental disabilities. The Specialist Immunization Team, based at a tertiary level teaching children's hospital, participated in process mapping activities using Motivational Interviewing (MI) techniques and reflective discussions. Team members developed a clinical pathway by incorporating parental feedback from semistructured interviews and clinical expertise from within the team, facilitated by colleagues from the Child Development Unit. A process map was developed that included process strengths and touch points with an action plan that was discussed and agreed upon. A repeat process mapping activity was conducted 16 months later. Reports from parental feedback included: positive, efficient, and successful experiences of having their child undergo catch-up vaccinations. The experience empowered families for further procedures. Team members reported improvements in triaging appropriate children for the pathway, and an increase in confidence to interact and manage behaviors of children with significant anxiety and challenging behaviors. They also reported an increase in successful vaccinations with improved clinical judgment of facilitating the sedation pathway. This study demonstrates that using group facilitation using motivational interviewing in reflective discussions and process mapping utilizing parent and staff feedback in service improvement activities results in efficient and successful service delivery with improved patient outcomes.
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Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Public Health, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Deidre Brogan
- Specialist Immunisation Team, Children's Hospital at WestmeadSydneyNew South WalesAustralia
- National Centre for Immunisation Research and SurveillanceSydneyNew South WalesAustralia
| | - Abbie Lucien
- UNSW MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Shayna Wolman
- St. Vincent's HospitalSydneyNew South WalesAustralia
| | | | - Lucy Deng
- Specialist Immunisation Team, Children's Hospital at WestmeadSydneyNew South WalesAustralia
- National Centre for Immunisation Research and SurveillanceSydneyNew South WalesAustralia
| | - Archana Koirala
- Specialist Immunisation Team, Children's Hospital at WestmeadSydneyNew South WalesAustralia
- National Centre for Immunisation Research and SurveillanceSydneyNew South WalesAustralia
| | - Pankaj Garg
- Specialist Intellectual Disability Health Team, South Western Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Ketaki Sharma
- Specialist Immunisation Team, Children's Hospital at WestmeadSydneyNew South WalesAustralia
- National Centre for Immunisation Research and SurveillanceSydneyNew South WalesAustralia
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Gregory SW, Aul AJ, Lodermeier TM, Rodemeyer JL, Weaver AL, Lynch BA. The certified child life specialist: A novel resource in the pediatric primary care clinic for managing children's pain during routine immunizations. PAEDIATRIC & NEONATAL PAIN 2023; 5:66-75. [PMID: 37744282 PMCID: PMC10514778 DOI: 10.1002/pne2.12101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 09/26/2023]
Abstract
This study evaluated the effect of the Certified Child Life Specialist (CCLS) on pediatric pain and pain management during routine immunization administration in the pediatric primary care clinic. Children 4-12 years of age (n = 125) presenting for a well child physical examination at a rural primary care clinic were selected to receive standard nursing care or standard nursing care plus CCLS support during routine immunization administration. Patient reported pain was measured using the Faces Pain Scale-Revised (FPS-R), and patient behavioral responses were measured during immunization administration using the Children's Emotional Manifestation Scale (CEMS). The performance of psychosocial interventions and administration of topical pain-relieving interventions were measured between both groups. CCLS support was associated with fewer negative emotional behaviors during immunization administration among 7- to 12-year-old children and a significantly higher provision of psychosocial interventions and topical pain-relieving interventions among all ages. This study demonstrates that the presence of a CCLS can increase the provision of psychosocial and pain-relieving interventions and reduce distress during immunization administration in a busy pediatric primary care clinic.
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Affiliation(s)
- Seth W. Gregory
- Department of Pediatric and Adolescent MedicineMayo Clinic Health SystemRed WingMinnesotaUSA
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | - Andrea J. Aul
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | - Tara M. Lodermeier
- Department of Nursing, Child Life ProgramMayo ClinicRochesterMinnesotaUSA
| | | | - Amy L. Weaver
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Brian A. Lynch
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
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de la Maza V, Fuentes V, Cabrolier E, Fernández MS, Saéz S, Concha C, Nicklas C, Castro M, Torres JP. Efficacy, Safety, and Pain Level of Subcutaneous Catheter Use for Administration of Granulocyte Colony-Stimulating Factor (G-CSF) in Children With Cancer: A Randomized Pilot Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:305-312. [PMID: 37920922 DOI: 10.1177/27527530231190373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Background: The aim of this study was to explore the efficacy, safety, and pain level of granulocyte colony-stimulating factor (G-CSF) administration via a subcutaneous catheter compared with direct injection in children with cancer. Method: This was a pilot randomized controlled trial of standard G-CSF administration versus subcutaneous catheter administration. Children 2-15 years of age who were beginning G-CSF after their first chemotherapy cycle and anticipated to receive G-CSF following the next three cycles of chemotherapy were eligible. Efficacy, safety, and pain were as outcomes of the study. Results: Twenty-nine children with cancer (median age 12 years) were enrolled in the study (16 children in the subcutaneous catheter group and 13 children in the direct injection group). During Cycle 2, the median number of days to reach absolute neutrophil count (ANC) ≥ 500/mm3 was greater among those in the subcutaneous catheter group (12 vs. 10; p = .02). In Cycle 3, however, the subcutaneous catheter group received fewer doses of G-CSF (8 vs. 12; p = .004). No complications related to subcutaneous catheter use were observed. No differences in the visual analog scale pain score were observed between groups in Cycles 1 to 3; however, in Cycle 4, children in the subcutaneous catheter group had lower median pain scores than those in the direct subcutaneous injection group (Mdn = 0, [IQR] = 0-2 vs. Mdn = 1, IQR = 0-6; p < 0.01). Conclusion: Results demonstrated administering G-CSF via a subcutaneous catheter enables ANC to recover with no pain or complications associated with its use. Thus, oncology teams may consider this administration method to be used in children with cancer.
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Affiliation(s)
- Verónica de la Maza
- Pediatrics and Pediatric Surgery Department, Dr. Luis Calvo Mackenna Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Valeska Fuentes
- Oncology Unit, Dr. Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Elisa Cabrolier
- Hematopoietic Transplant Unit, Dr. Luis Calvo Mackenna Hospital, Santiago, Chile
| | | | - Sara Saéz
- Hematopoietic Transplant Unit, Dr. Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Claudia Concha
- Oncology Unit, Dr. Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Carolina Nicklas
- Oncology Unit, Dr. Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Magdalena Castro
- Research and Epidemiology Unit, Medical School, Universidad Finis Terrae, Santiago, Chile
| | - Juan Pablo Torres
- Pediatrics and Pediatric Surgery Department, Dr. Luis Calvo Mackenna Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Bumin Aydin G, Ozkan Sipahioglu F, Alptekin A. Massaging as a pain-relieving intervention before performing intravenous access. Appl Nurs Res 2023; 72:151701. [PMID: 37423679 DOI: 10.1016/j.apnr.2023.151701] [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: 11/28/2022] [Revised: 04/11/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Pain is "an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of damage". Stimulating the skin by rubbing, stroking, massaging, or applying pressure near the injection site is pain-relieving. Needle-related procedures induce anxiety, distress, and fear in children and adults. The present study aimed to test the effectiveness of massaging the access site in reducing pain associated with intravenous access. DESIGN After obtaining institutional ethics committee approval, this prospective randomized single-blinded study was performed on 250 ASA I-II patients 18 to 65 years old, scheduled for elective minor general surgery under general anaesthesia. METHODS Patients were randomized into the Massaging Group (MG) and the Control Group (CG). A Situational Trait Anxiety Inventory (STAI) was conducted to evaluate the anxiety levels of the patients. In addition, the skin adjacent to the intravenous access site was massaged for 15 s in circular motions with moderate intensity by the investigator's right thumb before performing the intravenous access in the MG. The CG did not receive any massage adjacent to the access site. The primary endpoint, the intensity of perceived pain, was rated on a non-graduated 10-cm Visual Analogue Score (VAS). FINDINGS The groups' demographic data and STAI I-II scores were similar. There was a significant difference between the VAS scores of the two groups (p < 0.05). CONCLUSIONS Our results support massaging as an effective pain-relieving technique before intravenous intervention. As massaging is a universal and non-invasive intervention that requires no advanced preparation, we recommend massaging before each intravenous cannulation to reduce pain caused by intravenous access.
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Affiliation(s)
- Gozde Bumin Aydin
- University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Education Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
| | - Fatma Ozkan Sipahioglu
- University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Education Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Alp Alptekin
- University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Education Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
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Ogston-Tuck S. Intramuscular injection: exploring the evidence on effective administration. Nurs Stand 2023; 38:71-76. [PMID: 37357532 DOI: 10.7748/ns.2023.e12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/27/2023]
Abstract
Administering medicines by intramuscular (IM) injection is a familiar, though not necessarily common, nursing procedure. To ensure effective administration of IM injections it is important that nurses are up to date with the evidence on factors such as selection of injection site, use of appropriate equipment and injection technique. This article explores the evidence on effective administration of IM injections with the aim of enhancing nurses' decision-making and technique when undertaking this procedure.
