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Princip M, Ledermann K, Altwegg R, von Känel R. Cardiac disease-induced trauma and stress-related disorders. Herz 2024; 49:254-260. [PMID: 38990256 PMCID: PMC11286693 DOI: 10.1007/s00059-024-05255-0] [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] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE This review aims to present an updated overview of cardiac disease-induced trauma and stress-related disorders such as acute stress disorder (ASD), adjustment disorder (AjD), and posttraumatic stress disorder (PTSD). First, the prevalence of these disorders, their diagnostic criteria, and their differences from other trauma-related disorders are described. Special challenges in diagnosis and treatment are identified, with various screening tools being evaluated for symptom assessment. Additionally, the risk factors studied so far for the development of symptoms of cardiac-induced posttraumatic stress disorder and the bidirectional relationship between posttraumatic stress disorder and cardiovascular diseases are summarized. Various therapeutic interventions, including pharmacological approaches, are also discussed. Finally, various areas for future research are outlined. BACKGROUND Experiencing a cardiovascular disease, particularly a life-threatening cardiac event, can potentially lead to stress-related disorders such as ASD, AjD, and cardiac disease-induced PTSD (CDI-PTSD). If left untreated, these disorders are associated with a worsening cardiac prognosis and higher mortality rates. Approaching treatment through a trauma-focused lens may be beneficial for managing CDI-PTSD and stress-related disorders. CONCLUSION Future research should explore treatment options for both the patients and the caregivers as well as investigate the long-term effects of trauma-focused interventions on physical and mental health outcomes.
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MESH Headings
- Humans
- Stress Disorders, Post-Traumatic/therapy
- Stress Disorders, Post-Traumatic/etiology
- Stress Disorders, Post-Traumatic/diagnosis
- Heart Diseases/etiology
- Heart Diseases/therapy
- Risk Factors
- Adjustment Disorders/diagnosis
- Adjustment Disorders/therapy
- Adjustment Disorders/etiology
- Adjustment Disorders/psychology
- Prevalence
- Comorbidity
- Stress Disorders, Traumatic, Acute/therapy
- Stress Disorders, Traumatic, Acute/diagnosis
- Stress Disorders, Traumatic, Acute/etiology
- Stress Disorders, Traumatic, Acute/psychology
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Rahel Altwegg
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
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Iio M, Nagata M, Narita M. Factors associated with positive mental health in Japanese young adults with a history of chronic diseases during childhood: A qualitative study. J Pediatr Nurs 2024; 76:e9-e18. [PMID: 38281893 DOI: 10.1016/j.pedn.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Factors associated with positive mental health in children with chronic diseases remain unclear. Supporting the development of positive mental health in children with chronic diseases can enhance their mental health throughout childhood and adulthood. This study aimed to identify the factors associated with positive mental health among Japanese young adults with a history of chronic pediatric diseases. DESIGN AND METHODS Participants aged 18-25 years, with a history of chronic pediatric diseases, were recruited from a population of students at a university. Semi-structured interviews were conducted. The data were analyzed using thematic analysis. After the initial coding of each transcript, the researchers discussed and identified a set of main themes, categories, and subcategories. RESULTS Ten participants aged 19-22 years were interviewed. Their chronic diseases were diverse and included childhood cancers and allergic diseases. Seven themes (proactive coping, positive coping, negative coping, eudaimonia, hedonia, independence, and awareness) emerged from 21 categories and 70 subcategories identified. A thematic map was applied to two domains (protective factors and well-being factors) and to three inter-related constructs (individual, family, and community/society). CONCLUSIONS The findings indicated that within the well-being factors, meaning in life was prominent, and within the protective factors, stress coping was found to facilitate positive mental health among individuals with a history of chronic pediatric diseases. PRACTICE IMPLICATIONS In children with chronic diseases, support for finding appropriate coping strategies that enhance their optimism and symbiotic relationships in the community/society are important, including valuing little things in their lives, such as play and learning.
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Affiliation(s)
- Misa Iio
- Department of Nursing, College of Nursing, Kanto-Gakuin University, Yokohama, Kanagawa Prefecture, Japan.
| | - Mayumi Nagata
- Department of Nursing, College of Nursing, Kanto-Gakuin University, Yokohama, Kanagawa Prefecture, Japan
| | - Masami Narita
- Department of Pediatrics, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Peterson JK, Gentry-Russell N, Francis L. School Readiness Among Children With Congenital Heart Disease. THE JOURNAL OF SCHOOL HEALTH 2024; 94:279-281. [PMID: 37345223 DOI: 10.1111/josh.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Affiliation(s)
| | | | - Lucine Francis
- Johns Hopkins University School of Nursing, Baltimore, MD
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Cuneo AA, Sifflet C, Bardach N, Ly N, von Scheven E, Perito ER. Pediatric Medical Traumatic Stress and Trauma-Informed Care in Pediatric Chronic Illness: A Healthcare Provider Survey. J Pediatr 2023; 261:113580. [PMID: 37353148 DOI: 10.1016/j.jpeds.2023.113580] [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: 11/03/2022] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To inform approaches to pediatric medical traumatic stress (PMTS) by exploring providers' (1) perception of the impact of PMTS on the medical care of patients with pediatric-onset chronic illnesses, (2) self-reported competencies and practices of PMTS prevention, treatment, and counseling, and (3) perception of the barriers influencing the adoption of these practices. STUDY DESIGN A convenience sample of multidisciplinary healthcare providers was recruited through a multimodal recruitment strategy to participate in an electronic survey adapted from the Trauma-Informed Care Provider Survey. RESULTS Among participants (n = 304), 99% agreed that PMTS impacts patient health. Participants report altering medical care plans due to PMTS, including deferring or stopping treatments (n = 98 [32%]) and changing medication regimens (n = 88 [29%]). Sixty-eight percent (n = 208) report negative impact of PMTS on patient implementation of medical care plans, including medication nonadherence (n = 153 [50%]) and missed appointments (n = 119 [39%]). Although participants agreed it is their job to decrease patient stress (n = 292 [96%]) and perform PMTS assessments (n = 268 [88%]), few practiced PMTS-focused trauma informed care. Systems-level barriers to practice included insufficient training, absent clinical workflows, and lack of access to mental health experts. CONCLUSIONS Our findings have helped inform a conceptual framework for understanding the relationship between PMTS and health outcomes. Systems-level opportunities to optimize PMTS-focused trauma-informed care include (1) dissemination of provider training, (2) integrated workflows for PMTS mitigation, and (3) enhanced accessibility to mental health providers. Further work is required to determine if these interventions can improve health outcomes in patients with pediatric-onset chronic illnesses.
