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Kammerer E, Linkiewich D, Ali S. Healthcare professionals' perspectives on optimizing pain care-related education at a Canadian children's hospital: A qualitative study. Paediatr Child Health 2024; 29:163-167. [PMID: 38827367 PMCID: PMC11141606 DOI: 10.1093/pch/pxad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/06/2023] [Indexed: 06/04/2024] Open
Abstract
Objectives Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice. Methods Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital's Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education. Results Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities. Conclusion Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families.
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Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Delane Linkiewich
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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De Souza E, Parvathinathan G, Anderson TA. Pain Prevalence and Treatment in Hospitalized Children and Adolescents at a US Tertiary Pediatric Hospital. Clin Pediatr (Phila) 2024; 63:805-814. [PMID: 37671731 DOI: 10.1177/00099228231196473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Poorly controlled acute pain is associated with worsened patient outcomes. Prior studies suggest that acute pain is a common complaint among hospitalized pediatric patients, but recent studies with substantial numbers of patients from US hospitals are lacking. We retrospectively reviewed inpatients at a single academic children's hospital during twelve 24-hour periods in 2021. Outcomes were assessed for patients on non-intensive care unit (ICU) inpatient floors and in ICUs. The primary outcome was any presence of moderate to severe pain. Of 1355 patients on a non-ICU inpatient floor and 485 patients in the ICU, 23.5% and 58.6%, respectively, had ≥1 moderate to severe pain score during the 24-hour analysis period. While the mean pain score was low for the majority of patients, moderate to severe pain is frequent in hospitalized children. Future studies may focus on identification of variables associated with pediatric inpatients at risk of moderate to severe pain as well as improved pain prevention and reduction strategies.
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Affiliation(s)
- Elizabeth De Souza
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - T Anthony Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Cotter JM, Hall M, Neuman MI, Blaschke AJ, Brogan TV, Cogen JD, Gerber JS, Hersh AL, Lipsett SC, Shapiro DJ, Ambroggio L. Antibiotic route and outcomes for children hospitalized with pneumonia. J Hosp Med 2024. [PMID: 38678444 DOI: 10.1002/jhm.13382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/06/2024] [Accepted: 04/18/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Emerging evidence suggests that initial oral and intravenous (IV) antibiotics have similar efficacy in pediatric community-acquired pneumonia (CAP), but further data are needed. OBJECTIVE We determined the association between hospital-level initial oral antibiotic rates and outcomes in pediatric CAP. DESIGNS, SETTINGS AND PARTICIPANTS This retrospective cohort study included children hospitalized with CAP at 43 hospitals in the Pediatric Health Information System (2016-2022). Hospitals were grouped by whether initial antibiotics were given orally in a high, moderate, or low proportion of patients. MAIN OUTCOME AND MEASURES Regression models examined associations between high versus low oral-utilizing hospitals and length of stay (LOS, primary outcome), intensive care unit (ICU) transfers, escalated respiratory care, complicated CAP, cost, readmissions, and emergency department (ED) revisits. RESULTS Initial oral antibiotics were used in 16% (interquartile range: 10%-20%) of 30,207 encounters, ranging from 1% to 68% across hospitals. Comparing high versus low oral-utilizing hospitals (oral rate: 32% [27%-47%] and 10% [9%-11%], respectively), there were no differences in LOS, intensive care unit, complicated CAP, cost, or ED revisits. Escalated respiratory care occurred in 1.3% and 0.5% of high and low oral-utilizing hospitals, respectively (relative ratio [RR]: 2.96 [1.12, 7.81]), and readmissions occurred in 1.5% and 0.8% (RR: 1.68 [1.31, 2.17]). Initial oral antibiotics varied across hospitals without a difference in LOS. While high oral-utilizing hospitals had higher escalated respiratory care and readmission rates, these were rare, the clinical significance of these small differences is uncertain, and there were no differences in other clinically relevant outcomes. This suggests some children may benefit from initial IV antibiotics, but most would probably do well with oral antibiotics.