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Affiliation(s)
- Sherri Ogston-Tuck
- Institute of Health & Society, University of Worcester, Worcester, England
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Rava J, Rosenau KA, Wilkie K, Bernacki J, Curcio E, Kuo A. The Needle Anxiety Program: A Patient-Centered Initiative for Individuals With Developmental Disabilities. Cureus 2023; 15:e42253. [PMID: 37605699 PMCID: PMC10440050 DOI: 10.7759/cureus.42253] [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: 05/25/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Objective To describe the development process of a patient-centered initiative focused on improving primary care health outcomes of patients with intellectual and developmental disabilities (IDD) and needle-related anxiety using evidence-based practices and novel approaches that can be implemented in outpatient settings. The overall outcome of the program is to increase vaccine uptake and accessibility in the IDD population as well as improve needle-related procedures in primary care settings to be more humane and effective. Methods The development process occurred in the context of a large healthcare system serving a diverse patient population in the U.S. and was led by an expert committee made of an multidisciplinary team of physicians, psychologists, ambulatory and clinic nurses, pharmacists, and anesthesiologists committed to promoting quality healthcare for the IDD population. Committee members were recruited within the healthcare system based on their relevant expertise. The methodology included an iterative and collaborative process that took place over three development phases: ideation and design, literature review and synthesis, and expert engagement. The ideation and design phase included a series of planning meetings among the expert committee, in which committee members identified preliminary concerns based on their expertise in the field and background knowledge on the current procedures related to improving routine care for individuals with IDD and/or needle-related anxiety. The literature review and synthesis phase led to the development of an annotated bibliography of research and clinical guidelines that synthesized findings on needle anxiety in clinical care. The expert engagement phase included all Committee members meeting for a final discussion to establish a tiered approach to utilizing evidence-based strategies that could be implemented across clinics within the healthcare system. Results The multidisciplinary team of experts developed a three-tier system, deployed sequentially as needed. The first tier focuses on training nurses in evidence-based behavioral modification strategies to implement as standard of care. The second tier uses the addition of a distraction device and topical analgesic to reduce anxiety in patients with slightly elevated procedural anxiety. The third tier involves a novel minimal sedation protocol using intranasal midazolam for patients with needle phobia that can be administered in an outpatient setting. Conclusion The Needle Anxiety Program eases the administration of needle-related medical procedures in the primary care setting for patients with IDD and needle-related anxiety. The use of evidence-based practices and a novel minimal sedation protocol for individuals with needle phobia assists in the completion of routine healthcare procedures, such as vaccinations and phlebotomy, in a patient-preferred setting. The purpose of delineating needle-related processes and procedures through the Needle Anxiety Program is to reduce health disparities for patients with IDD and promote uptake of the Needle Anxiety Program in similar healthcare settings.
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Affiliation(s)
- Julianna Rava
- Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Kashia A Rosenau
- Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Kendal Wilkie
- Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Jessica Bernacki
- Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Eric Curcio
- Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Alice Kuo
- Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
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Pillai Riddell RR, Bucsea O, Shiff I, Chow C, Gennis HG, Badovinac S, DiLorenzo-Klas M, Racine NM, Ahola Kohut S, Lisi D, Turcotte K, Stevens B, Uman LS. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2023; 6:CD006275. [PMID: 37314064 PMCID: PMC10265939 DOI: 10.1002/14651858.cd006275.pub4] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite evidence of the long-term implications of unrelieved pain during infancy, it is evident that infant pain is still under-managed and unmanaged. Inadequately managed pain in infancy, a period of exponential development, can have implications across the lifespan. Therefore, a comprehensive and systematic review of pain management strategies is integral to appropriate infant pain management. This is an update of a previously published review update in the Cochrane Database of Systematic Reviews (2015, Issue 12) of the same title. OBJECTIVES To assess the efficacy and adverse events of non-pharmacological interventions for infant and child (aged up to three years) acute pain, excluding kangaroo care, sucrose, breastfeeding/breast milk, and music. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE-Ovid platform, EMBASE-OVID platform, PsycINFO-OVID platform, CINAHL-EBSCO platform and trial registration websites (ClinicalTrials.gov; International Clinical Trials Registry Platform) (March 2015 to October 2020). An update search was completed in July 2022, but studies identified at this point were added to 'Awaiting classification' for a future update. We also searched reference lists and contacted researchers via electronic list-serves. We incorporated 76 new studies into the review. SELECTION CRITERIA: Participants included infants from birth to three years in randomised controlled trials (RCTs) or cross-over RCTs that had a no-treatment control comparison. Studies were eligible for inclusion in the analysis if they compared a non-pharmacological pain management strategy to a no-treatment control group (15 different strategies). In addition, we also analysed studies when the unique effect of adding a non-pharmacological pain management strategy onto another pain management strategy could be assessed (i.e. additive effects on a sweet solution, non-nutritive sucking, or swaddling) (three strategies). The eligible control groups for these additive studies were sweet solution only, non-nutritive sucking only, or swaddling only, respectively. Finally, we qualitatively described six interventions that met the eligibility criteria for inclusion in the review, but not in the analysis. DATA COLLECTION AND ANALYSIS: The outcomes assessed in the review were pain response (reactivity and regulation) and adverse events. The level of certainty in the evidence and risk of bias were based on the Cochrane risk of bias tool and the GRADE approach. We analysed the standardised mean difference (SMD) using the generic inverse variance method to determine effect sizes. MAIN RESULTS: We included total of 138 studies (11,058 participants), which includes an additional 76 new studies for this update. Of these 138 studies, we analysed 115 (9048 participants) and described 23 (2010 participants) qualitatively. We described qualitatively studies that could not be meta-analysed due to being the only studies in their category or statistical reporting issues. We report the results of the 138 included studies here. An SMD effect size of 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. The thresholds for the I2 interpretation were established as follows: not important (0% to 40%); moderate heterogeneity (30% to 60%); substantial heterogeneity (50% to 90%); considerable heterogeneity (75% to 100%). The most commonly studied acute procedures were heel sticks (63 studies) and needlestick procedures for the purposes of vaccines/vitamins (35 studies). We judged most studies to have high risk of bias (103 out of 138), with the most common methodological concerns relating to blinding of personnel and outcome assessors. Pain responses were examined during two separate pain phases: pain reactivity (within the first 30 seconds after the acutely painful stimulus) and immediate pain regulation (after the first 30 seconds following the acutely painful stimulus). We report below the strategies with the strongest evidence base for each age group. In preterm born neonates, non-nutritive sucking may reduce pain reactivity (SMD -0.57, 95% confidence interval (CI) -1.03 to -0.11, moderate effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.61, 95% CI -0.95 to -0.27, moderate effect; I2 = 81%, considerable heterogeneity), based on very low-certainty evidence. Facilitated tucking may also reduce pain reactivity (SMD -1.01, 95% CI -1.44 to -0.58, large effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.59, 95% CI -0.92 to -0.26, moderate effect; I2 = 87%, considerable heterogeneity); however, this is also based on very low-certainty evidence. While swaddling likely does not reduce pain reactivity in preterm neonates (SMD -0.60, 95% CI -1.23 to 0.04, no effect; I2 = 91%, considerable heterogeneity), it has been shown to possibly improve immediate pain regulation (SMD -1.21, 95% CI -2.05 to -0.38, large effect; I2 = 89%, considerable heterogeneity), based on very low-certainty evidence. In full-term born neonates, non-nutritive sucking may reduce pain reactivity (SMD -1.13, 95% CI -1.57 to -0.68, large effect; I2 = 82%, considerable heterogeneity) and improve immediate pain regulation (SMD -1.49, 95% CI -2.20 to -0.78, large effect; I2 = 92%, considerable heterogeneity), based on very low-certainty evidence. In full-term born older infants, structured parent involvement was the intervention most studied. Results showed that this intervention has little to no effect in reducing pain reactivity (SMD -0.18, 95% CI -0.40 to 0.03, no effect; I2 = 46%, moderate heterogeneity) or improving immediate pain regulation (SMD -0.09, 95% CI -0.40 to 0.21, no effect; I2 = 74%, substantial heterogeneity), based on low- to moderate-certainty evidence. Of these five interventions most studied, only two studies observed adverse events, specifically vomiting (one preterm neonate) and desaturation (one full-term neonate hospitalised in the NICU) following the non-nutritive sucking intervention. The presence of considerable heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of evidence of very low to low certainty based on GRADE judgements. AUTHORS' CONCLUSIONS Overall, non-nutritive sucking, facilitated tucking, and swaddling may reduce pain behaviours in preterm born neonates. Non-nutritive sucking may also reduce pain behaviours in full-term neonates. No interventions based on a substantial body of evidence showed promise in reducing pain behaviours in older infants. Most analyses were based on very low- or low-certainty grades of evidence and none were based on high-certainty evidence. Therefore, the lack of confidence in the evidence would require further research before we could draw a definitive conclusion.