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Affiliation(s)
- Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, CA.
| | - Christopher Sifflet
- School of Public Health, University of California, Berkeley, Berkeley, CA; School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Naomi Bardach
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ngoc Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Emily von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
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Freiberger A, Richter C, Huber M, Beckmann J, Freilinger S, Kaemmerer H, Ewert P, Kohls N, Henningsen P, Allwang C, Andonian-Dierks C. Post-Traumatic Distress in Adults With Congenital Heart Disease: an Under-Recognized Complication? Am J Cardiol 2023; 203:9-16. [PMID: 37478638 DOI: 10.1016/j.amjcard.2023.06.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
The stressful and potentially traumatic perception of repeated hospitalization, outpatient check-ups, and medical interventions places a high stress burden on patients with congenital heart disease (CHD). These experiences can lead to post-traumatic stress symptoms (PTSSs). This study aimed to estimate the prevalence of PTSSs in adults with CHD (ACHDs) and to identify the associated risk factors. In this cross-sectional study, 234 ACHDs were recruited from November 2021 to August 2022 at a dedicated tertiary care center. Data were collected on general health, anxiety and depression, PTSSs, and on quality of life using validated and standardized questionnaires. In addition, the reasons for PTSSs were assessed using free-text responses. Overall, 17.1% to 20.5% (mean age: 35.2 ± 10.8 [18 to 66] years, 46.6% women) of the enrolled patients met the criteria for clinically relevant PTSSs related to their CHD or treatment. The associated risk factors (p <0.05) included preexisting mental distress (odds ratio [OR] 4.86), depression (OR 5.565) and anxiety (OR 3.36,), level of perceived mental distress during the traumatic event (OR 1.46), and number of medical procedures (OR 1.17). In addition, a worse clinical state was associated with more PTSSs (p = 0.018). Using free-text responses, the various reasons for PTSSs were identified, ranging from cardiac procedures to social stigma. In conclusion, the high prevalence of PTSSs calls for increased awareness of PTSSs in ACHDs in cardiovascular care. PTSSs and their associated disorder can adversely affect the manifestation and progression of cardiac disease. Thus, it is necessary to reflect upon psychocardiac prevention and intervention as an integral part of multidisciplinary cardiac care.
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Affiliation(s)
- Annika Freiberger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany.
| | - Cristina Richter
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Maximilian Huber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Niko Kohls
- Division of Health Promotion, Department of Social Work and Health, University of Applied Sciences Coburg, Coburg, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Caroline Andonian-Dierks
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
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Cook SC, Saidi A, Singh HS, Madder RD, Cohen SB, Van Oosterhout S, Samuel BP, Finn MT. Preprocedural Anxiety in Adults With Congenital Heart Disease: The PANIC Study. JACC. ADVANCES 2023; 2:100589. [PMID: 38939501 PMCID: PMC11198359 DOI: 10.1016/j.jacadv.2023.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2024]
Abstract
Background Preprocedural anxiety may have detrimental effects both cognitively and physiologically. Objectives The objective of this study was to determine the association between state (situational) and trait (persistent in everyday life) anxiety and differences between the adult congenital heart disease (ACHD) and acquired heart disease populations. Methods The State-Trait Anxiety Inventory and financial stress scale were administered to adults with acquired and CHD at 4 tertiary referral centers in the United States prior to cardiac catheterization. Student's t-test and least absolute shrinkage and selection operator regression analyses were used to assess differences in anxiety between groups and identify the optimal model of predictors of anxiety. Results Of the 291 patients enrolled, those with CHD (n = 91) were younger (age 41.3 ± 16.3 years vs 64.7 ± 11.3 years, P < 0.001), underwent more cardiac surgeries (P < 0.001), and had higher levels of trait anxiety (t[171] = 2.62, P = 0.001, d = 0.33). There was no difference in state anxiety between groups (t[158.65] = 1.37, P = 0.17, d = 0.18). State anxiety was singularly associated with trait anxiety. Trait anxiety was negatively associated with age and positively associated with state anxiety and financial stress. Patients with CHD of great complexity were more trait (F[2,88] = 4.21, P = 0.02) and state anxious (F[2,87] = 4.59, P = 0.01), though with relatively small effect size. Conclusions Trait anxiety levels are higher in the ACHD population and directly associated with state anxiety. Specialists caring for ACHD patients should not only recognize the frequency of trait anxiety but also high-risk subgroups that may benefit from psychological or social interventions to reduce preprocedural anxiety.
