Clown therapy for procedural pain in children: a systematic review and meta-analysis

Exploring experiences and needs among children with cancer undergoing peripherally inserted central catheter insertion: A qualitative study

Objective

This study aimed to explore the experiences of children with cancer undergoing peripherally inserted central catheter (PICC) insertion.

Methods

This study employed a descriptive qualitative approach. A total of 20 children undergoing PICC insertion were enrolled through purposive sampling. Semi-structured interviews, supplemented by draw-and-tell techniques, were conducted to collect data. Thematic analysis method was employed to analyze the interview data.

Results

Four themes and 11 subthemes were identified regarding the experience of peripherally inserted central catheter insertion in pediatric cancer patients, including (1) uncertainty (unknown procedure and lack of confidence); (2) high sensitivity (vulnerable to environmental influences and care what others think); (3) psychophysical changes (stress response, physical discomfort, disruption of daily routines, and accepted with pleasure); and (4) multidimensional needs (information, comfort, and self-actualization needs).

Conclusions

The findings underscore the importance of gaining a deeper understanding of the symptoms and needs of pediatric cancer patients undergoing PICC insertion. By appreciating and honoring children's voices, we can effectively cater to their distinct worries and guarantee they get the care and consideration they merit.

Medical clown intervention shortens length of hospitalization in children with pneumonia

Community-acquired pneumonia (CAP) is a leading cause of hospitalization in children. The hospitalization duration depends on factors as child's well-being, vital signs, need for parenteral treatments, and development of complications. Medical clowns (MCs) are known to assist in reducing pain and alleviating anxiety and have been integrated into many aspects of hospital treatment routines. Our aim was to evaluate the effect of MC intervention on length of hospitalization in children admitted with CAP. A prospective quasi-randomized controlled trial allocated 51 children (2-18 years) hospitalized for CAP to receive standard care (control group, n = 25) or standard care plus 15-minute MC visits twice daily during the first 48 h of hospitalization (intervention group, n = 26). The primary outcome was hospitalization duration. Both groups were comparable in all demographic and clinical characteristics at admission with a mean age of 4.4 ± 3.6 years. The intervention group had significantly shorter duration of hospitalization (43.5 vs. 70 h, p = 0.03) and IV antibiotic treatment duration (48 vs. 72 h, p < 0.01) compared to controls. When comparing day 1 to day 2 in each group, significant decreases in respiratory rate, heart rate, white blood cell count, and absolute neutrophil count were noted in the study group. No significant differences were observed between the two groups in changes in patient well-being. The integration of MC into the pediatric CAP care-team reduced length of hospitalization and need for IV antibiotics. This can improve the quality of care as well as the burden and cost endured by hospitalization with CAP. Future larger studies are warranted to support these positive effects of MC.Trial registration ClinicalTrials.gov Identifier NCT06750029, 27/12/2024.

Managing Preoperative Anxiety and Thromboprophylaxis in Children Undergoing Urological Procedures: An Update of the European Association of Urology/European Society for Paediatric Urology Guidelines on Paediatric Urology

Context

The literature on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures is still limited, resulting in a generally low level of evidence. These guidelines aim to provide a practical approach based on a consensus from the European Association of Urology (EAU)/European Society for Paediatric Urology (ESPU) Paediatric Urology Guidelines Panel.

Objective

The authors aim to provide the 2024 EAU/ESPU Paediatric Urology Guidelines Panel update of the chapter on perioperative management of urological procedures in children.

Evidence acquisition

A structured literature review was performed for all relevant publications published from the last update until April 03, 2023.

Evidence synthesis

The most important updates include the following: anxiety and distress should be prevented or relieved by combining measures such as premedication, distraction techniques, and presence of parents or caregivers. Clinicians should select the appropriate premedication depending on the patient's age, underlying conditions, and psychological status. A particular focus must be placed on paediatric patients with "special needs", including children with psychophysical disorders that impact their relational and cognitive abilities. This unique population requires carefully tailored perioperative management. The incidence of perioperative thromboembolic events in the paediatric population is generally low. Controversies still exist on whether to perform a preoperative coagulation panel test on a routine basis. Neonates and adolescents are at a higher risk of perioperative thromboembolic events than the other children. Standard perioperative antithrombotic prophylaxis is not recommended due to a lack of high-quality evidence-based data.