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Affiliation(s)
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, Canada
| | - Ilana Shiff
- Department of Psychology, York University, Toronto, Canada
| | - Cheryl Chow
- Department of Psychology, York University, Toronto, Canada
| | | | | | | | - Nicole M Racine
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Sara Ahola Kohut
- Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
| | - Diana Lisi
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Kara Turcotte
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Bonnie Stevens
- Nursing Research, The Hospital for Sick Children, Toronto, Canada
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Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy Diagnostic Criteria for Acute Needle Pain. THE JOURNAL OF PAIN 2023; 24:387-402. [PMID: 36243317 DOI: 10.1016/j.jpain.2022.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
Needle procedures are among the most common causes of pain and distress for individuals seeking health care. While needle pain is especially problematic for children needle pain and associated fear also has significant impact on adults and can lead to avoidance of appropriate medical care. Currently there is not a standard definition of needle pain. A taxonomy, or classification system, for acute needle pain would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including needle pain. To accomplish this, a working group of experts in needle pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact and/or functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific needle pain. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of needle associated fear, are proposed to define the types of acute needle pain. PERSPECTIVE: This article presents a taxonomy for acute needle pain. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients undergoing needle procedures.
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Sblendorio E. Intramuscular vaccine administrations including the adoption of “Zeta-track technique” & “without aspiration slow injection technique” (ZTT & WASiT): a prospective review. FRONTIERS OF NURSING 2023. [DOI: 10.2478/fon-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Objective
To review the current literature on the practice of intramuscular injections (IMIs), focusing on immunizations.
Methods
The present study comprises 2 reviews, characterized by high-quality evidence, pertaining to the deployment of the slow injection technique without aspiration (referred to in this paper as the without-aspiration slow injection technique [WASiT]) and combined with the Zeta-track technique (ZTT). The literature review is oriented toward the analysis of 2 features associated with IMIs techniques: safety and pain, integrating new evidence on vaccinee positioning for each muscle site and general relaxation techniques in the multi-parametric analysis.
Results
The rigorous and in-depth reviews in the current study reveal the usefulness of including, among the international guidelines for via intramuscular immunizations, the adoption of WASiT only for compliant vaccinees, and in combination with all validated techniques for IMIs, and the use of ZTT limitedly if specific well-developed muscles are indicated. All the technique’s limitations are exposed.
Conclusions
Future research directions are presented by including the author’s study designs to provide indirect evidence for the validity of the rationale of the slow injection technique using scientific methods, and for the conduction of future randomized controlled trials (RCTs) focused on revisiting the adoption of ZTT in a dynamic and integrated immunizations protocol in anterolateral thigh (ALT), ventrogluteal (VG), and also in the deltoid muscle, in the specific cases analyzed.
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Affiliation(s)
- Elena Sblendorio
- a Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari , Bari , Italy
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
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Demblon MC, Bicknell C, Aufegger L. Systematic review of the development and effectiveness of digital health information interventions, compared with usual care, in supporting patient preparation for paediatric hospital care, and the impact on their health outcomes. FRONTIERS IN HEALTH SERVICES 2023; 3:1103624. [PMID: 37089454 PMCID: PMC10117991 DOI: 10.3389/frhs.2023.1103624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/14/2023] [Indexed: 04/25/2023]
Abstract
Background and aim Elective surgery can be overwhelming for children, leading to pre-operative anxiety, which is associated with adverse clinical and behavioural outcomes. Evidence shows that paediatric preparation digital health interventions (DHIs) can contribute to reduced pre-operative anxiety and negative behavioural changes. However, this evidence does not consider their design and development in the context of behavioural science. This systematic review used the Theoretical Domains Framework (TDF) to evaluate the design and development of DHIs used to support children up to 14 years of age and their parents, prepare for hospital procedures, and determine any correlation to health outcomes. It also considered whether any behavioural frameworks and co-production were utilised in their design. Methods A search of the MEDLINE, EMBASE, PsycINFO, and HMIC databases was carried out, looking for original, empirical research using digital paediatric preparation technologies to reduce pre-operative anxiety and behavioural changes. Limitations for the period (2000-2022), English language, and age applied. Results Seventeen studies were included, sixteen randomised control trials and one before and after evaluation study. The results suggest that paediatric preparation DHIs that score highly against the TDF are (1) associated with improved health outcomes, (2) incorporate the use of co-production and behavioural science in their design, (3) are interactive, and (4) are used at home in advance of the planned procedure. Conclusion Paediatric preparation DHIs that are co-produced and designed in the context of behavioural science are associated with reduced pre-operative anxiety and improved health outcomes and may be more cost-effective than other interventions. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022274182.
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Canbulat Şahiner N, Türkmen AS, Şahin D. Effect of using vacutainers with cartoon characters on the pain and fear levels of preschoolers during bloodletting. J Paediatr Child Health 2022; 58:1571-1577. [PMID: 35657084 DOI: 10.1111/jpc.16042] [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: 03/28/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Abstract
AIM Our study aims to analyse the effect of using a vacutainer with cartoon characters on preschoolers' pain and fear levels during the bloodletting process. METHODS The experimental, randomised controlled clinical trial was conducted with 102 children aged 3-6 years, randomised into control and experimental groups. The bloodletting routine was applied to the control group. The vacutainer of each child in the experimental group was covered with the illustration of their chosen cartoon character and blood was drawn with it. The fear and pain levels during the bloodletting procedure were examined in both groups. RESULTS Pain and fear levels were significantly lower in the experimental group than in the experimental group (P < 0.05). CONCLUSIONS Our research highlighted that using a cartoon character sticker with a vacutainer can reduce preschoolers' pain and fear during bloodletting.
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Affiliation(s)
- Nejla Canbulat Şahiner
- Faculty of Health Science, Pediatric Nursing Department, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Ayşe S Türkmen
- Faculty of Health Science, Pediatric Nursing Department, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Dilara Şahin
- Faculty of Health Science, Pediatric Nursing Department, Karamanoğlu Mehmetbey University, Karaman, Turkey
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Summers KM, Paganini GA, Lloyd EP. Poor Toddlers Feel Less Pain? Application of Class-Based Pain Stereotypes in Judgments of Children. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2022. [DOI: 10.1177/19485506221094087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Across four studies, we investigated whether perceptions of children’s pain are influenced by their socioeconomic status (SES). We found evidence that children with low SES were believed to feel less pain than children with high SES (Study 1), and this effect was not moderated by child’s age (Study 2). Next, we examined life hardship as a mediator of this effect among children, finding that children with low SES were rated as having lived a harder life and thus as feeling less pain (Study 3). Finally, we examined downstream consequences for hypothetical treatment recommendations. We found that participants perceived children with low SES as less sensitive to pain and therefore as requiring less pain treatment than children with high SES (Study 4). Thus, we consistently observe that stereotypes of low-SES individuals as insensitive to pain may manifest in judgments of children and their recommended pain care. Implications of this work for theory and medical practice are discussed.
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Sobol M, Sobol MK. Parents’ Time Perspective as a Predictor of Child’s Postsurgical Pain, Emergence Delirium, and Parents’ Posttraumatic Stress Disorder Symptoms after Child’s Surgery. CHILDREN 2022; 9:children9040539. [PMID: 35455583 PMCID: PMC9027689 DOI: 10.3390/children9040539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
Background: The aim of this study was to predict children’s postsurgical pain, emergence delirium and parents’ posttraumatic stress disorder symptoms after a child’s surgery based on the parents’ time perspective. Method: A total of 98 children, aged 2 to 15, and their accompanying parents participated in this study. Measures of parents’ time perspective and posttraumatic stress disorder symptoms were obtained based on questionnaires. The level of children’s postsurgical pain and delirium were rated by nurses and anaesthesiologist. Results: Parents’ future-negative perspective was a predictor of emergence delirium in the group of children aged 8–15 years. Low parents’ past-positive perspective turned out to be a predictor of parents’ posttraumatic stress disorder symptoms after child’s surgery. Conclusions: The results provide evidence for associations between parents’ time perspective with child’s emergence delirium and parents’ posttraumatic stress disorder symptoms after child’s surgery.
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Affiliation(s)
- Małgorzata Sobol
- Department of Psychology, University of Warsaw, ul. Stawki 5/7, 00-183 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-554-97-05
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Modanloo S, Barrowman N, Martelli B, Yoxon H, Wilding J, Dragic S, Vaillancourt R, Long D, Larocque C, Reszel J, Harrison D. Be Sweet to Hospitalized Toddlers During Venipuncture: A Randomized Controlled Trial of Sucrose Compared With Water. Clin J Pain 2021; 38:41-48. [PMID: 34699407 DOI: 10.1097/ajp.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High-quality evidence demonstrates analgesic effects of sweet-tasting solutions for infants during painful procedures. However, evidence of the analgesic effects of sucrose beyond 12 months of age is less certain. The aim of this study was to ascertain the efficacy of oral sucrose in hospitalized toddlers (ages 12 to 36 mo) compared with placebo (water) during venipuncture. MATERIALS AND METHODS Blinded, 2-armed randomized controlled trial including hospitalized toddlers aged 12 to 36 months. Toddlers were randomized to either 25% sucrose or water before venipuncture, stratified by age (12 to 24 mo and more than 24 to 36 mo). Standard of care included topical anesthetics for both groups. Pain assessment included cry duration and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Descriptive statistics and linear models were used to report the percentage of time crying and mean differences in FLACC scores. Data analysis was performed using R, version 3.6.3. RESULTS A total of 95 toddlers were randomized and 85 subsequently studied. The median percentage of time spent crying between insertion of the first needle and 30 seconds after the end of procedure in both groups was 81% (interquartile range=66%). There was no significant difference in crying time and FLACC scores between groups (P>0.05). When examining effects of sucrose for the younger toddlers (less than 24 mo of age) there was a reduction in crying time of 10% and a 1.2-point reduction in mean FLACC scores compared with the toddlers older than 24 months. DISCUSSION Findings highlight that toddlers become highly distressed during venipuncture, despite the standard care of topical anesthetics. In addition, sucrose does not effectively reduce distress especially in the older group of toddlers.