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Affiliation(s)
- Stephen C. Cook
- Indiana University Health Adult Congenital Heart Disease Program, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Arwa Saidi
- Congenital Heart Center, University of Florida Health, Gainesville, Florida, USA
| | - Harsimran S. Singh
- Adult Congenital Heart Disease Program, Weill Cornell Medical Center, New York, New York, USA
| | - Ryan D. Madder
- Division of Cardiology, Corewell Health, Grand Rapids, Michigan, USA
| | - Scott B. Cohen
- Adult Congenital Heart Disease Program, Herma Heart Institute, Milwaukee Hospital-Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Stacie Van Oosterhout
- Division of Cardiology, Corewell Health Office of Research and Education, Grand Rapids, Michigan, USA
| | - Bennet P. Samuel
- Karl and Patricia Betz Congenital Heart Center, Corewell Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan, USA
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Cassedy A, Wray J, Qadir AA, Ernst MM, Brown K, Franklin R, Wernovsky G, Marino BS. Behavioral and Emotional Outcomes in Children with Congenital Heart Disease: Effects of Disease Severity, Family Life Stress, Disease-Related Chronic Stress, and Psychosocial Adaptation. J Pediatr 2023; 259:113450. [PMID: 37164178 DOI: 10.1016/j.jpeds.2023.113450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/03/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate whether effects of congenital heart disease (CHD) severity and family life stress on behavioral and emotional functioning are mediated by disease-related chronic stress and psychosocial adaptation. STUDY DESIGN A cross-sectional analysis of the Pediatric Cardiac Quality of Life Inventory Testing Study was performed. Relationships between CHD severity (comprising 3 groups: mild heart disease, moderate biventricular disease, and single ventricle) and family life stress, on patient- and parent disease-related chronic stress, psychosocial adaptation, and behavioral-emotional outcomes were assessed using structural equation modeling. Patient and parent models were reported separately. RESULTS There were 981 patient-parent dyads: 22% had mild heart disease, 63% biventricular, and 15% single ventricle; 19% of families reported moderate to major family life stress. Path models revealed that CHD severity and family life stress were mediated by disease-related chronic stress and psychosocial adaptation factors (R2 = 0.18-0.24 for patient outcomes and R2 = 0.33-0.34 for parent outcomes, P < .001, respectively). CONCLUSIONS The effects of greater CHD severity and family life stress on behavioral-emotional outcomes were mediated by worse disease-related chronic stress and psychosocial adaptation factors. Both disease-related chronic stress and psychosocial adaptation factors may be targets for interventions to improve behavioral and emotional outcomes.
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Affiliation(s)
- Amy Cassedy
- Division of Biostatistics and Epidemiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Jo Wray
- Heart and Lung Directorate, Department of Pediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH BRC, London, United Kingdom
| | - Asad A Qadir
- Division of Cardiology, Pediatric Heart Center, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Michelle M Ernst
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Behavioral Medicine at Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Katherine Brown
- Heart and Lung Directorate, Department of Pediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH BRC, London, United Kingdom
| | - Rodney Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Gil Wernovsky
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Divisions of Cardiac Critical Care and Pediatric Cardiology, Children's National Hospital, Washington, DC
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH
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Princip M, Ledermann K, von Känel R. Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease. Curr Cardiol Rep 2023; 25:455-465. [PMID: 37129760 DOI: 10.1007/s11886-023-01870-1] [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] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE OF REVIEW To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. RECENT FINDINGS A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Davis KA, Dietrich MS, Gilmer MJ, Fuchs DC, Akard TF. Postoperative opioid administration and post-traumatic stress symptoms in preschool children after cardiac surgery. J Pediatr Nurs 2023; 68:44-51. [PMID: 36333168 DOI: 10.1016/j.pedn.2022.10.005] [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: 02/03/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to explore relationships between postoperative opioid administration and posttraumatic stress symptoms (PTSS) in preschool-aged children surviving cardiac surgery. DESIGN AND METHODS This was a cross-sectional, descriptive study using survey administration and medical chart review. Primary caregivers of children aged three to six years who underwent cardiac surgery at our institution between 2018 and 2020 were invited to participate. Opioid administration was calculated according to morphine milligram equivalents and indexed to the child's body weight. Caregivers completed the Young Child Posttraumatic Stress Disorder Checklist to explore child PTSS. We used correlational methods to assess the strength and direction of relationships between postoperative opioid administration and child PTSS. RESULTS We did not find a statistically significant relationship between total postoperative opioid administration and child PTSS. When analyzing individual opioid agents, morphine did show a significant inverse relationship to YCPC scores (rs = -.57, p = .017) in children with single ventricle physiology. CONCLUSIONS Total postoperative opioid administration was not statistically significantly related to child PTSS in our sample. Differing patterns of association were noted among children with single- versus bi-ventricular physiology. Postoperative morphine administration was favorably associated with PTSS in children with single-ventricle physiology. PRACTICE IMPLICATIONS Nurses caring for preschool children who undergo cardiac surgery should anticipate the potential development of PTSS in their patients. Studies using larger sample sizes and longitudinal design are needed to replicate the significant relationship between morphine administration and PTSS in preschoolers with single-ventricle physiology.