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Affiliation(s)
- Jillian M Cotter
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Mathew Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne J Blaschke
- Department of Pediatrics, Division of Pediatric Infectious Diseases, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Thomas V Brogan
- Division of Critical Care, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan D Cogen
- Division of Pulmonary Medicine and Sleep Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Susan C Lipsett
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Shapiro
- Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Lilliam Ambroggio
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
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Kammerer E, Elliott SA, Hartling L, Basi C, Dennett L, Khangura JK, Scott SD, Candelaria P, Ruzycki S, Ali S. Pain experiences of marginalized children in the emergency department: A scoping review protocol. PLoS One 2024; 19:e0296518. [PMID: 38635744 PMCID: PMC11025926 DOI: 10.1371/journal.pone.0296518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Pain affects all children, and in hospitals across North America, this pain is often undertreated. Children who visit the emergency department (ED) experience similar undertreatment, and they will often experience a painful procedure as part of their diagnostic journey. Further, children and their caregivers who experience social injustices through marginalization are more likely to experience healthcare disparities in their pain management. Still, most of our knowledge about children's pain management comes from research focused on well-educated, white children and caregivers from a middle- or upper-class background. The aim of this scoping review is to identify, map, and describe existing research on (a) how aspects of marginalization are documented in randomized controlled trials related to children's pain and (b) to understand the pain treatment and experiences of marginalized children and their caregivers in the ED setting. METHODS AND ANALYSIS The review will follow Joanna Briggs Institute methodology for scoping reviews using the Participant, Concept, Context (PCC) framework and key terms related to children, youth, pain, ED, and aspects of marginalization. We will search Medline, Embase, PsychInfo, CINAHL, Web of Science, Cochrane Library Trials, iPortal, and Native Health Database for articles published in the last 10 years to identify records that meet our inclusion criteria. We will screen articles in a two-step process using two reviewers during the abstract and full-text screening stages. Data will be extracted using Covidence for data management and we will use a narrative approach to synthesize the data. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated in academic manuscripts, at academic conferences, and with partners and knowledge users including funders of pain research and healthcare professionals. Results of this scoping review will inform subsequent quantitative and qualitative studies regarding pain experiences and treatment of marginalized children in the ED.
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Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Calveen Basi
- Departments of Chemistry and Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Jaspreet K. Khangura
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Patricia Candelaria
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shannon Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Lorenc J, Flaucher N, Evans E, Schurman JV. Establishing a plan to improve pediatric patient comfort during PIV insertions and blood specimen collection: a quality improvement effort. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S36-S42. [PMID: 38578933 DOI: 10.12968/bjon.2024.33.7.s36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
HIGHLIGHTS Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. BACKGROUND Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. DESIGN AND METHODS The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. AIMS AND OBJECTIVES The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. RESULTS From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. CONCLUSIONS While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.
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Affiliation(s)
- Jamie Lorenc
- Department of Patient Care Services, Children's Mercy Kansas City, Kansas City, MO
| | - Nicholas Flaucher
- Department of Patient Care Services, Children's Mercy Kansas City, Kansas City, MO
| | - Emily Evans
- Department of Patient Care Services, Children's Mercy Kansas City, Kansas City, MO
| | - Jennifer V Schurman
- University of Missouri Kansas City School of Medicine/Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO
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McNeil MJ, Garcia Quintero X, Gonzalez M, Zheng Y, Ugaz Olivares C, Morales R, Boldrini E, Rebollo de Campos D, Ferreira D, Coopasamy K, Caneba J, Padernilla ML, Friedrichsdorf S, Baker JN, Friedrich P. Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries. Cancers (Basel) 2024; 16:1025. [PMID: 38473383 DOI: 10.3390/cancers16051025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.