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Affiliation(s)
- Shokoufeh Modanloo
- University of Ottawa-School of Nursing, Faculty of Health Sciences
- Children's Hospital of Eastern Ontario (CHEO)
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario (CHEO) Research Institute
| | | | - Helen Yoxon
- Children's Hospital of Eastern Ontario (CHEO)
| | - Jodi Wilding
- Children's Hospital of Eastern Ontario (CHEO) Research Institute
| | | | | | - Deborah Long
- EORLA (Eastern Ontario Regional Laboratory Association), Children's Hospital of Eastern Ontario (CHEO) site, Ottawa, ON, Canada
| | | | - Jessica Reszel
- Children's Hospital of Eastern Ontario (CHEO) Research Institute
| | - Denise Harrison
- University of Ottawa-School of Nursing, Faculty of Health Sciences
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
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Rheel E, Malfliet A, Van Ryckeghem DML, Pas R, Vervoort T, Ickmans K. The Impact of Parental Presence on their Children during Painful Medical Procedures:A Systematic Review. PAIN MEDICINE 2021; 23:912-933. [PMID: 34453832 DOI: 10.1093/pm/pnab264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Whether parental presence during their children's painful medical procedures is advantageous with regard to child's pain-related outcomes is questionable. Research regarding this topic is equivocal and additional questions, such as whether levels of parental involvement may play a role as well, remain to be assessed. The purpose of this systematic review is to summarize and critically appraise the literature regarding the impact of parental presence versus absence during their children's painful medical procedures on the child's pain-related outcomes. METHODS The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2157 participants. Studies were considered eligible if they included children (≤ 18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure. RESULTS The children's pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence versus absence with regard to children's self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children's self-reported fears, anxiety and distress, and observed pain-related behaviors. CONCLUSIONS : In order to provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review.
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Affiliation(s)
- Emma Rheel
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium
| | - Anneleen Malfliet
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.,Section Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Institute for Health and Behavior, INSIDE, University of Luxembourg, Luxembourg City, Luxembourg
| | - Roselien Pas
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium
| | - Kelly Ickmans
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
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Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth 2021; 127:608-619. [PMID: 34340838 DOI: 10.1016/j.bja.2021.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes. METHODS We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0-18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using 'R' of children's procedural pain and anxiety and caregivers' anxiety. RESULTS Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=-0.43; 95% confidence interval [CI]: -0.67 to -0.20), anxiety (SMD=0.61; 95% CI: -0.88 to -0.34), and caregivers' procedural anxiety (SMD=-0.31; 95% CI: -0.58 to -0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. CONCLUSIONS Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety.
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Lepa T, Valentine M, Alshehry AO, Morgan EP, Sessa K, Fischetti B. Use of Lidocaine Cream for Pain Management During Immunizations of Infants at an Urban Health Clinic. J Pharm Pract 2021; 35:911-915. [PMID: 34018445 DOI: 10.1177/08971900211017862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immunizations are a common source of pain and anxiety within the pediatric population. Implementation of lidocaine 4% cream, which has a short onset of action, as a standard of care for immunization practices may be feasible. OBJECTIVE The objective of this study was to assess the efficacy of lidocaine 4% cream as pain management during immunizations and to evaluate satisfaction of caregivers and nursing staff. METHODS This study was a prospective, randomized, placebo-controlled trial in an urban clinic, which included patients who were ≤ 14 months old accompanied by a caregiver who witnessed the patient receiving an immunization within the previous 7 months. Patients were randomized to receive either lidocaine 4% cream or placebo cream prior to vaccination. Time to cry and duration of cry were recorded. Caregivers completed surveys evaluating attitudes toward pain associated with immunizations as well as their satisfaction with the immunization process through Likert Scale ratings. Nurses completed a questionnaire assessing efficacy and feasibility of lidocaine 4% cream for pain management. RESULTS A total of 44 patients were included in the analysis in order to achieve 80% power with a p-value < 0.05. Mean duration of cry in patients receiving lidocaine 4% cream was 48.6 seconds in comparison to 65.9 seconds in patients receiving placebo (95%CI, -33.97 seconds to -0.48 seconds; p < 0.05). CONCLUSIONS Lidocaine 4% cream decreased total duration of cry following vaccinations in comparison to placebo with both caregivers and nurses willing to utilize lidocaine 4% cream in a clinic setting if available.
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Affiliation(s)
- Trisha Lepa
- 25058New York City Health and Hospitals, Gouverneur Clinic, New York, NY, USA
| | - Menogh Valentine
- Department of Pediatrics, The 24508Brooklyn Hospital Center, Brooklyn, NY, USA
| | | | | | - Kelly Sessa
- 3368Atlantic Health System, Morristown Medical Center, Morristown, NJ, USA
| | - Briann Fischetti
- Arnold and Marie Schwartz College of Pharmacy, Brooklyn, NY, USA
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Effect of prophylactic administration of antipyretics on the immune response to pneumococcal conjugate vaccines in children: a systematic review. Pneumonia (Nathan) 2021; 13:7. [PMID: 33894782 PMCID: PMC8070291 DOI: 10.1186/s41479-021-00085-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/29/2021] [Indexed: 02/01/2023] Open
Abstract
Background Prophylactic administration of antipyretics at the time of immunization seems to decrease some side effects, however reduced immune responses have been reported in some studies. This systematic review aimed to investigate the effect of prophylactic use of antipyretics on the immune response following administration of pneumococcal conjugate vaccines (PCVs). Methods A systematic review of randomized controlled trials and observational studies concerning the immune response to PCVs after antipyretic administration was performed up to November 2020 in the electronic databases of Pubmed and Scopus. Results Of the 3956 citations retrieved, a total of 5 randomized control trials including 2775 children were included in the review. Included studies were referred to PCV10 (3 studies), PCV7 and PCV13 (one study each). The prophylactic administration of paracetamol decreased the immune response to certain pneumococcal serotypes in all included studies. The effect was more evident following primary vaccination and with immediate administration of paracetamol. Despite the reductions in antibody geometric mean concentrations, a robust memory response was observed following the booster dose. Besides, antibody titers remained above protective levels in 88–100% of participants. The use of ibuprofen, that was evaluated in two studies, did not seem to affect the immunogenicity of PCVs . Conclusion Although the reviewed studies had significant heterogeneity in design, paracetamol administration seems to affect the immune response for certain serotypes. The clinical significance of reduced immunogenicity especially before booster dose needs further investigation.
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Erdim L. The effect on pain and anxiety levels of using DistrACTION® Cards to distract children during a skin-prick test: a randomized controlled experimental study. Minerva Pediatr (Torino) 2021; 74:167-175. [PMID: 33820412 DOI: 10.23736/s2724-5276.21.06008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The effect of using Distraction® Cards to distract children aged 6-10 during a skin-prick test on their levels of pain and anxiety was explored in this study. METHODS The study was conducted as randomized, controlled, experimental research with a total of 104 children presenting at a hospital for a skin-prick test, 52 of whom comprised the experimental and 52 the control group. DistrACTION® Cards were employed in the experimental group of children to distract their attention during a skin prick test by observer nurse. The observer nurse asked each child to look at the pictures on the cards and answer her questions. The pictures on the cards portray various details. The children's pain and anxiety levels were independently assessed on the basis of the feedback provided by the children, the observer nurse and the parents. The children's pain levels were assessed with the Wong-Baker Pain Scale (W-BPS) and their anxiety levels with the Children's Fear Scale (CFS). No intervention was carried out for the children in the control group. RESULTS It was found that the children's pain scores during (D:0.57±1.14; C:3.15±3.07) and after the procedure (D:0.05±0.23; C:2.32±3.42) were significantly lower than those of the control group. It was seen that the anxiety scores of the experimental group during (D: 0.63±0.97; C:2.69±1.26) and after the procedure (D:0.11±0.37; C:1.82±1.53) were significantly lower than those of the control group. CONCLUSIONS It was observed that the use of DistrACTION® Cards during a skin prick test was effective in reducing children's pain and anxiety levels.