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Affiliation(s)
- Kelly A Davis
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA; Division of Pediatric Critical Care, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA; Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Drive Nashville, TN 37232, USA
| | - Mary Jo Gilmer
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA
| | - D Catherine Fuchs
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Terrah Foster Akard
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA
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Pediatric Medical Traumatic Stress in Inflammatory Bowel Disease, Pancreatitis, and Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2022; 75:455-461. [PMID: 35881966 DOI: 10.1097/mpg.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Known as pediatric medical traumatic stress (PMTS), posttraumatic stress symptoms from medical experiences have not been explored in children with chronic gastrointestinal diseases. This cross-sectional study of children and adolescents with inflammatory bowel disease, chronic pancreatitis and cystic fibrosis, aimed to (1) estimate the prevalence of medical potentially traumatic events (PTEs) and PMTS, (2) explore potential risk factors for PMTS, and (3) explore potential consequences of PMTS. METHODS This cross-sectional study used validated, self-report measures to evaluate PTEs and PMTS. Descriptive statistics and regression analyses were used to achieve study objectives. RESULTS Over two-thirds of children reported a medical potentially traumatic event (91 of 132, 69%). Forty-eight had PMTS symptoms (36%). PMTS was associated with medication burden, emergency and intensive care visits, and parent posttraumatic stress disorder in multivariate analysis. Potential consequences associated with PMTS included school absenteeism, home opioid use, poor quality of life, and parent missed work. CONCLUSIONS A substantial portion of our cohort reported medical PTEs and PMTS. The exploratory analysis identified potential associations between PMTS and illness factors, parent posttraumatic stress disorder, and functional impairments. Further studies of PMTS detection, prevention and treatment are integral to optimizing these children's health and quality of life.
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Pelosi C, Kauling R, Cuypers J, van den Bosch A, Bogers A, Helbing W, Hesselink JR, Legerstee J, Utens E. Development of psychopathology in adults with congenital heart disease: A 40–53 years follow-up study. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cunningham S, Campbell K, Miller T, Winter S, Presson A, Ou Z, Glotzbach K. Anxiety symptoms and associated functional impairment in children with CHD in a neurodevelopmental follow-up clinic. Cardiol Young 2022; 33:1-8. [PMID: 35723019 PMCID: PMC10704710 DOI: 10.1017/s1047951122001767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine the prevalence of anxiety symptoms and associated functional impairment to adaptive skills among elementary-aged children with CHD and to determine the need for anxiety screening in this high-risk population. STUDY DESIGN In a single-centre retrospective, cohort design, caregivers reported anxiety symptoms using Conner's scales and functional impairment to adaptive skills using the Adaptive Behavior Assessment System. A total of 194 children were stratified across two cohorts: early elementary (ages 3-6 years) and late elementary (ages 6-14 years). Descriptive statistics summarised the frequency of anxiety symptoms and functional impairment. Spearman's correlations compared anxiety symptoms to functional impairment of adaptive functioning. Univariable logistic regressions examined demographic and clinical characteristics associated with anxiety symptoms. RESULTS The majority of patients presented with anxiety, early elementary (63%), and late elementary cohorts (78%). Functional impairment was moderately correlated with anxiety symptoms in the early elementary cohort (rs = -.42, 95% CI [-0.58, -0.21], p = <.001). Greater anxiety symptoms were associated with lower cardiac complexity at primary age of surgery in the late elementary cohort (OR = 12.15, p = 0.019). Lesser anxiety symptoms were associated with having private insurance (OR = 0.25, p = 0.014). CONCLUSION This study demonstrates anxiety symptoms are common and associated with functional impairment to adaptive functioning in younger children with CHD. No clear clinical predictors exist for anxiety symptoms or functional impairment; therefore, screening for anxiety symptoms may need to be added to standard clinical assessment of all children with CHD participating in neurodevelopmental follow-up.
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Affiliation(s)
- Sean Cunningham
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Kathleen Campbell
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Miller
- Department of Cardiology, Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Sarah Winter
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Presson
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Kristi Glotzbach
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
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Ismail TI, Mahrous RSS. Parental active participation during induction of general anesthesia to decrease children anxiety and pain. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2069335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Tarek I Ismail
- Department of Anaesthesia and Surgical Intensive Care, Helwan University, Cairo, Egypt
| | - Rabab S. S. Mahrous
- Department of Anaesthesia and Surgical Intensive Care, Alexandria University
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McDowell BM. Caring for Critically Ill Children Experiencing Traumatic Stress. Crit Care Nurse 2022; 42:68-73. [PMID: 35100626 DOI: 10.4037/ccn2022104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
TOPIC/CLINICAL RELEVANCE Traumatic stress occurs in children when their coping mechanisms are overwhelmed by exposure to traumatic events or situations. Estimates indicate that as many as 80% of ill and injured children experience traumatic stress after such exposure. Critically ill or injured children are especially at risk for the development of traumatic stress, including acute stress reaction and posttraumatic stress disorder. OBJECTIVE To explore the phenomenon of traumatic stress disorders in critically ill or injured children to assist bedside nurses in decreasing the severity of short- and long-term consequences in this patient population. CONTENT COVERED This article presents types of traumatic stress, risk factors for the development of traumatic stress, clinical findings in children and adolescents, and nursing strategies for preventing and managing traumatic stress in pediatric patients. Critical care and acute care nurses are in an excellent position to assess children for symptoms of acute stress reaction and posttraumatic stress disorder during or after a stay in the intensive care unit, to implement strategies to prevent or ease the symptoms of acute stress reaction and posttraumatic stress disorder, and to make appropriate referrals for children and their families after exposure to traumatic stressors.