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Affiliation(s)
- Michael J McNeil
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ximena Garcia Quintero
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Miriam Gonzalez
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yawen Zheng
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Roxana Morales
- Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Daiane Ferreira
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Joliza Caneba
- Philippines General Hospital, Manila 1000, Philippines
| | | | - Stefan Friedrichsdorf
- Division of Pediatric Pain, Palliative Care & Integrative Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford University, Palo Alto, CA 94305, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Jain S, Armstrong M, Luna J, Thakkar RK, Fabia R, Groner JI, Noffsinger D, Ni A, Nelson E, Xiang H. Features of virtual reality impact effectiveness of VR pain alleviation therapeutics in pediatric burn patients: A randomized clinical trial. PLOS DIGITAL HEALTH 2024; 3:e0000440. [PMID: 38271320 PMCID: PMC10810440 DOI: 10.1371/journal.pdig.0000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024]
Abstract
Key features of virtual reality (VR) that impact the effectiveness of pain reduction remain unknown. We hypothesized that specific features of the VR experience significantly impact VR's effectiveness in reducing pain during pediatric burn dressing care. Our randomized controlled trial included children 6 to 17 years (inclusive) who were treated in the outpatient clinic of an American Burn Association-verified pediatric burn center. Participants were randomly assigned (1:1:1) to active VR (playing the VR), passive VR (immersed in the same VR environment without interactions), or standard-of-care. On a scale from 0 to 100, participants rated overall pain (primary outcome) and features of the VR experience (game realism, fun, and engagement). Path analysis assessed the interrelationships among these VR key features and their impact on self-reported pain scores. From December 2016 to January 2019, a total of 412 patients were screened for eligibility, and 90 were randomly assigned (31 in the active VR group, 30 in the passive VR group, and 29 in the standard-of-care group). The current study only included those in the VR groups. The difference in median scores of VR features was not statistically significant between the active (realism, 77.5 [IQR: 50-100]; fun, 100 [IQR: 81-100]; engagement, 90 [IQR: 70-100]) and passive (realism, 72 [IQR: 29-99]; fun, 93.5 [IQR: 68-100]; engagement, 95 [IQR: 50-100]) VR distraction types. VR engagement had a significant direct (-0.39) and total (-0.44) effect on self-reported pain score (p<0.05). Key VR features significantly impact its effectiveness in pain reduction. The path model suggested an analgesic mechanism beyond distraction. Differences in VR feature scores partly explain active VR's more significant analgesic effect than passive VR. Trial Registration: ClinicalTrials.gov Identifier: NCT04544631.
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Affiliation(s)
- Soumil Jain
- College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Megan Armstrong
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - John Luna
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Rajan K. Thakkar
- College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Trauma and Burn Program, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Renata Fabia
- College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Trauma and Burn Program, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Jonathan I. Groner
- College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Trauma and Burn Program, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Dana Noffsinger
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Trauma and Burn Program, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Ai Ni
- Division of Biostatistics, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Eric Nelson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Henry Xiang
- College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
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Cil M, Fidanci BE. The effect of dry heat and dry cold application on pain, anxiety and fear levels before blood sample collection in school age children (7-12 years): A randomized controlled study. J Pediatr Nurs 2023; 73:e401-e408. [PMID: 37863785 DOI: 10.1016/j.pedn.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Blood sampling, which is frequently performed on children admitted to hospital, causes them pain, anxiety and fear. OBJECTIVES The study was carried out to determine the effects of dry heat and dry cold application before blood sampling on pain, anxiety and fear levels in school age children. METHODS The study was conducted between June and January 2021 with a parallel-group randomized controlled experimental design. It was carried out with 117 children who applied to the Pediatric Blood Collection Polyclinic of a training and research hospital. The children were assigned to dry heat application, dry cold application and control group by simple randomization. Data were collected using the Child-Family Introductory Information Form, Wong Baker Faces Pain Rating Scale (WBFPS), Child Fear Anxiety Scale (CFAS) and Medical Procedure Fear Scale (MPFS). In the data analysis, descriptive statistics, the Kruskal-Wallis H test, the Dunn test, Yates correction and the Pearson Chi-Square test were used. A level of p < 0.05 was considered statistically significant. RESULTS It was found that children who were treated with dry heat and dry cold before blood sampling experienced less pain. The anxiety of the children in the dry heat treatment group was lower than the control group. According to the children's MPFS Operational Fear sub-dimension median scores, procedural fear was found to be lower in the dry heat application group. PRACTICE IMPLICATIONS Pediatric nurses can safely use dry heat and dry cold application in the management of invasive procedure-related pain, and dry heat application in the management of anxiety. TRIAL REGISTRATION This trial is registered with the US National Institutes of Health (ClinicalTrials.gov) under the number NCT05974319.