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Affiliation(s)
- Leyla Erdim
- Midwifery Department, Istanbul University-Cerrahpasa Faculty of Health Sciences, İstanbul, Turkey -
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Viggiano C, Occhinegro A, Siano MA, Mandato C, Adinolfi M, Nardacci A, Caiazzo AL, Viggiano D, Vajro P. Analgesic effects of breast- and formula feeding during routine childhood immunizations up to 1 year of age. Pediatr Res 2021; 89:1179-1184. [PMID: 32392576 DOI: 10.1038/s41390-020-0939-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/22/2020] [Accepted: 03/23/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Data on analgesic effects of breast/formula milk sucking while receiving routine childhood immunizations are available only in early infancy, have rarely been compared in the same study, and are not accompanied by information on mothers' satisfaction/acceptance. Here we aimed to compare the analgesic effect of both methods vs. held-only controls up to 1 year of age, and verify mothers' satisfaction. METHODS Two to 12 months children subjected to vaccine were allocated into three groups: breastfed, formula-fed, and held-only controls. A video recording was performed to analyze pain parameters: crying latency/duration and specific scales [FLACC (Face, Legs, Activity, Cry, and Consolability), NIPS (Neonatal Infant Pain Scale)]. After the procedure, mothers filled in a satisfaction questionnaire. RESULTS One-hundred and sixty-two children were recruited: 54 breastfed, 35 formula fed, and 73 controls. Breastfed showed the longest crying latency, and together with formula fed, had the shortest duration and lowest pain scores. Most mothers appreciated not only the respective feeding-mediated pain mitigation method used, but also the simply-holding procedure. In all cases, they felt reassured, with an unexpected frequent underestimation of their child's pain during the shot. CONCLUSIONS The analgesic effect of breastfeeding during vaccination extends also to children >6 months old, and is obtained by formula too. Embracing the child may help to reassure mothers. IMPACT We confirmed the analgesic effect of breastfeeding during the vaccination procedures in early infancy. We show for the first time that this effect is extended also to children up to 1 year of age, and it may be obtained by formula feeding as well. Most mothers appreciated pain mitigation not only through feeding, but also the simply-holding procedure. In all cases, mothers felt reassured, with an unexpected frequent underestimation of their child' pain during the shot. The promotion of these easily feasible and well-accepted strategies should be further encouraged within health professionals during vaccination procedures.
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Affiliation(s)
- Claudia Viggiano
- Pediatrics Section, Medical School, University of Salerno "Scuola Medica Salernitana", 84081, Baronissi, Salerno, Italy.,Residency Program in Pediatrics, University of Milan, 20122, Milan, Italy
| | - Annachiara Occhinegro
- Pediatrics Section, Medical School, University of Salerno "Scuola Medica Salernitana", 84081, Baronissi, Salerno, Italy
| | - Maria Anna Siano
- Pediatrics Section, Medical School, University of Salerno "Scuola Medica Salernitana", 84081, Baronissi, Salerno, Italy
| | - Claudia Mandato
- Department of Pediatrics, AORNSantobono-Pausilipon, 80129, Naples, Italy
| | | | | | | | | | - Pietro Vajro
- Pediatrics Section, Medical School, University of Salerno "Scuola Medica Salernitana", 84081, Baronissi, Salerno, Italy.
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BİLGİÇ Ş. THE COMPARISON OF THE EFFECTIVENESS OF LOCAL ICE AND MANUAL PRESSURE APPLICATIONS IN DECREASING PAIN RELATED TO INTRAMUSCULAR INJECTION. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.778676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Jenkins N, Orsini F, Elia S, Perrett K. Minimising Immunisation Pain of childhood vaccines: The MIP pilot study. J Paediatr Child Health 2021; 57:376-382. [PMID: 33099850 DOI: 10.1111/jpc.15229] [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: 04/02/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022]
Abstract
AIM Pain associated with immunisations can result in distress and/or anxiety for children and parents. We assessed the feasibility and acceptability of two novel devices; Coolsense (cold) and Buzzy (vibration ± cooling pads) versus standard care to minimise pain during immunisations. We also evaluated compliance to the devices and parent's perception of the effectiveness of the devices/standard care for minimising pain during immunisation. DESIGN Open label, pilot, randomised controlled trial (RCT). METHODS Forty children aged 3.5 to 6 years attending an Immunisation Centre at The Royal Children's Hospital in Melbourne, Australia, were randomised (1:1:1:1) into four groups: (i) Coolsense plus standard care; (ii) Buzzy with cold plus standard care; (iii) Buzzy without cold plus standard care; and (iv) Standard care alone (distraction with bubbles). RESULTS AND ANALYSIS Recruitment was completed in 12 days. Seventy percent were compliant with Buzzy (±cold), 82% with Coolsense, and 60% with standard care. Buzzy (with cold) was identified as effective by 70% of parents, Coolsense by 64%, Buzzy without cold by 50% and standard care by 60%. CONCLUSIONS This pilot study demonstrated feasibility. A larger RCT is needed to provide definitive evidence to inform best practice for minimising immunisation pain in young children.
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Affiliation(s)
- Narelle Jenkins
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Allergy, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Francesca Orsini
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sonja Elia
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Kirsten Perrett
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Allergy, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Dincer B, Yildirim D. The effect of vibration stimulation on intramuscular injection pain and patient satisfaction: Single-blind, randomised controlled study. J Clin Nurs 2021; 30:1615-1622. [PMID: 33590594 DOI: 10.1111/jocn.15715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/16/2020] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to assess the effect of vibration stimulation application in ventrogluteal region on intramuscular injection pain and patient satisfaction. BACKGROUND Intramuscular injection pain caused distress for the patients and affected their compliance with the treatment. DESIGN This was a prospective, single-blind, cross-over study. The study complied with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). METHODS Eighty-four patients who applied to the adult emergency department received an intramuscular injection of amoxicillin\ cefuroxime sodium to the ventrogluteal site with and without vibration in a random order following a standard procedure by the same investigator. Pain and satisfaction were assessed immediately after the injection with Visual Analogue Scale (VAS), by a researcher blinded to the study. The data were evaluated using mean, standard deviation, percentage, Student's t-test, paired sample t-test, linear regression analysis and generalised linear mixed model. RESULTS A total of 174 injections were analysed. The result of the study revealed that vibration decreased the severity of pain and increased the patient satisfaction. CONCLUSIONS Vibration is a non-pharmacologic approach, which can be effective in decreasing the injection pain and increasing patient satisfaction. RELEVANCE TO CLINICAL PRACTICE Intramuscular injection is the most frequently used nursing practice in the clinic. The use of vibration in decreasing pain due to intramuscular applications can help increase the self-confidence of nurses and the quality of the care they provide.
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Affiliation(s)
- Berna Dincer
- Department of Medical Nursing, Istanbul Medeniyet University Faculty of Health Sciences, Istanbul Medeniyet University, Health Science Faculty, Cevizli Yerleşkesi, Şehit Hakan Kurban Caddesi, Istanbul, Turkey
| | - Dilek Yildirim
- Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Küçükçekmece, Istanbul, Turkey
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Cherian V, Saini NK, Sharma AK, Philip J. Prevalence and predictors of vaccine hesitancy in an urbanized agglomeration of New Delhi, India. J Public Health (Oxf) 2021; 44:70-76. [DOI: 10.1093/pubmed/fdab007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/04/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The immunization program has been an important part of Indian public health policy for three decades; yet only 62% of children are being fully immunized. Vaccine hesitancy is a major contributor to the immunization gap that needs to be addressed.
Methods
A cross-sectional descriptive study of prevalence and predictors of vaccine hesitancy was conducted in 350 households having at least one child in the age group of 13–24 months. Statistical analysis was done using chi-square test and logistic regression.
Results
The prevalence of vaccine hesitancy was 28.9%. Fear of needles, concern about pain during vaccination, lack of family support, and apprehension regarding side effects were ascertained as reasons for vaccine hesitancy. The type of family, time taken to reach the health facility and antenatal care received by the mother were significant predictors of vaccine hesitancy.
Conclusion
The prevalence of vaccine hesitancy was found to be high. In 2019, the World Health Organization earmarked vaccine hesitancy as one of the major roadblocks to better global health. A better understanding of the subject can help public health agencies enhance vaccination coverage, not just in children but also as a tool to protect entire populations in this age of re-emerging epidemics.
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Affiliation(s)
- Vinu Cherian
- Department of Community Medicine, Sree Narayana Institute of Medical Sciences, Ernakulam, Kerala 683594, India
| | - Narinder Kumar Saini
- Department of Community Medicine, University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Arun Kumar Sharma
- Department of Community Medicine, University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Joel Philip
- Department of Psychiatry, Peejays Neurocenter, Kochi, Kerala 682019, India
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Hall LM, Ediriweera Y, Banks J, Nambiar A, Heal C. Cooling to reduce the pain associated with vaccination: A systematic review. Vaccine 2020; 38:8082-8089. [DOI: 10.1016/j.vaccine.2020.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 01/31/2023]
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Ellerton K, Tharmarajah H, Medres R, Brown L, Ringelblum D, Vogel K, Dolphin A, McKellar S, Bridson F, John-White M, Craig S. The VRIMM study: Virtual Reality for IMMunisation pain in young children-protocol for a randomised controlled trial. BMJ Open 2020; 10:e038354. [PMID: 32819997 PMCID: PMC7443262 DOI: 10.1136/bmjopen-2020-038354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Pain caused by routine immunisations is distressing to children, their parents and those administering injections. If poorly managed, it can lead to anxiety about future medical procedures, needle phobia and avoidance of future vaccinations and other medical treatment. Several strategies, such as distraction, are used to manage the distress associated with routine immunisations. Virtual reality (VR), a technology which transports users into an immersive 'virtual world', has been used to manage pain and distress in various settings such as burns dressing changes and dental treatments. In this study, we aim to compare the effectiveness of VR to standard care in a general practice setting as a distraction technique to reduce pain and distress in 4-year-old children receiving routine immunisations. METHODS AND ANALYSIS The study is a randomised controlled clinical trial comparing VR with standard care in 100 children receiving routine 4-year-old vaccination. Children attending a single general practice in metropolitan Melbourne, Australia will be allocated using blocked randomisation to either VR or standard care. Children in the intervention group will receive VR intervention prior to vaccination in addition to standard care; the control group will receive standard care. The primary outcome is the difference in the child's self-rated pain scores between the VR intervention and control groups measured using The Faces Pain Scale-Revised. Secondary outcomes include another measure of self-rated pain (the Poker Chip Tool), parent/guardian and healthcare provider ratings of pain (standard 100 mm visual analogue scales) and adverse effects. ETHICS AND DISSEMINATION Ethics approval has been obtained in Australia from the Royal Australian College of General Practitioners National Research and Evaluation Ethics Committee (NREEC 18-010). Recruitment commenced in July 2019. We plan to submit study findings for publication in a peer-reviewed journal and presentation at relevant conferences. TRIAL REGISTRATION NUMBER ACTRN12618001363279.