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Affiliation(s)
- Betsy M McDowell
- Betsy M. McDowell is a pediatric nurse and retired nurse educator at Newberry College, Newberry, South Carolina
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15
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Simeone RM, Downing KF, Bobo WV, Grosse SD, Khanna AD, Farr SL. Post-traumatic stress disorder, anxiety, and depression among adults with congenital heart defects. Birth Defects Res 2022; 114:124-135. [PMID: 34935303 PMCID: PMC8828688 DOI: 10.1002/bdr2.1971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Due to invasive treatments and stressors related to heart health, adults with congenital heart defects (CHDs) may have an increased risk of post-traumatic stress disorder (PTSD), anxiety, and/or depressive disorders. Our objectives were to estimate the prevalence of these disorders among individuals with CHDs. METHODS Using IBM® MarketScan® Databases, we identified adults age 18-49 years with ≥2 outpatient anxiety/depressive disorder claims on separate dates or ≥1 inpatient anxiety/depressive disorder claim in 2017. CHDs were defined as ≥2 outpatient CHD claims ≥30 days apart or ≥1 inpatient CHD claim documented in 2007-2017. We used log-binomial regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between CHDs and anxiety/depressive disorders. RESULTS Of 13,807 adults with CHDs, 12.4% were diagnosed with an anxiety or depressive disorder. Adults with CHDs, compared to the 5,408,094 without CHDs, had higher prevalence of PTSD (0.8% vs. 0.5%; aPR: 1.5 [CI: 1.2-1.8]), anxiety disorders (9.9% vs. 7.5%; aPR: 1.3 [CI: 1.3-1.4]), and depressive disorders (6.3% vs. 4.9%; aPR: 1.3 [CI: 1.2-1.4]). Among individuals with CHDs, female sex (aPR range: 1.6-3.3) and inpatient admission (aPR range 1.1-1.9) were associated with anxiety/depressive disorders. CONCLUSION Over 1 in 8 adults with CHDs had diagnosed PTSD and/or other anxiety/depressive disorders, 30-50% higher than adults without CHDs. PTSD was rare, but three times more common in women with CHDs than men. Screening and referral for services for these conditions in people with CHDs may be beneficial.
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Affiliation(s)
- Regina M. Simeone
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amber D. Khanna
- Department of Internal Medicine, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Department of Pediatrics, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Huebschmann NA, Cook NE, Murphy S, Iverson GL. Cognitive and Psychological Outcomes Following Pediatric Cardiac Arrest. Front Pediatr 2022; 10:780251. [PMID: 35223692 PMCID: PMC8865388 DOI: 10.3389/fped.2022.780251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac arrest is a rare event in children and adolescents. Those who survive may experience a range of outcomes, from good functional recovery to severe and permanent disability. Many children experience long-term cognitive impairment, including deficits in attention, language, memory, and executive functioning. Deficits in adaptive behavior, such as motor functioning, communication, and daily living skills, have also been reported. These children have a wide range of neurological outcomes, with some experiencing specific deficits such as aphasia, apraxia, and sensorimotor deficits. Some children may experience emotional and psychological difficulties, although many do not, and more research is needed in this area. The burden of pediatric cardiac arrest on the child's family and caregivers can be substantial. This narrative review summarizes current research regarding the cognitive and psychological outcomes following pediatric cardiac arrest, identifies areas for future research, and discusses the needs of these children for rehabilitation services and academic accommodations.
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Affiliation(s)
- Nathan A Huebschmann
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,New York University Grossman School of Medicine, New York, NY, United States
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Sarah Murphy
- Division of Pediatric Critical Care, MassGeneral Hospital for Children, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Spaulding Research Institute, Charlestown, MA, United States
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17
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Ferraz-Torres M, Escalada-Hernandez P, San Martín-Rodriguez L, Delarosa R, Saenz R, Soto-Ruiz MN. Predictive Factors for Anxiety during Blood Sampling and Insertion of Peripheral Intravenous Catheters in Paediatric Patients in Spain. J Pediatr Nurs 2021; 61:e35-e41. [PMID: 33931258 DOI: 10.1016/j.pedn.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Invasive procedures for diagnosis purposes such as venepuncture and peripheral venous catheter insertion are painful procedures that cause great stress for paediatric patients. The objective of this study is to find out the factors that have an impact on the level of anxiety experienced by children undertaken these procedures. DESIGN AND METHODS Prospective study, 359 children between 2 and 15 years old were included, treated in a tertiary reference hospital in the region of Navarra (Spain). The impact of the variables recorded was analysed using a regressive analysis, the Wong-Baker and FLACC scales were used to measure the level of pain and the PACBIS scale to measure the level of stress and anxiety. RESULTS The average age of the participants was 7.93 years (SD: 4.04), with 51.8% (n = 186) boys and 48.2% (n = 173) girls. The mean value of pain recorded was 4.43 (SD:3.10). 45.7% (n = 123) of the venepuncture techniques was associated with minimum level of anxiety, including 11.1% of intravenous catheterization. Variables determining the anxiety has been detected such as age, sex, level of pain, parental conduct and time spent on the procedure. CONCLUSIONS Paediatric patients experience high levels of anxiety when undergoing painful procedures which are conditioned by multifactorial reasons. The increase in stress is directly related to the older age (>6 years old) of the patient, and statistically significant by the female gender, the longer duration of the technique and the parental block. PRACTICE IMPLICATIONS Healthcare professionals should work on some of the variables and apply measures aimed to mitigate anxiety levels. For example, reducing the duration of the procedure, training parents, and distracting techniques.
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Affiliation(s)
- M Ferraz-Torres
- Clinical Records at Complejo Hospitalario de Navarra (CHN), Spain.
| | | | | | - R Delarosa
- Oncología pediátrica, Complejo Hospitalario Donostia, Spain.
| | - R Saenz
- Unidad de reanimación post-anestésica, Complejo Hospitalario de Navarra, Spain.