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Affiliation(s)
- Merve Cil
- Department of Child Health and Disease Nursing, Faculty of Health Sciences, University of Lokman Hekim, Söğütözü, Ankara, Turkey.
| | - Berna Eren Fidanci
- Department of Child Health and Disease Nursing, Gulhane Faculty of Nursing, University of Health Sciences, Etlik, Ankara, Turkey.
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Merino-Lobato C, Rodríguez-Gallego I, Pabón-Carrasco M, Romero-Castillo R, Jiménez-Picón N. Virtual reality vs. buzzy®. efficacy in pain and anxiety management during pediatric venipuncture. Systematic review and meta-analysis. J Pediatr Nurs 2023; 73:22-33. [PMID: 37603924 DOI: 10.1016/j.pedn.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/13/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
PROBLEM Non-pharmacological distraction methods are novel alternatives that can help to alleviate pain and anxiety generated by venipuncture in the pediatric population. The aim is to determine the effectiveness of virtual reality, compared to cold and vibration devices (Buzzy® device), as a distraction method used during venipuncture in the management of pain and anxiety in children. ELIGIBILITY CRITERIA Clinical trials, cohort and quasi-experimental studies, published between 2017 and 2022, in Spanish or English and pediatric age, found in Medline, the Cochrane Library, Scopus, Web Of Science, CINAHL and Embase databases. SAMPLE Twenty-one studies were included and ten met the criteria for meta-analysis. RESULTS Fifty-seven percent of the studies evaluate virtual reality, 33.3% the Buzzy® device and 9.5% both comparatively. The effectiveness of virtual reality in reducing pain (66.6%, n = 14) and anxiety (47.6%, n = 10) compared to standard care (control group), 95% CI = 1.53 [0.91-2.16], p < 0.001, I2 = 78% and 95% CI = 1.53 [1.16-1.90]), p < 0.001, I2 = 77% respectively is demonstrated. Similarly, the effectiveness of Buzzy® in reducing pain (42.9%, n = 9) and anxiety (23.8%, n = 5), 95% CI = 1.62 [0.90-2.34], p < 0.001, I2 = 94% and 95% CI = 1.40 [0.06-2.20, p < 0.001, I2 = 91% respectively is demonstrated. Comparatively, there is no significant difference between both methods 95% CI = 0.29 [-0.19-0.78], p = 0.24, I2 = 81%. CONCLUSIONS The methods studied are effective in relieving pain and anxiety during venipuncture. Further research is needed on the level of satisfaction, adverse effects and cost-benefit. IMPLICATIONS This study provides evidence of novel tools in daily practice to provide more humane, holistic and quality care.
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Affiliation(s)
| | - Isabel Rodríguez-Gallego
- Virgen del Rocio University Hospital, 41013, Seville, Spain; Centro Universitario de Enfermería Cruz Roja, adscrito a la Universidad de Sevilla, 41009 Seville, Spain.
| | | | - Rocío Romero-Castillo
- Departamento de Enfermería de la Universidad de Sevilla, Centro Universitario de Enfermería Cruz Roja, adscrito a la Universidad de Sevilla, 41009 Seville, Spain.
| | - Nerea Jiménez-Picón
- Centro Universitario de Enfermería Cruz Roja, adscrito a la Universidad de Sevilla, 41009 Seville, Spain.