Conclusions

This paper is a summary of evidence on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures.

Patient summary

In this summary and update of the European Association of Urology/European Society for Paediatric Urology guidelines on paediatric urology, we provide practical considerations for preventative measures against anxiety and antithrombotic management in children undergoing urological procedures.

[Breastfeeding, an analgesic technique for painful care that can be used in rehabilitation?]

Pain management in infants is crucial during painful care. This work evaluates the effect of breastfeeding on procedural pain, measured by the Neonatal Infant Pain Scale score. A rapid review included nine randomized controlled trials (RCT) on PubMed, comparing breastfeeding with other techniques (maternal contact, sucrose, etc.). Breastfeeding significantly reduces pain compared with maternal contact, and is comparable in efficacy to sucrose. Despite methodological limitations, this simple and effective technique could be integrated into pain management in pediatric rehabilitation. Further studies are needed to clarify its benefits.

The Effect of storybook use in pediatric health services on children's fear and anxiety levels: A meta-analysis study

BACKGROUND

Invasive procedures are commonly used in pediatric healthcare, and storybooks can be used as an adjunct analgesic method.

OBJECTIVES

This study was conducted to evaluate the effectiveness of using storybooks as a distraction technique to reduce fear and anxiety in pediatric healthcare. This study was conducted with the aim of revealing the level of effect of storybook use on children's fear and anxiety level in pediatric health services.

METHODS

For this meta-analysis study, the studies were obtained by searching PubMed, Web of Scıence, Scopus, EBSCOhost, Google Scholar and YÖK Thesis Center databases in April-June 2024 without any year limitation. After the reviews, 15 studies were included in the study. The data were synthesized by meta-analysis and narrative methods.

FINDINGS

In this meta-analysis, it was found that storybook use in pediatric health services was effective on children's anxiety (SMD: -4.412, 95 % CI: -7.727 to -1.097; Z = -2.608, p = 0.009; I2 = 99.890 %) and fear (SMD: -1.13, 95 % CI: -1.71 to -0.54; Z = -3.78, p = 0.000; I2 = 83.065 %) levels. In addition, it was determined that the characteristics of the intervention group, age group, the characteristics and content of the storybook, the duration of the intervention and the time of the intervention played a role in the effectiveness of the storybook use intervention in pediatric health services on children's anxiety and fear levels.

CONCLUSION

The use of story books in children's health services reduces the level of fear and anxiety in children.

Psychological Factors Modulate Quantitative Sensory Testing Measures in Fibromyalgia Patients: A Systematic Review and Meta-Regression Analysis

OBJECTIVE

Considering the growing evidence that psychological variables might contribute to fibromyalgia syndrome (FMS), our study aims to understand the impact of psychological factors in quantitative sensory testing (QST) in FMS patients by performing a systematic review with meta-analysis.

METHODS

A systematic search was carried out in PubMed/MEDLINE, EMBASE, Web of Science, and PsycINFO databases for records up until January 2024. We included 20 studies ( n = 1623, 16 randomized controlled trials, and 4 nonrandomized controlled trials) with low or moderate risk of bias included.

RESULTS

From nonrandomized evidence, our meta-analysis found a baseline relationship between anxiety, depression, and pain catastrophizing and QST measures in FMS patients. Higher pain catastrophizing levels were associated with less efficient conditioned pain modulation. Higher anxiety and depression were associated with lower pain threshold (PT). Randomized evidence showed a statistically significant increase in PT after fibromyalgia treatments (effect size = 0.29, 95% confidence interval = 0.03-0.56). The effect was not influenced by treatment type. Moreover, we found that only anxiety levels before treatment negatively influenced the PT improvements after treatment.