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Affiliation(s)
- Kirrily Ellerton
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
| | - Harishan Tharmarajah
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
- Monash University Department of General Practice, Notting Hill, Victoria, Australia
| | - Rimma Medres
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
- Monash University Health Service, Clayton, Victoria, Australia
| | - Lona Brown
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
| | - David Ringelblum
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
| | - Kateena Vogel
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
| | - Amanda Dolphin
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
| | - Sue McKellar
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
| | - Fiona Bridson
- Wellness on Wellington General Practice, Rowville, Victoria, Australia
| | - Marietta John-White
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Simon Craig
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
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Neshat H, Aslani K, Jamshidi M, Aslanabadi S, Ghorbani F. Comparison of the Effect of Massage and EMLA Cream on Children's Physiological Indices During Venipuncture: A Factorial Clinical Trial. J Perianesth Nurs 2020; 35:619-624. [PMID: 32782077 DOI: 10.1016/j.jopan.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to identify the effect of massage, EMLA cream, and the combination of these two methods on changes in physiological indices because of pain caused by intravenous line insertion in preschool children. DESIGN A four-group randomized nonblinded clinical trial with factorial design. METHODS In total, 140 eligible 3- to 6-year-old children entered the study in Tabriz Children's Hospital in 2017 and were randomly allocated to four groups (EMLA cream, massage, combination of the two, and control). Physiological responses were measured before and immediately after interventions in all groups. Data were collected and analyzed using SPSS version 19. FINDINGS Comparison of the physiological indices changes caused by pain between groups showed that changes in children's heart rate (HR) and respiratory rate (RR) in the EMLA group and in the combined-method group were statistically significant (P < .05). No significant differences were found in systolic blood pressure and oxygen saturation (SPo2) between the four groups. CONCLUSIONS Results indicated that EMLA cream was more effective than massage and a combination of EMLA and massage in reducing an increase in the HR and RR caused by pain in children. Massage alone was not effective in significantly lowering the children's increased physiological indices such as the HR and RR, and it seems the effectiveness of massage is more noticeable in conjunction with EMLA cream.
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Affiliation(s)
- Hanieh Neshat
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran; Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kafiyeh Aslani
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Pediatric Surgery Unit, Pediatric Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Massoud Jamshidi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Pediatric Surgery Unit, Pediatric Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Aslanabadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Pediatric Surgery Unit, Pediatric Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ghorbani
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran; Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Martin V, Copeland E, Fazilat R, Cronin J, Johnson C, Frosch DL. Revaccination management of a large cohort of pediatric patients following a potential lapse in cold storage. Vaccine 2020; 38:6638-6644. [PMID: 32788133 DOI: 10.1016/j.vaccine.2020.07.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In a pediatric clinic in California (US), 3823 patients were vaccinated with potentially-compromised vaccines following lapses in cold storage chain management between February 2014 and April 2015. A revaccination program was initiated in May 2015. Families were contacted by mail and encouraged to discuss follow-up options with their care team, namely: revaccination, serological testing and/or revaccination, or no further action. This study aimed: to understand which families were more likely to respond to the outreach, and to engage in any testing and/or revaccination; to determine whether or not vaccination with these potentially-compromised vaccines elicited sufficient immune response in pediatric patients; and to estimate the program cost. METHODS Patients who had received potentially-compromised vaccines were identified, and relevant data were extracted from their electronic health records. Logistic regression analyses were performed to identify factors associated with response to outreach, serological testing and/or revaccination. RESULTS 3823 patients between 0 and 21 years received an average of 3.1 potentially-compromised vaccines. 2547 revaccinations were performed (1515 patients) and 544 patients had serological testing results. Non-immune titer levels were only reported for 3-4% and 8% of the tested patients who had received potentially-compromised tetanus and hepatitis B vaccines, respectively, and only for children two years old and younger. Three years after the revaccination program started, 77% of all cases were considered resolved and 62.5% of patients (1970/3152) who were administered potentially-compromised vaccines were either revaccinated or had seroprotective titers. Response to outreach and decision to choose serological testing and/or revaccinate were affected by patient age, race/ethnicity and zip code median income (p < 0.05). CONCLUSION We observed race/ethnicity, patient age and income differences in response to the outreach and decision-making. For patients vaccinated with potentially-compromised vaccines, serological testing should be considered prior to revaccination. Revaccination may not be the most appropriate course of action for all patients.
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Affiliation(s)
- Veronique Martin
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA 94301, United States
| | - Elizabeth Copeland
- Palo Alto Foundation Medical Group, 325 Distel Drive, Los Altos, CA 94022, United States
| | - Rebecca Fazilat
- Palo Alto Foundation Medical Group, 325 Distel Drive, Los Altos, CA 94022, United States
| | - Julia Cronin
- Palo Alto Foundation Medical Group, 325 Distel Drive, Los Altos, CA 94022, United States
| | - Chantel Johnson
- Palo Alto Medical Foundation, 325 Distel Drive, Los Altos, CA 94022, United States
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA 94301, United States.
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Parent Factors are Associated With Pain and Activity Limitations in Youth With Acute Musculoskeletal Pain: A Cohort Study. Clin J Pain 2020; 35:222-228. [PMID: 30362984 DOI: 10.1097/ajp.0000000000000668] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Biopsychosocial models emphasize the influence of parent/family factors on pediatric chronic pain. Little is known about how parent factors differ across the acute to chronic pain continuum, or contribute to youths' pain experience in the acute pain period. The purpose of the study was to describe parent factors in youth with acute musculoskeletal pain (n=84) compared with youth with chronic pain (n=60) and youth without pain (n=61). Further, within the acute pain sample, we tested parent factors as predictors of child pain characteristics, as well as the moderating role of child sex on associations. METHODS Participants were 205 youth (age, 10 to 17) and one biological parent per child. Children reported on their own pain and activity limitations. Parents reported on their own chronic pain, somatization, and protective pain responses. RESULTS Parents of youth with acute pain had higher prevalence of chronic pain and greater somatization than parents of youth without pain. Parents of youth with acute and chronic pain did not differ. Linear regressions within the acute pain sample revealed presence of parent chronic pain and protective behavior were associated with child pain. Moreover, parent somatization was associated with child activity limitations. Within the acute pain sample, associations between parent protectiveness and child pain were moderated by child sex, with relationships stronger for female children. DISCUSSION Findings highlight the importance of parent factors on pain experiences of youth with acute musculoskeletal pain. Future longitudinal research can elucidate temporal associations that underlie how parent factors may impact transition from acute to chronic pain.
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Oneko M, Cherop YR, Sang T, Gutman JR, Wiegand R, Nyang'au EM, Odila AD, Akach D, Hamel MJ, Samuels AM, Kariuki S, Abebe Y, Nzuu EL, Wijayalath W, James ER, Sim BKL, Billingsley PF, Richie TL, Hoffman SL, Seder RA, Steinhardt LC. Feasibility of direct venous inoculation of the radiation-attenuated Plasmodium falciparum whole sporozoite vaccine in children and infants in Siaya, western Kenya. Vaccine 2020; 38:4592-4600. [PMID: 32444192 DOI: 10.1016/j.vaccine.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
PfSPZ Vaccine, composed of radiation-attenuated, aseptic, purified, cryopreserved Plasmodium falciparum sporozoites, is administered by direct venous inoculation (DVI) for maximal efficacy against malaria. A critical issue for advancing vaccines that are administered intravenously is the ability to efficiently administer them across multiple age groups. As part of a pediatric safety, immunogenicity, and efficacy trial in western Kenya, we evaluated the feasibility and tolerability of DVI, including ease of venous access, injection time, and crying during the procedure across age groups. Part 1 was an age de-escalation, dose escalation trial in children aged 13 months-5 years and infants aged 5-12 months; part 2 was a vaccine efficacy trial including only infants, using the most skilled injectors from part 1. Injectors could use a vein viewer, if needed. A total of 1222 injections (target 0.5 mL) were initiated by DVI in 511 participants (36 were 5-9-year-olds, 65 were 13-59-month-olds, and 410 infants). The complete volume was injected in 1185/1222 (97.0%) vaccinations, 1083/1185 (91.4%) achieved with the first DVI. 474/511 (92.8%) participants received only complete injections, 27/511 (5.3%) received at least one partial injection (<0.5 mL), and in 10/511 (2.0%) venous access was not obtained. The rate of complete injections by single DVI for infants improved from 77.1% in part 1 to 92.8% in part 2. No crying occurred in 51/59 (86.4%) vaccinations in 5-9-year-olds, 25/86 (29.1%) vaccinations in 13-59-month-olds and 172/1067 (16.1%) vaccinations in infants. Mean administration time ranged from 2.6 to 4.6 minutes and was longer for younger age groups. These data show that vaccination by DVI was feasible and well tolerated in infants and children in this rural hospital in western Kenya, when performed by skilled injectors. We also report that shipping and storage in liquid nitrogen vapor phase was simple and efficient. (Clinicaltrials.gov NCT02687373).