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18
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Röhrich C, Giordano J, Kohls NB. Narrative view of the role of health promotion and salutogenesis in the treatment of chronic disease: viability and value for the care of cardiovascular conditions. Cardiovasc Diagn Ther 2021; 11:591-601. [PMID: 33968636 DOI: 10.21037/cdt-20-610] [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] [Indexed: 11/06/2022]
Abstract
Health promotion provides a complementary scientific and practical approach to medicine, which may help to create, maintain and restore wellness even in the presence of disease and illness. Salutogenesis, as key concept, focuses upon the emergence of health and thus, leads to fortifying individuals' and communities' health determinants and resources. The potential integration of health promotion and medicine can contribute to a more person-centred focus of integrative care to address and realize individuals' health potential and needs, rather than merely an emphasis upon the underlying disease, such as congenital heart diseases. We posit that it is possible-and advisable-to address lifestyle modification aspects, and to change the focus of therapeutic encounters and health care programs to be more tailored to and aligned with individual needs, demands and expectations. By adopting a health promotional approach to the individual patient as person, their subjective biography, narrative and lifeworld can serve as resources for developing more beneficial coping styles, resilience and trajectories for personal growth over the life span, despite the occurrence and durability of chronic conditions, such as long-term cardiovascular disease. Implications, important contingencies and requirements for education and training of health-care professionals are addressed, as they are key issues that may affect the successful development and engagement of health promotion programs within health care systems at-large.
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Affiliation(s)
- Christina Röhrich
- Division Health Promotion, University of Applied Sciences and Arts, Coburg, Coburg, Germany
| | - James Giordano
- Departments of Neurology and Biochemistry, and Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
| | - Nikola Boris Kohls
- Division Health Promotion, University of Applied Sciences and Arts, Coburg, Coburg, Germany
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19
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Behavioral and Emotional Disorders in Children and Their Anesthetic Implications. CHILDREN-BASEL 2020; 7:children7120253. [PMID: 33255535 PMCID: PMC7759846 DOI: 10.3390/children7120253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022]
Abstract
While most children have anxiety and fears in the hospital environment, especially prior to having surgery, there are several common behavioral and emotional disorders in children that can pose a challenge in the perioperative setting. These include anxiety, depression, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, post-traumatic stress disorder, and autism spectrum disorder. The aim of this review article is to provide a brief overview of each disorder, explore the impact on anesthesia and perioperative care, and highlight some management techniques that can be used to facilitate a smooth perioperative course.
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20
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Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial. Eur J Anaesthesiol 2020; 36:728-737. [PMID: 31356373 PMCID: PMC6738544 DOI: 10.1097/eja.0000000000001059] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pre-operative anxiety in children is very common and is associated with adverse outcomes. OBJECTIVE The aim of this study was to investigate if virtual reality exposure (VRE) as a preparation tool for elective day care surgery in children is associated with lower levels of anxiety, pain and emergence delirium compared with a control group receiving care as usual (CAU). DESIGN A randomised controlled single-blind trial. SETTING A single university children's hospital in the Netherlands from March 2017 to October 2018. PATIENTS Two-hundred children, 4 to 12 years old, undergoing elective day care surgery under general anaesthesia. INTERVENTION On the day of surgery, children receiving VRE were exposed to a realistic child-friendly immersive virtual version of the operating theatre, so that they could get accustomed to the environment and general anaesthesia procedures. MAIN OUTCOME MEASURES The primary outcome was anxiety during induction of anaesthesia (modified Yale Preoperative Anxiety Scale, mYPAS). Secondary outcomes were self-reported anxiety, self-reported and observed pain, emergence delirium, need for rescue analgesia (morphine) and parental anxiety. RESULTS A total of 191 children were included in the analysis. During induction of anaesthesia, mYPAS levels (median [IQR] were similar in VRE, 40.0 [28.3 to 58.3] and CAU, 38.3 [28.3 to 53.3]; P = 0.862). No differences between groups were found in self-reported anxiety, pain, emergence delirium or parental anxiety. However, after adenoidectomy/tonsillectomy, children in the VRE condition needed rescue analgesia significantly less often (55.0%) than in the CAU condition (95.7%) (P = 0.002). CONCLUSION In children undergoing elective day care surgery, VRE did not have a beneficial effect on anxiety, pain, emergence delirium or parental anxiety. However, after more painful surgery, children in the VRE group needed rescue analgesia significantly less often, a clinically important finding because of the side effects associated with analgesic drugs. Options for future research are to include children with higher levels of anxiety and pain and to examine the timing and duration of VRE. TRIAL REGISTRATION Netherlands Trial Registry: NTR6116.
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21
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Morton L, Cogan N, Kornfält S, Porter Z, Georgiadis E. Baring all: The impact of the hospital gown on patient well‐being. Br J Health Psychol 2020; 25:452-473. [DOI: 10.1111/bjhp.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Liza Morton
- School of Psychological Science and Health University of Strathclyde Glasgow UK
| | - Nicola Cogan
- School of Psychological Science and Health University of Strathclyde Glasgow UK
| | - Susanna Kornfält
- School of Psychological Science and Health University of Strathclyde Glasgow UK
| | - Zoe Porter
- School of Psychological Science and Health University of Strathclyde Glasgow UK
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22
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Pinquart M. Posttraumatic Stress Symptoms and Disorders in Children and Adolescents with Chronic Physical Illnesses: a Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:1-10. [PMID: 32318223 PMCID: PMC7163825 DOI: 10.1007/s40653-018-0222-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of the present meta-analysis was to compare levels of posttraumatic stress symptoms (PTSS) and the prevalence of posttraumatic stress disorders (PTSD) in individuals with and without pediatric chronic physical illnesses, and to analyze correlates of these symptoms. In total, 150 studies were identified that provided relevant data. On average, 11.5% of the participants with pediatric chronic physical illnesses met the criteria of PTSD (Odds Ratio 2.70). PTSS were also more common in this group than in control groups without chronic physical illnesses. While the PTSS levels did not differ across physical diseases, we found positive associations of PTSS with illness severity and duration/intensity of treatment, as well as negative associations with duration of illness, time since last treatment, treatment adherence, and family functioning. We conclude that individuals with pediatric chronic physical illnesses who experienced traumatic events should be screened for PTSS and receive psychological interventions when needed.