CONCLUSION

FMS patients with higher anxiety levels at baseline showed a smaller increase in PT after the intervention. Depression factor was not significant in either changes in anxiety or depression. Baseline anxiety levels should be monitored as possible confounders of QST measurements. Understanding how psychological factors and QST are related in FMS patients is critical for improving the syndrome's management and treatment.Protocol Registration: CRD42023429397.

Family participatory clown therapy in venipuncture in hospitalized children: A non-randomized controlled trial

OBJECTIVE

To explore the effectiveness of family participatory clown therapy in venipuncture in hospitalized children.

METHODS

We recruited 104 children aged 3 to 6 years for a non-randomized controlled trial from March to December 2022. All participants required peripheral venepuncture infusions for treatment. The children were assigned to either the control group (n = 52) or the experimental group (n = 52).Standard care was utilized in the control group. In the experimental group, two clown nurses and a parent provided family participatory clown therapy for 35-45 minutes per child before, during, and after venipuncture. We assessed children's pain (FLACC and W-B FPS), anxiety (VAS-A), medical fear (CFS), crying incidence, compliance, parental anxiety (S-AI), and parental satisfaction.

RESULTS

At venipuncture, the FLACC score was lower in the experimental group (4.46±2.053) compared to the control group (5.96±2.441), the W-B FPS score was also lower in the experimental group (4.96±2.392) than in the control group (6.35±2.266), with a statistically significant difference (P<0.05).The children in the experimental group had lower levels of anxiety, medical fear, crying, and parental anxiety than the control group. In addition, child compliance and parent satisfaction were higher in the experimental group than in the control group, with statistically significant differences (P<0.05).

CONCLUSION

Family participatory clown therapy can reduce pain, anxiety, medical fear, and crying during venipuncture in children. It can also improve venipuncture compliance, reduce parental anxiety, and increase parental satisfaction.

Effectiveness of distraction-based interventions for relieving anxiety, fear, and pain in hospitalized children during venous blood sampling: a systematic review protocol

OBJECTIVE

The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling.

INTRODUCTION

Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling.

INCLUSION CRITERIA

This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling.

METHODS

CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence.

REVIEW REGISTRATION

PROSPERO CRD42023455617.

Mind-Body Therapies in the Management of Otolaryngologic Disease: A State-of-the-Art Review of Randomized Controlled Trials

OBJECTIVE

To review and assess the peer-reviewed literature on the utility of mind-body therapy (MBT) as an adjunct treatment in the management of otolaryngologic disease.

DATA SOURCES

PubMed, Embase, and Cochrane.

REVIEW METHODS

Randomized control trials (RCTs) of MBTs in the management of otolaryngologic disease from 2002 to 2022 were identified and included according to predefined criteria. Interventions requiring expensive equipment were excluded because the goal of MBT is to be cost-conscious. All studies were subjected to a two-stage blinded screening, extraction, and appraisal process. The outcomes of the intervention and control groups were compared.

CONCLUSION

RCTs of MBTs, including breathing exercises (4), aromatherapy (2), biofeedback (2), meditation, (2), and yoga (2), have been studied in several otolaryngologic conditions, including septoplasty/rhinoplasty (3), head and neck cancer (2), facial palsy (2), and tinnitus (2). Most studies were of moderate risk of bias on appraisal, and each MBT studied was found to significantly reduce subjective and objective distress associated with the otolaryngologic condition in question.

IMPLICATIONS FOR PRACTICE

Despite a paucity of strong evidence supporting the universal use of MBTs, our review suggests that MBTs are cost-effective and easily deployable complementary tools in the management of otolaryngologic disease. Future large, methodologically rigorous RCTs are needed to address the limitations of the included studies, such as improper blinding and inappropriate statistical analysis. As MBTs are studied further, a case for their current use can be made because of their low cost and minimal risk to patients.

A presença dos pais durante procedimentos pediátricos invasivos: depende de quê?