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Bray L, Carter B, Kiernan J, Horowicz E, Dixon K, Ridley J, Robinson C, Simmons A, Craske J, Sinha S, Morton L, Nafria B, Forsner M, Rullander AC, Nilsson S, Darcy L, Karlsson K, Hubbuck C, Brenner M, Spencer-Little S, Evans K, Rowland A, Hilliard C, Preston J, Leroy PL, Roland D, Booth L, Davies J, Saron H, Mansson ME, Cox A, Ford K, Campbell S, Blamires J, Dickinson A, Neufeld M, Peck B, de Avila M, Feeg V, Mediani HS, Atout M, Majamanda MD, North N, Chambers C, Robichaud F. Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus. Eur J Pediatr 2023; 182:4707-4721. [PMID: 37566281 PMCID: PMC10587267 DOI: 10.1007/s00431-023-05131-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds. Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.
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Affiliation(s)
| | | | - Joann Kiernan
- Edge Hill University and Alder Hey Children’s Hospital, Liverpool, UK
| | | | | | - James Ridley
- Edge Hill University and National Restraint Reduction Network, Ormskirk, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carol Hilliard
- Children’s Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | | | - Piet L. Leroy
- Maastricht University Medical Centre / Maastricht University, Maastricht, The Netherlands
| | - Damian Roland
- University Hospitals of Leicester NHS Trust and Leicester University, Leicester, UK
| | | | | | | | | | - Ann Cox
- Midlands Partnership NHS Foundation Trust & Keele University, Keele, UK
| | - Karen Ford
- University of Tasmania and the Royal Hobart Hospital, Tasmani, Australia
| | | | - Julie Blamires
- Auckland University of Technology, Auckland, New Zealand
| | | | | | - Blake Peck
- Federation University, Victoria, Australia
| | | | - Veronica Feeg
- Molloy College in Rockville Centre, New York City, USA
| | | | | | | | - Natasha North
- The Harry Crossley Children’s Nursing Development Unit, University of Cape Town, Cape Town, South Africa
| | | | - Fanny Robichaud
- Ulluriaq, Ungava Tulattavik Health Center and UQAM UQO, Québec, Canada
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11
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Simoncini E, Stiaccini G, Morelli E, Trentini E, Peroni DG, Di Cicco M. The Effectiveness of the Buzzy Device in Reducing Pain in Children Undergoing Venipuncture: A Single-Center Experience. Pediatr Emerg Care 2023; 39:760-765. [PMID: 37478814 PMCID: PMC10547103 DOI: 10.1097/pec.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
OBJECTIVES Needle-related procedures are among the most important sources of pain in children in different health care settings. Our study was aimed to evaluate the effectiveness of Buzzy (MMJ Labs, Atlanta, Ga.), a palm-sized bee/ladybug-shaped device combining vibration and cold, as a nonpharmacological strategy to manage needle-related pain in children. METHODS In this single-center, randomized (1:1) controlled open-label study, we enrolled patients aged from 1 month to 18 years who had to undergo a planned outpatient blood sampling in Pisa University Hospital's Department of Pediatrics and randomly allocated them to either the BUZZY group (intervention group) or NO BUZZY group (control group). Pain was estimated using proper pain scales according to age. RESULTS Between May 2021 and January 2022, 234 children aged 8.8 ± 5.1 years (50.8% girls) were enrolled and 117 were treated with the Buzzy device. In the study population, pain inversely correlated with age (r = -0.52, P < 0.001); the intervention group showed significantly lower pain (2.5 ± 2.4 vs 4.7 ± 2.8, P < 0.001) and no difference was found between boys and girls. Significant reduction in pain scores was confirmed when stratifying children by age (29 days to <3 years, P = 0.002; ≥3 to ≤8 years, P < 0.001; >8 years, P < 0.001). CONCLUSIONS The Buzzy device effectively reduces pain caused by percutaneous antecubital venipuncture in children in different age groups and represents a cheap and easy-to-use strategy to manage routine needle-related procedures.