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Affiliation(s)
- Martin Pinquart
- Department of Psychology, Philipps University, Gutenbergstr. 18, D-35032 Marburg, Germany
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23
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Meentken MG, van der Mheen M, van Beynum IM, Aendekerk EWC, Legerstee JS, van der Ende J, Del Canho R, Lindauer RJL, Hillegers MHJ, Moll HA, Helbing WA, Utens EMWJ. EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep. Eur J Psychotraumatol 2020; 11:1705598. [PMID: 32002140 PMCID: PMC6968501 DOI: 10.1080/20008198.2019.1705598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4-15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems.
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Affiliation(s)
- Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Malindi van der Mheen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Department of Pediatrics, division of Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Riwka Del Canho
- Department of Pediatrics, Maasstad hospital, Rotterdam, The Netherlands
| | - Ramón J L Lindauer
- De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriette A Moll
- Department of Pediatrics, division of Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wim A Helbing
- Department of Pediatrics, division of Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Pediatrics, division of Cardiology, Radboud UMC - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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24
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Eijlers R, Utens EMWJ, Staals LM, de Nijs PFA, Berghmans JM, Wijnen RMH, Hillegers MHJ, Dierckx B, Legerstee JS. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth Analg 2019; 129:1344-1353. [PMID: 31136330 PMCID: PMC6791566 DOI: 10.1213/ane.0000000000004165] [Citation(s) in RCA: 230] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medical procedures often evoke pain and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide distraction during, or to prepare patients for, medical procedures. This meta-analysis is the first to collate evidence on the effectiveness of VR on reducing pain and anxiety in pediatric patients undergoing medical procedures. METHODS On April 25, 2018, we searched EMBASE, MEDLINE, CENTRAL, PubMed, Web of Science, and PsycINFO with the keywords "VR," "children," and "adolescents." Studies that applied VR in a somatic setting with participants ≤21 years of age were included. VR was defined as a fully immersive 3-dimensional environment displayed in surround stereoscopic vision on a head-mounted display (HMD). We evaluated pain and anxiety outcomes during medical procedures in VR and standard care conditions. RESULTS We identified 2889 citations, of which 17 met our inclusion criteria. VR was applied as distraction (n = 16) during venous access, dental, burn, or oncological care or as exposure (n = 1) before elective surgery under general anesthesia. The effect of VR was mostly studied in patients receiving burn care (n = 6). The overall weighted standardized mean difference (SMD) for VR was 1.30 (95% CI, 0.68-1.91) on patient-reported pain (based on 14 studies) and 1.32 (95% CI, 0.21-2.44) on patient-reported anxiety (based on 7 studies). The effect of VR on pediatric pain was also significant when observed by caregivers (SMD = 2.08; 95% CI, 0.55-3.61) or professionals (SMD = 3.02; 95% CI, 0.79-2.25). For anxiety, limited observer data were available. CONCLUSIONS VR research in pediatrics has mainly focused on distraction. Large effect sizes indicate that VR is an effective distraction intervention to reduce pain and anxiety in pediatric patients undergoing a wide variety of medical procedures. However, further research on the effect of VR exposure as a preparation tool for medical procedures is needed because of the paucity of research into this field.
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Affiliation(s)
- Robin Eijlers
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Elisabeth M. W. J. Utens
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Child Psychiatry, The Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Lonneke M. Staals
- Department of Anesthesiology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Pieter F. A. de Nijs
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Johan M. Berghmans
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children’s Hospital, Antwerp, Belgium
| | - René M. H. Wijnen
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Manon H. J. Hillegers
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Bram Dierckx
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Jeroen S. Legerstee
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
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25
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Lewis CL, Langhinrichsen-Rohling J, Selwyn CN, Lathan EC. Once BITTEN, Twice Shy: An Applied Trauma-Informed Healthcare Model. Nurs Sci Q 2019; 32:291-298. [PMID: 31514618 DOI: 10.1177/0894318419864344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nurses need a pragmatic theory to understand and respond to the impact of vulnerable patients' previous healthcare experiences, as these are likely to influence response and adherence to treatment plans. The authors of this paper present the new BITTEN (Betrayal history by health-related institutions, Indicator for healthcare engagement, Traumas related to healthcare, Trust in healthcare providers, patient Expectations and Needs) Model of Trauma-Informed Healthcare. BITTEN identifies patients' current healthcare expectations and needs as a function of their previous betrayal by healthcare systems, which operates in conjunction with their current health indicators to potentially trigger trauma symptoms and impact trust in healthcare providers.
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Affiliation(s)
- Chrystal L Lewis
- Assistant Professor, College of Nursing, University of South Alabama, Mobile, AL, USA
| | | | - Candice N Selwyn
- Research Assistant Professor, College of Nursing, University of South Alabama, Mobile, AL, USA
| | - Emma C Lathan
- Clinical and Counseling Psychology Doctoral Candidate, University of South Alabama, Mobile, AL, USA
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26
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Morton L. Using psychologically informed care to improve mental health and wellbeing for people living with a heart condition from birth: A statement paper. J Health Psychol 2019; 25:197-206. [DOI: 10.1177/1359105319826354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the last few decades, medical and surgical advances have led to a growing population of individuals living with congenital heart disease. The challenges of this condition can reach beyond physical limitations to include anxiety, depression and post-traumatic stress disorder. To date, these psychological outcomes have been neglected; yet, they need not be inevitable. The factors contributing to these difficulties are considered here, drawing on current evidence and neuropsychological theories including the novel application of polyvagal theory. Suggestions for developing psychologically informed medical and social care to improve mental health, wellbeing and recovery and influence policy and training are proposed (See supplemental material for video abstract).