Resumo Objetivo: o atendimento centrado na família durante procedimentos invasivos tem sido endossado por muitas organizações profissionais de saúde. O objetivo deste estudo foi avaliar as atitudes dos profissionais de saúde em relação à presença dos pais durante o procedimento invasivo realizado em seus filhos. Método: os prestadores de serviços de saúde pediátricos (divididos em categorias profissionais e faixa etária) de um dos maiores hospitais da Espanha foram solicitados a preencher um questionário e escrever comentários de texto livre. Resultados: a pesquisa foi respondida por 227 pessoas. A maioria (72%) dos participantes, em suas respostas, relatou que os pais algumas vezes estão presentes durante as intervenções, embora houvesse diferenças entre as categorias profissionais a esse respeito. Os procedimentos em que os pais estavam presentes eram aqueles considerados “menos invasivos” (96% dos casos), enquanto apenas 4% estavam presentes naqueles considerados “mais invasivos”. Quanto mais velho o profissional, a presença dos pais foi considerada menos necessária. Conclusão: as atitudes em relação à presença dos pais durante o procedimento pediátrico invasivo são influenciadas pela categoria profissional, a idade do prestador de serviço de saúde e a invasividade do procedimento.

Presencia de los padres durante procedimientos pediátricos invasivos: ¿De qué depende?

Resumen Objetivo: la atención centrada en la familia durante procedimientos invasivos ha sido respaldada por muchas organizaciones profesionales dedicadas al cuidado de la salud. El objetivo de este estudio fue evaluar las actitudes de los profesionales de la salud con respecto a la presencia de los padres durante los procedimientos invasivos realizados en niños. Método: a los prestadores de atención médica en Pediatría (divididos en categorías profesionales y rangos de edad) de uno de los hospitales más importantes de España se les solicitó que respondieran un cuestionario y redactaran comentarios de texto libre. Resultados: un total de 227 profesionales respondieron la encuesta. En sus respuestas, la mayoría (72%) de los participantes informó que, en ocasiones, los padres están presentes durante las intervenciones, aunque se registraron diferencias entre las distintas categorías profesionales al respecto. Los procedimientos en los que los padres estuvieron presentes se consideraron como “menos invasivos” (96% de los casos), mientras que solamente el 4% estuvo presente en los considerados “más invasivos”. A mayor edad de los profesionales, menos necesaria se consideró la presencia de los padres. Conclusión: las actitudes con respecto a la presencia de los padres durante procedimientos pediátricos invasivos se vieron influenciadas por la categoría profesional, la edad del prestador de salud y la invasividad de los procedimientos.

Effects of Laughter Therapy on Improving Negative Emotions Associated with Cancer: A Systematic Review and Meta-Analysis

INTRODUCTION

With aging and growth of the population, the risk of cancer incidence and mortality is rapidly increasing. However, psychosocial treatment has been seriously neglected in many healthcare settings. Laughter therapy is a therapeutic program to improve emotional wellbeing and health which has been applied as a complementary treatment. We aim to explore effects of laughter therapy for patients with cancer on their negative emotions such as depression, anxiety, stress, pain, and fatigue.

METHODS

We searched the Cochrane Library, Embase, PubMed, Scopus, Web of Science, WANFANG data, Weipu (VIP), Chinese National Knowledge Infrastructure (CNKI) and independently rated the risk of bias in every article using the Cochrane Collaboration's Risk of Bias Assessment Tool. Review Manager and STATA software were used to pool the individually included studies.

RESULTS

Seven studies were found eligible to be included in the present review. Overall, study quality was relatively high. Our findings suggest that laughter therapy might have a positive effect on improving emotional response in cancer patients. Arguably, laughter therapy, whether humor or laughter, has a positive effect on anxiety, stress, pain feeling, fatigue, and depression in cancer patients.

CONCLUSIONS

Laughter therapy is a convenient, multi-modality, flexible-duration therapy to improve negative emotions in cancer patients, regardless of their gender, age, and type of cancer.

Active versus passive distraction for reducing procedural pain and anxiety in children: a meta-analysis and systematic review

BACKGROUND

Procedural pain is very important in clinical children care. We aimed to evaluate the effects of active versus passive distraction for reducing procedural pain and anxiety in children.