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Affiliation(s)
- Elisa Simoncini
- From the Paediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Giulia Stiaccini
- From the Paediatrics Unit, Pisa University Hospital, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Morelli
- From the Paediatrics Unit, Pisa University Hospital, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Trentini
- From the Paediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Diego G. Peroni
- From the Paediatrics Unit, Pisa University Hospital, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Di Cicco
- From the Paediatrics Unit, Pisa University Hospital, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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12
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Hale AE, Bujoreanu S, LaVigne TW, Coakley R. Rapid Mobilization of an Evidence-Based Psychological Intervention for Pediatric Pain during COVID-19: The Development and Deployment of the Comfort Ability ® Program Virtual Intervention (CAP-V). CHILDREN (BASEL, SWITZERLAND) 2023; 10:1523. [PMID: 37761484 PMCID: PMC10529482 DOI: 10.3390/children10091523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The gold standard of treatment for chronic pain is a multidisciplinary approach in which psychology plays a leading role, but many children and caregivers do not gain access to this treatment. The Comfort Ability® Program (CAP) developed a CBT-oriented group intervention for adolescents and caregivers designed expressly to address access to evidence-based psychological care for pediatric chronic pain. Before the COVID-19 disruption of in-person services, the CAP workshop had been disseminated to a network of 21 children's hospitals across three countries. In March 2020, a virtual (telehealth) format was needed to ensure that children with chronic pain could continue to access this clinical service throughout the CAP Network. METHODS A model of knowledge mobilization was used to adapt the CAP workshop to a virtual format (CAP-V) and disseminate it to network sites. A pilot study assessing participant and clinician perceptions of acceptability, feasibility, and treatment satisfaction included baseline, post-sessions, and post-program questionnaires. RESULTS A knowledge mobilization framework informed the rapid development, refinement, and mobilization of CAP-V. Data from a pilot study demonstrated feasibility and high acceptability across participants and clinicians. CONCLUSIONS A knowledge mobilizationframework provided a roadmap to successfully develop and deploy a virtual behavioral health intervention for adolescents with chronic pain and their caregivers during a worldwide pandemic. While CAP-V has demonstrated preliminary clinical feasibility and acceptability at the CAP hub, ongoing research is needed.
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Affiliation(s)
- Amy E. Hale
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
- Division of Gastroenterology, Hepatology & Nutrition, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Simona Bujoreanu
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
| | - Timothy W. LaVigne
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
| | - Rachael Coakley
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
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13
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Würtz G, Schmidt C, Jensen CS, Teilman G, Konradsen H. Pediatric pain knowledge and attitudes among health care professionals-A National Danish Survey. PAEDIATRIC & NEONATAL PAIN 2023; 5:76-85. [PMID: 37744283 PMCID: PMC10514779 DOI: 10.1002/pne2.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/05/2023] [Accepted: 03/23/2023] [Indexed: 09/26/2023]
Abstract
Aim To explore and compare Danish health-care professionals' attitudes and knowledge towards pain management of children. Methods The cross-sectional study was carried out using the Pediatric Pain Knowledge and Attitudes Questionnaire. The questionnaire was distributed to all health care professionals caring for children in three hospital settings, including nurses and physicians in departments of pediatric, emergency, and anesthesia and medical laboratory technologists. Results The study was conducted in 2020 and 765 health care professionals participated. Within the six main categories included in the questionnaire, there were significant differences between nurses and physicians in three subcategories: view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Comparing nurses with medical laboratory technicians, there were significant differences in the subcategory "view on the care of children in pain." Comparing types of clinical departments, there were significant differences in the subcategories' view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Overall, we found that the participating health professionals did not have a uniform understanding of pain management and therefore might treat children differently. Conclusion The present study highlights the need to align health care professionals' knowledge regarding pain assessment and management of children, as well as the need to develop and test interventions that support the use of knowledge in practice.