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27
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Peterson JK. Supporting Optimal Neurodevelopmental Outcomes in Infants and Children With Congenital Heart Disease. Crit Care Nurse 2018; 38:68-74. [PMID: 29858197 PMCID: PMC6563801 DOI: 10.4037/ccn2018514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Improved survival has led to increased recognition of developmental delays in infants and children with congenital heart disease. Risk factors for developmental delays in congenital heart disease survivors may not be modifiable; therefore, it is important that lifesaving, high-technology critical care interventions be combined with nursing interventions that are also developmentally supportive. Implementing developmental care in a pediatric cardiac intensive care unit requires change implementation strategies and widespread support from all levels of health care professionals. This manuscript reviews developmentally supportive interventions such as massage, developmentally supportive positioning, kangaroo care, cue-based feeding, effective pain/anxiety management, and procedural preparation and identifies strategies to implement developmentally supportive interventions in the care of infants and children with congenital heart disease. Improving developmental support for these infants and children at high risk for developmental delay may improve their outcomes and help promote family-centered care.
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Affiliation(s)
- Jennifer K Peterson
- Jennifer K. Peterson is a PhD candidate at University of California, Irvine, Sue & Bill Gross School of Nursing, as well as the Children's Heart Institute Clinical Program Director at Miller Children's and Women's Hospital in Long Beach, California.
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28
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Berghmans JM, Poley MJ, van der Ende J, Veyckemans F, Poels S, Weber F, Schmelzer B, Himpe D, Verhulst FC, Utens E. Association between children's emotional/behavioral problems before adenotonsillectomy and postoperative pain scores at home. Paediatr Anaesth 2018; 28:803-812. [PMID: 30079454 DOI: 10.1111/pan.13450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children undergoing adenotonsillectomy are at risk of severe postoperative pain and sleep problems. Little is known about the specific child risk factors for these problems. AIMS The aim of this study was to assess the occurrence of postoperative pain, sleep problems, and medication adherence, and assess the influence of internalizing and externalizing problems on postoperative pain. METHODS This prospective cohort study included 160 children, aged 1.5-5 years undergoing day-care adenotonsillectomy. Parents rated their child's pain with the Parents' Postoperative Pain Measure and their child's sleep problems with Vernon's Post Hospital Behavioral Questionnaire during the first 3 days and at day 10 postoperatively. Emotional/behavioral problems (ie, internalizing and externalizing behaviors) during the past 2 months were assessed using the Child Behavior Checklist. Regression analysis was used to assess whether children's pain intensity at home was associated with internalizing/externalizing problems, after controlling for age, preoperative child state anxiety, parental state anxiety, parental need for information, and socioeconomic status. RESULTS Applying a threshold of ≥6 on the Parents' Postoperative Pain Measure, the incidence of moderate to severe pain was 57.6% at day 1, 53.5% at day 2, 35.4% at day 3, and 4.8% at day 10. During the first three postoperative nights, 37.1% of the children woke up. Internalizing problems (β = 0.343; P = 0.001) and parental need for information (β = 0.207; P = 0.011) were independently associated with higher pain scores at home during the first 3 days (R2 = 0.225). CONCLUSION Following adenotonsillectomy, children often experienced moderate to severe pain and sleep problems during the first 3 days at home. Preoperative internalizing problems and parental need for information were independently associated with increased pain at home. Screening for these problems can help to identify vulnerable children and adapt the perioperative analgesic strategy accordingly (which includes preparation, information, and prescription of pain analgesics).
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Affiliation(s)
- Johan M Berghmans
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Anesthesia, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marten J Poley
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Francis Veyckemans
- Department of Anesthesiology, Hôpital Jeanne de Flandre, University Hospital Lille, Lille, France
| | - Stephanie Poels
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Frank Weber
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bert Schmelzer
- Department of Ear, Nose and Throat surgery, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Dirk Himpe
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, Academic Center for Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam/de Bascule, Amsterdam, The Netherlands
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Multidisciplinary family-centred psychosocial care for patients with CHD: consensus recommendations from the AEPC Psychosocial Working Group. Cardiol Young 2018; 28:192-198. [PMID: 28889827 DOI: 10.1017/s1047951117001378] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Because of the enormous advances in the medical treatment of CHD, the long-term survival of patients suffering from this disease has increased significantly. Currently, about 90% of patients reach adulthood, which entails many new challenges both for patients and their families and for healthcare professionals. The main objective of family-centred psychosocial care is to strengthen the emotional resilience of chronically ill patients and their families by adopting a holistic approach. During the biannual meeting of the psychosocial working group in 2012, participants expressed the need for general European guidelines. The present recommendations were written to support medical staff and psychosocial healthcare professionals to provide the best care for children and adolescents with CHD as well as for their families. This article describes in detail how the integrated family-centred psychological care modules work, involving different healthcare specialists, including a paediatric/congenital cardiologist or a general paediatrician. The different clinical implications and specific needs have been taken into account and recommendations have been provided on the following: structured follow-up screening; identification of stressful periods related to cardiac surgery or invasive medical procedures; evidence-based, disease-specific, and family-oriented psychosocial interventions; and interactive media links to medical and psychosocial information.
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