METHODS

Two researchers searched the Web of Science, PubMed, EMBASE, Cochrane, SinoMed, Wanfang, China National Knowledge Infrastructure, Weipu databases for the randomized controlled trials(RCTs) on the active versus passive distraction affecting procedural pain and anxiety in children until May 18, 2023. The literature screening and data extraction were carried out by two researchers independently. Review Manager 5.3 software was used for data analysis.

RESULTS

13 RCTs were finally included. 553 children received active distraction intervention and 551 children received passive distraction intervention. There were no significant differences in the children self-reported procedural pain betweent active and passive distraction. The parent-reported procedural pain, medical staff-reported procedural pain, children-reported procedural anxiety, parent-reported procedural anxiety, medical staff-reported procedural anxiety in the active distraction were significant less than that of active distraction. Egger regression analysis showed that there was no publication bias in the results.

CONCLUSIONS

Existing evidence suggests that active distraction may be more effective in reducing operational pain and anxiety in children than passive distraction. More studies on the effects of active distraction versus passive distraction in children with larger sample size are needed in the future.

Parental presence during invasive pediatric procedures: what does it depend on?

OBJECTIVE

family-centered care during invasive procedures has been endorsed by many professional health care organizations. The aim of this study was to evaluate the health professionals' attitudes towards parental presence during their child's invasive procedure.

METHOD

pediatric healthcare providers (divided in professional categories and range of ages) from one of the Spain's largest hospitals were asked to complete a questionnaire and write free-text comments.

RESULTS

227 responded the survey. Most (72%) participants, in their answers, reported that parents are sometimes present during interventions, although there were differences between professional categories in this respect. The procedures in which the parents were present were those considered "less invasive" (96% of cases), while only 4% were present in those considered "more invasive". The older the professional, the less necessary parental presence was considered.

CONCLUSION

the attitudes towards parental presence during pediatric invasive procedure are influenced by the professional category, the age of the healthcare provider and the invasiveness of the procedure.

The beneficial effect of medical clowns on performance of EEG in young children: a randomized controlled study

Electroencephalography (EEG) is an important test in the diagnosis of epilepsy. To perform the test, many electrodes are placed on the child's scalp, a stressful situation that may contribute to uncooperative behavior. The aim of our study was to investigate the effects provided by a close collaboration with medical clowns on the performance of EEG in young children. A prospective randomized control study was conducted between July 2020 and September 2021. The study included children aged 1-5 years who were scheduled to undergo EEG testing at the Bnai Zion Medical Center. The children were randomly allocated to each group (study group with medical clowns and control group without medical clowns) according to the day of the test. The medical clowns, the EEG technician, and the children's caregivers all independently rated the entire process in designated questionnaires composed of items rated on a 5-point Likert scale. In addition, the technical quality of all EEG tests was evaluated and rated by one neurologist (G.J.) in a blinded manner. One hundred children participated in the study. Fifty children underwent the EEG accompanied by one of two medical clowns (study group), and fifty children underwent routine EEG, without medical clowns (control group). The physician-rated technical score of the EEG recording was significantly higher in the study group (p < 0.001). Among parents of the study group, 96% were highly satisfied from the presence of the medical clowns during the EEG (median 5). Both the EEG technician and the parents denoted a significantly higher cooperation rate in the study group children, of 72% and 82%, respectively, compared to the control group. The rating of child/parent's cooperation was not correlated with age, sex, or ethnicity of the child. There was no need for sedation in the study group.

CONCLUSION

Performing EEG in young children in collaboration with medical clowns can increase the quality of the EEG recording possibly due to higher cooperation rates, which in turn lead to mutual satisfaction of both parents and technicians with the procedure.

TRIAL REGISTRATION

NCT05257096.

WHAT IS KNOWN

• Performing EEG in young children may be a stressful experience. • Use of sedation during EEG may cause side effects. To avoid need for sedation various methods are used to overcome the stressful experience: Natural daytime nap, partial sleep deprivation, oral melatonine and reassurance of parents.

WHAT IS NEW

• Performing EEG in young children in collaboration with medical clowns can increase the quality of the EEG recording. • Medical clown intervention led to mutual satisfaction of both parents and technicians with the EEG test procedure.