Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial

Clinical Considerations for an Evidence-Based Assessment of Anxiety Disorders in Children and Adolescents

This article provides an overview of evidence-based assessment (EBA) of anxiety disorders in children and adolescents. First, this article provides an overview of using clinician-rated scales in the diagnostic process. Second, this article reviews the clinical utility of clinician-rated measures, and parent-report and youth-report measures to characterize anxiety severity and monitor treatment response in clinical practice. Additionally, rating scales that capture clinical constructs that are relevant in anxiety disorders-such as accommodation and avoidance behaviors-are succinctly reviewed. Finally, the article concludes with recommendations for conducting an EBA for anxiety disorders in children and adolescents.

Clinical Considerations for an Evidence-Based Assessment of Anxiety Disorders in Adults

Evidence-based assessment (EBA) is critical for successful diagnosis and treatment of adult anxiety disorders. First, diagnostic interviews are reviewed with emphasis on how these tools can be used inform clinical diagnoses. Second, clinician-rated measures and self-report scales used to characterize anxiety symptom severity in adults are discussed. Third, to further inform clinical care, rating scales that illustrate clinical profiles contributing to symptom maintenance and severity-namely accommodation and avoidance behaviors-are discussed. Lastly, a summary of recommendations for using EBA for the diagnosis and treatment of anxiety disorders in adults is shared.

Different Uses of Conscious Sedation for Managing Dental Anxiety During Third-Molar Extraction: Clinical Evidence and State of the Art

Dental anxiety, linked to avoiding dental treatment and heightened medical and surgical risks, prompted this systematic review. The objective is to synthesize existing evidence on conscious sedation techniques employed for managing dental anxiety in patients scheduled for third molar extraction surgery, aiming to identify optimal approaches and address knowledge gaps. This systematic review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" checklist and the population, investigation, comparation, outcome framework. The protocol still needs to be registered. A thorough search was conducted, incorporating MEDLINE/PubMed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews until February 2024. Only randomized controlled trials were considered, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The risk of bias was evaluated following the Cochrane Handbook for Systematic Reviews of Interventions. Eighteen randomized controlled trials involving 2081 patients were included. Certain factors limited the feasibility of a meaningful meta-analysis, leading to a narrative synthesis. Conscious sedation with virtual reality showed an association with improved dental anxiety in 4 studies. One study reported reduced cortisol levels with midazolam compared with a placebo, whereas another noted significant variations in perioperative renin levels with remifentanil versus placebo. This review reveals inconclusive and conflicting findings regarding the role of conscious sedation in managing dental anxiety during third molar extraction surgery. Persistent uncertainties arise due to a need for consistent, standardized outcome measures. Addressing these limitations in study design is crucial for future research.

Child life specialist services, practice, and utilization across health care: a scoping review

OBJECTIVE

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization.

INTRODUCTION

The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked.

INCLUSION CRITERIA

All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included.

METHODS

This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022.

RESULTS

Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade, with more than 50% of studies published in the past 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 9 countries, plus 1 publication that surveyed people across Europe. The contexts spanned a wide scope of clinical settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings.

CONCLUSION

Mapping the research can help delineate the barriers and facilitators to child life specialist services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings, with recent increases in research publications involving child life specialist services.

Virtual Reality Distraction for Needle-Related Pain and Distress in Children: A Multicenter Randomized Controlled Trial

This international multicenter randomized controlled trial aimed to compare the effectiveness of virtual reality (VR) distraction with an identical non-VR game in reducing needle-related pain and anxiety in children undergoing venous blood draw. The study involved 304 children aged 5-9 years undergoing a blood draw procedure, randomly allocated to one of three groups: VR distraction, non-VR distraction, and control group (usual care). The distraction task was based on the Multiple Object Tracking (MOT) paradigm, and the game was identical in design and gameplay for both VR and non-VR distraction groups. The primary outcome was self-reported pain intensity using the Faces Pain Scale-Revised (FPS-R). Secondary outcomes included child distress, attention/distraction to the blood draw, and parent and medical staff satisfaction with procedure. Analyses were conducted using analysis of variance and multivariable linear regression models. The results showed that VR distraction and non-VR distraction performed similarly, showing large effect sizes compared with standard care. There was no significant difference between the two types of distraction. The study's findings suggest that VR and non-VR distraction are similarly effective in reducing needle-related pain and anxiety in children undergoing venous blood draw. This is the first well-powered study comparing modern VR distraction with an identical task displayed on a smartphone or monitor screen. The study's results have important implications for using VR in clinical settings and suggest that investing in expensive VR equipment for acute pain management may not be necessary. The study protocol was pre-registered on Open Science Framework at https://osf.io/frsyc.

Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature

BACKGROUND

It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments.

METHODS

The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations.

RESULTS

Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered.

CONCLUSIONS

this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.

Effects of robot-assisted digital storytelling on hospitalized children's communication during the COVID-19 pandemic

This study proposed a robot-assisted digital storytelling approach to reduce hospitalized children's anxiety about intravenous injections and to improve their therapeutic communication and therapeutic engagement. In order to verify the effectiveness of the robot-assisted digital storytelling approach, a randomized controlled study was implemented. A total of 47 children from a regional hospital were randomly assigned to an experimental group (n = 21) and a control group (n = 26). The experimental group adopted the robot-assisted digital storytelling approach in health education for intravenous injections, while the control group received video-based health education. The study results indicated that the proposed robot-assisted digital storytelling approach not only reduced the children's anxiety, but also had positive effects on children's communication about intravenous injections, emotions during hospitalization, and therapeutic engagement. As a consequence, it is suggested that educators and researchers consider adopting robot-assisted digital storytelling to facilitate nursing clinical health education for children.

Effectiveness of virtual reality intervention on reducing the pain, anxiety and fear of needle-related procedures in paediatric patients: A systematic review and meta-analysis

AIMS

To evaluate the effectiveness of virtual reality (VR) intervention in the management of pain, anxiety and fear in paediatric patients undergoing needle-related procedures.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES

A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI, and Wanfang databases was conducted to identify research articles in English or Chinese on RCTs up to February 28, 2022.

REVIEW METHODS

Two researchers independently screened eligible articles. The Cochrane Handbook for Systematic Reviews was used to assess the risk of bias in the included studies. A fixed- or random-effects meta-analysis model was used to determine the pooled mean difference based on the results of the heterogeneity test.

RESULTS

A total of 2269 articles were initially screened. The meta-analysis included data from 27 studies representing 2224 participants. Compared with the non-VR group, the VR intervention group significantly reduced pain, anxiety, and fear in paediatric patients who underwent puncture-related procedures. Subgroup analysis showed that VR has advantages over conventional and other distraction methods.

CONCLUSION

Paediatric patients undergoing needle-related procedures would benefit from VR interventions for pain, anxiety and fear management.

IMPACT

VR intervention has the potential to reduce pain, anxiety and fear in paediatric patients undergoing puncture-related procedures. Future clinical interventions could incorporate VR into puncture procedures as an effective method to reduce negative emotions in children eligible for VR distractions.

PATIENT OR PUBLIC CONTRIBUTION

Our paper is a systematic review and meta-analysis and such details don't apply to our work.