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Affiliation(s)
- M Oneko
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
| | - Y R Cherop
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - T Sang
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - J R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R Wiegand
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E M Nyang'au
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - A D Odila
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - D Akach
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - M J Hamel
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A M Samuels
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Y Abebe
- Sanaria Inc., Rockville, MD, USA
| | - E L Nzuu
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | | | | | | | | | | | | | - R A Seder
- National Institutes of Health, Bethesda, MD, USA
| | - L C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Moline RL, Constantin KL, Gauthier MN, Powell DM, McMurtry CM. SUPER scale to the rescue: reconciling what parents say and what they communicate during their child's pain. Pain Manag 2020; 10:179-194. [PMID: 32362183 DOI: 10.2217/pmt-2019-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Fully illuminating mechanisms relating parent behaviors to child pain require examining both verbal and nonverbal communication. We conducted a multimethod investigation into parent nonverbal communication and physiology, and investigated the psychometric properties of the Scheme for Understanding Parent Emotive Responses Scale to assess parent nonverbals accompanying reassurance and distraction. Materials & methods: 23 children (7-12 years of age) completed the cold pressor task with their parent (predominately mothers). Parent heart rate and heart rate variability were monitored and assessed. The Scheme for Understanding Parent Emotive Responses Scale coding of parent nonverbal behaviors (i.e., vocal cues, facial expressions, posture) was used to detect levels of fear, warmth, disengagement and humor. Results & conclusion: Preliminary evidence for the psychometric properties of the scale are offered. Parent reassurance was associated with more fear, less warmth and less humor compared with distraction.
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Affiliation(s)
- Rachel L Moline
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | | | - Megan N Gauthier
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Deborah M Powell
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.,Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, L8N 3Z5, Canada.,Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5C1, Canada
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Naber SK, Bruijning-Verhagen PCJL, de Hoog MLA, van Giessen A. Cost-effectiveness of inactivated influenza vaccination in children with medical risk conditions in the Netherlands. Vaccine 2020; 38:3387-3396. [PMID: 32115297 DOI: 10.1016/j.vaccine.2020.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In many countries, annual immunization with inactivated influenza vaccine (IIV) is recommended for children with medical risk conditions. Prior cost-effectiveness analyses found such immunization to be cost saving, but assumed effectiveness against non-severe influenza outcomes and a higher effectiveness against severe influenza outcomes than recent studies would suggest. However, recent vaccine studies do not indicate any reduction in community or outpatient disease episodes in IIV immunized individuals. We therefore evaluated cost-effectiveness of IIV immunization in children with medical risk conditions in the Netherlands, assuming that IIV reduces influenza-related hospitalization and death, but has no meaningful impact on non-severe health outcomes. METHODS A health economic decision tree model was developed to evaluate health effects and costs of annual IIV immunization versus no immunization. Model inputs were based on our study on influenza-related primary care visits and other literature. Immunization was considered cost effective if associated costs were less than €20,000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses were performed to assess robustness of results, and one-way sensitivity analyses and scenario analyses were done to assess the influence of individual parameters. RESULTS Annual IIV prevents an average of 1.59 influenza-related hospitalizations and 0.02 deaths per 1,000 children with medical risk conditions. This results in an expected QALY gain of 0.43 at incremental costs of €21,564 per 1,000 children, corresponding to an incremental cost-effectiveness ratio (ICER) of €50,297/QALY compared to no immunization. Under base case assumptions, immunization had a 5% probability of being cost effective. Results were most influenced by vaccine efficacy against fatal influenza, QALY loss due to death, and mortality rate. CONCLUSIONS If IIV only reduces severe disease outcomes, as current evidence suggests, annual immunization of medical risk children is unlikely to be cost effective. Results should however be interpreted with caution as cost-effectiveness is largely dependent on incidence and QALY losses for fatal influenza, for which evidence is scarce.
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Affiliation(s)
- Steffie K Naber
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Marieke L A de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anoukh van Giessen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Erdoğan Ç, Turan T, Pınar B. The effect of maternal voice for procedural pain in paediatric intensive care unit: A randomised controlled trial. Intensive Crit Care Nurs 2020; 56:102767. [PMID: 31735564 DOI: 10.1016/j.iccn.2019.102767] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/24/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of the maternal voice in reducing pain during painful procedures in children between one and three years old receiving treatment in paediatric intensive care unit. DESIGN AND METHODS This research was designed as a randomised controlled experimental study. Sixty children were randomised into two groups, the maternal-voice group and the controls. The children in the maternal-voice group listened to the maternal voice during the procedure. Although questionnaire forms were used to determine the descriptive characteristics of infants, the Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment scale was used to evaluate pain level. Heart rate and oxygen saturation were also measured. RESULTS There were significant differences in the pain, heart rate and oxygen saturation levels between the maternal-voice and control groups. Pain levels and heart rates of the children in the experimental group during and after the painful procedures were much lower, and their oxygen saturations were higher than those of the children in the control group. PRACTIC IMPLICATIONS Distraction methods, such as listening to the maternal voice, should be used as a nursing intervention to reduce pain and decrease heart rate and increaseoxygen saturation in children during painful procedures in the paediatric intensive care unit. The maternal voice is recommended as a helpful option in cases when a pain control method is required. Future research needs to explore different interventional practices.
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Affiliation(s)
- Çiğdem Erdoğan
- Faculty of Health Science, Pediatric Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Türkan Turan
- Faculty of Health Science, Pediatric Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Bakiye Pınar
- Pamukkale University Hospital, Pediatric Intensive Care Unit, Pamukkale University, Denizli, Turkey
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Kassab M, Almomani B, Nuseir K, Alhouary AA. Efficacy of Sucrose in Reducing Pain during Immunization among 10- to 18-Month-Old Infants and Young Children: A Randomized Controlled Trial. J Pediatr Nurs 2020; 50:e55-e61. [PMID: 31870702 DOI: 10.1016/j.pedn.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Sucrose is recommended to reduce pain associated with vaccination in neonates. However, research results concerning its effectiveness in infants and young children are inconclusive. This study aims to determine the efficacy of sucrose administration in reducing pain during immunization in 10- to 18-month-old infants and young children as assessed by behavioral pain parameters, crying time, and saliva substance (P) concentration. DESIGN AND METHODS This was a double-blind, randomized controlled trial and included healthy infants and young children undergoing their 10- to 18-month immunization. Behavioral pain outcome was measured during, and shortly after the last injection. The infant's pain was also measured by a salivary test using substance (P), and videotaping of crying time. RESULTS The study results indicate that, compared with a placebo group, the sucrose group had significantly less pain post-immunization (F (1,129) = 1.72, p = 0.001). Moreover, substance (P) was lower in the intervention group post-immunization, and it could be considered a good predictor of pain reduction associated with immunization. CONCLUSIONS Sucrose administration during immunization injection helps in reducing pain, which is one of the most critical factors affecting compliance with the immunization schedule. Substance (P) measurement can be used as a predictor of immunization pain level in 10- to 18-month-old infants and young children. PRACTICE IMPLICATIONS Sucrose is an effective method to reduce needle pain during immunization; therefore, healthcare providers should administer sucrose as a pain relief intervention in the immunization clinical setting.
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Affiliation(s)
- Manal Kassab
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan; University of Technology, Sydney (UTS), Sydney, Australia.
| | - Basima Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Science and Technology, Irbid, Jordan.
| | - Khawla Nuseir
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Science and Technology, Irbid, Jordan.
| | - Ala A Alhouary
- Department of Anesthesia, King Abdullah University Hospital (KAUH), Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan.
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Naber SK, Bruijning-Verhagen PC, de Hoog ML, van Giessen A. WITHDRAWN: Cost-effectiveness of inactivated influenza vaccination in children with medical risk conditions in the Netherlands. Vaccine X 2019. [DOI: 10.1016/j.jvacx.2019.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Yilmaz Kurt F, Aytekin Ozdemir A, Atay S. The Effects of Two Methods on Venipuncture Pain in Children: Procedural Restraint and Cognitive-Behavioral Intervention Package. Pain Manag Nurs 2019; 21:594-600. [PMID: 31628067 DOI: 10.1016/j.pmn.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/27/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Invasive interventions can produce fear, anxiety, and pain in children. This may negatively affect the children's treatment and care. AIM This study was conducted to determine the effects of procedural restraint (PR) and cognitive-behavioral intervention package (CBIP) on venipuncture pain in children between 6-12 years of age. DESIGN Quasi-experimental study. SETTINGS The study was conducted in the pediatric blood collection service of the hospital in Turkey between October 1, 2015, and April 1, 2016. PARTICIPANTS/SUBJECTS The population of the study consisted of children admitted to the blood collection service during the study period who met the inclusion criteria. METHODS The children included in the study were divided into two groups. Group 1 (n = 31) received PR in accordance with routine clinical practice. Group 2 (n = 30) received the CBIP. The data were collected by the researchers using a questionnaire, the visual analog scale (VAS), and the Wong-Baker FACES (WB-FACES) Pain Rating Scale. RESULTS The children in the PR group had a mean VAS score of 5.90 ± 3.22 and a mean WB-FACES score of 8.70 ± 2.22. The children in the CBIP group had a mean VAS score of 2.43 ± 2.02 and a mean WB-FACES score of 2.80 ± 2.49. A statistically significant difference was found between the mean VAS and WB-FACES pain scores of the groups (p < .05). CONCLUSIONS The results of this study showed that the children in the CBIP group had a lower pain level during venipuncture compared to those restrained for the procedure.
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Affiliation(s)
- Fatma Yilmaz Kurt
- Department of Child Health Nursing, School of Health, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Aynur Aytekin Ozdemir
- Department of Nursing, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Selma Atay
- Department of Fundamentals of Nursing, School of Health, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Karlsson K, Galvin K, Darcy L. Medical procedures in children using a conceptual framework that keeps a focus on human dimensions of care - a discussion paper. Int J Qual Stud Health Well-being 2019; 14:1675354. [PMID: 31621530 PMCID: PMC6807864 DOI: 10.1080/17482631.2019.1675354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose: Children’s perspectives in the context of health service delivery have historically been seen as unimportant. They have been viewed as unintelligent, unable to effectively share or tell of their experiences or fully participate in their care, potentially resulting in a sense of dehumanisation. Method: The present paper illustrates children’s experiences when undergoing medical procedures, using application of the eight dimensions of humanised care theoretical framework. Results: Findings from six published papers were reflectively interrogated to identify implicit findings related to the dimensions of humanised care. These implicit findings show ways of caring for childrenwhichcan lead to enhanced human sensitivity in care or conversely where the dimensions of being human are obscured to greater or lesser degrees and can result in forms of dehumanisation. Conclusions: Inadvertent dehumanising features of practice can be mediated by encouraging the inclusion of children’s own lifeworld perspective and make room for their voices in both care and research. In this way the present well documented power imbalance could be addressed. Adding the value of the theoretical framework highlights areas of need for young children to be cared for as human beings.
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Affiliation(s)
- Katarina Karlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Boras , Boras , Sweden
| | - Kathleen Galvin
- Faculty of Caring Science, Work Life and Social Welfare, University of Boras , Boras , Sweden.,School of Health Science, University of Brighton , Brighton , UK
| | - Laura Darcy
- Faculty of Caring Science, Work Life and Social Welfare, University of Boras , Boras , Sweden
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Şanlialp Zeyrek A, Takmak Ş, Kurban NK, Arslan S. Systematic review and meta‐analysis: Physical‐procedural interventions used to reduce pain during intramuscular injections in adults. J Adv Nurs 2019; 75:3346-3361. [DOI: 10.1111/jan.14183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Şenay Takmak
- Institute of Health Sciences Pamukkale University Denizli Turkey
| | - Nevin Kuzu Kurban
- Faculty of Health Sciences Nursing Department Pamukkale University Denizli Turkey
| | - Sümeyye Arslan
- Faculty of Health Sciences Nursing Department Pamukkale University Denizli Turkey
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43
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Using Buzzy, Shotblocker, and Bubble Blowing in a Pediatric Emergency Department to Reduce the Pain and Fear Caused by Intramuscular Injection: A Randomized Controlled Trial. J Emerg Nurs 2019; 45:502-511. [DOI: 10.1016/j.jen.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022]
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44
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Nakajima Y, Fujii T, Mukai K, Ishida A, Kato M, Takahashi M, Tsuda M, Hashiba N, Mori N, Yamanaka A, Ozaki N, Nakatani T. Anatomically safe sites for intramuscular injections: a cross-sectional study on young adults and cadavers with a focus on the thigh. Hum Vaccin Immunother 2019; 16:189-196. [PMID: 31403356 PMCID: PMC7012163 DOI: 10.1080/21645515.2019.1646576] [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: 12/18/2022] Open
Abstract
The anatomical safety of intramuscular injections at the deltoid and ventrogluteal sites has been investigated; however, the anatomical relationship between intramuscular injection sites in the thigh and major blood vessels and nerves remains unclear. We aimed to compare intramuscular injection sites in the rectus femoris and vastus lateralis with those at the deltoid and ventrogluteal sites and identify safe intramuscular injection sites in the thigh. Twenty-seven young adult volunteers were recruited, and the thicknesses of subcutaneous tissue and muscle as well as the number of blood vessels present were evaluated at two sites on the deltoid, ventrogluteal, and thigh using ultrasound equipment. The right thighs of 24 cadavers were used, and the thickness of muscle, number of blood vessels or nerves present, and the distance between each examined site and major blood vessels or nerves were evaluated in the rectus femoris and vastus lateralis. A major blood vessel was observed in the middle of the rectus femoris in young adults. In cadavers, the descending branch of the lateral circumflex femoral artery and muscle branch of the femoral nerves to the vastus lateralis were observed at the middle point, distal two-thirds point, and middle point between the middle and distal two-thirds points of the rectus femoris, but not at the middle of the vastus lateralis. The middle of the vastus lateralis is an appropriate site for intramuscular injections because of the low risk of vascular or nerve damage. The present results support good practices for site selection for intramuscular injections.
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Affiliation(s)
- Yukari Nakajima
- Division of Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Taiga Fujii
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
| | - Kanae Mukai
- Division of Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Asami Ishida
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Moeka Kato
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mao Takahashi
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mihiro Tsuda
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Nanami Hashiba
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Namiko Mori
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Ayaka Yamanaka
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Noriyuki Ozaki
- Department of Functional Anatomy, Graduate school of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Toshio Nakatani
- Division of Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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O'Neill MC, Ahola Kohut S, Pillai Riddell R, Oster H. Age‐related differences in the acute pain facial expression during infancy. Eur J Pain 2019; 23:1596-1607. [DOI: 10.1002/ejp.1436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 05/18/2019] [Accepted: 05/27/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Sara Ahola Kohut
- York University Toronto Ontario Canada
- Hospital for Sick Children Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
| | - Rebecca Pillai Riddell
- York University Toronto Ontario Canada
- Hospital for Sick Children Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
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46
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Ueki S, Yamagami Y, Makimoto K. Effectiveness of vibratory stimulation on needle-related procedural pain in children. ACTA ACUST UNITED AC 2019; 17:1428-1463. [DOI: 10.11124/jbisrir-2017-003890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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47
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Cwynar CM, Osborne K. Immunization-Associated Pain: Taking Research to the Bedside. J Pediatr Health Care 2019; 33:446-454. [PMID: 31036444 DOI: 10.1016/j.pedhc.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/26/2018] [Accepted: 12/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immunization-associated pain is the number one cause of pain in pediatric settings. Untreated pain has many short- and long-term detrimental effects. The purpose of this project was to implement a nonpharmaceutical immunization-associated-pain prevention program. METHOD This project was implemented at a pediatric primary care clinic. Staff were educated about immunization-associated pain and techniques for decreasing/preventing pain. Families were educated about pain control, and the practitioner and parent/child picked interventions to decrease pain. Preimplementation and postimplementation data were collected using previously validated pain and satisfaction scales. RESULTS Pain prevention interventions decreased pain for children between 2 months and 7 years of age by 4.7 points on a Faces, Legs, Activity, Cry, Consolability (i.e., FLACC) scale. For children 7 years and older, pain during immunization decreased on average by 1.76 points on the visual analog scale. CONCLUSION Non-pharmaceutical interventions are effective in decreasing immunization-associated pain.
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Canbulat Şahiner N, Türkmen AS. The Effect of Distraction Cards on Reducing Pain and Anxiety During Intramuscular Injection in Children. Worldviews Evid Based Nurs 2019; 16:230-235. [DOI: 10.1111/wvn.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Nejla Canbulat Şahiner
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
| | - Ayşe Sonay Türkmen
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
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49
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Pavlova M, Graham SA, Jordan A, Chorney J, Vinall J, Rasic N, Brookes J, Hoy M, Yunker WK, Noel M. Socialization of Pain Memories: Parent-Child Reminiscing About Past Painful and Sad Events. J Pediatr Psychol 2019; 44:679-691. [DOI: 10.1093/jpepsy/jsz009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/20/2019] [Accepted: 01/30/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - Susan A Graham
- Department of Psychology, University of Calgary
- Owerko Centre
| | | | - Jill Chorney
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University
| | | | - Nivez Rasic
- Department of Anesthesia, University of Calgary
| | | | - Monica Hoy
- Department of Surgery, University of Calgary
| | | | - Melanie Noel
- Department of Psychology, University of Calgary
- Alberta Children’s Hospital Research Institute
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50
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News of the Academy of Neonatal Nursing. Neonatal Netw 2019; 37:126-132. [PMID: 29615161 DOI: 10.1891/0730-0832.37.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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