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Affiliation(s)
- Gitte Würtz
- Department of PediatricsHerlev and Gentofte University HospitalHerlevDenmark
| | - Christina Schmidt
- Department of PediatricsHerlev and Gentofte University HospitalHerlevDenmark
| | - Claus Sixtus Jensen
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
- Research Center for Emergency MedicineAarhus University HospitalAarhusDenmark
- Department of Clinical Medicine HealthAarhus UniversityAarhusDenmark
| | - Grete Teilman
- Department of Pediatrics and Adolescent Medicine, Nordsjællands HospitalUniversity of CopenhagenHillerødDenmark
| | - Hanne Konradsen
- Department of GastroenterologyHerlev and Gentofte University HospitalHerlevDenmark
- Division of Nursing, Department of Neurobiology, Care Science and SocietyKarolinska InstitutetStockholmSweden
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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H A, Rao A, Natarajan S, Yarmunja Mahabala K, Nayak A. Efficacy of an external cold and vibrating device in reducing discomfort during the administration of an inferior alveolar nerve block in children: A split-mouth randomised crossover study. F1000Res 2023; 12:984. [PMID: 38550249 PMCID: PMC10973762 DOI: 10.12688/f1000research.138340.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 04/02/2024] Open
Abstract
Background: Local anaesthesia is the backbone of pain management. However, the administration of a local anaesthetic injection itself is considered a painful procedure and triggers fear and anxiety in the patient. Methods: A split-mouth randomised controlled crossover trial was designed to study the efficacy of an "external cold and vibrating" device in reducing discomfort during the administration of an inferior alveolar nerve block (IANB) in children. A total of 40 children who fulfilled the inclusion criteria were evaluated for pain response following administration of IANB with and without the "external cold and vibrating" device. Randomisation was performed to determine whether the subject received the control intervention first or the test intervention first. The intensity of the pain response and discomfort were recorded using the Wong-Baker FACES Pain Rating Scale and the Faces Legs Activity Cry and Consolability scale. Results: There was a statistically significant difference in the pain response between the test group and the control group (p<0.001). Females reported a higher pain response than males, with a statistically significant difference, when the FLACC scores were compared. Conclusions: The "external cold and vibrating" device reduced discomfort during the administration of an IANB in children selected for the study.
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Affiliation(s)
- Ananthu H
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Mangalore, Karnataka, India
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwin Rao
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Mangalore, Karnataka, India
| | - Srikant Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Karuna Yarmunja Mahabala
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Mangalore, Karnataka, India
| | - Anupama Nayak
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Mangalore, Karnataka, India
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15
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Kasahun AE, Sendekie AK, Abebe RB. Assessment of pain management adequacy among hospitalized pediatric patients: institutional-based cross-sectional study. Front Pediatr 2023; 11:1195416. [PMID: 37593444 PMCID: PMC10427853 DOI: 10.3389/fped.2023.1195416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
Background As the evidence showed, despite the magnitude of the effects that pain can have on a child, it is often inadequately assessed and treated. However, whether pain is adequately treated or not, evidence is lacking in the study setting. Objectives This study assessed pain management adequacy among hospitalized pediatric patients at the University of Gondar Comprehensive Specialized Hospital, Ethiopia. Methods An institution-based cross-sectional study was conducted among pediatric patients admitted to the University of Gondar Comprehensive and Specialized Hospital between June and August 2021. Eligible patients were enrolled in the study using consecutive sampling techniques. Data were collected using a structured interview-based questionnaire and a review of the patient's medical records that were prepared after reviewing earlier studies. Pain management adequacy was determined using the pain management index (PMI) score. Statistical Software for Social Sciences (SPSS) version 22 was used for data entry and analysis. Descriptive statistics such as frequencies, percentages, and means with standard deviation were used to describe the respective variables. Logistic regression was used to assess predictor variables of pain management adequacy. A p-value <0.05 at a 95% CI was considered statistically significant. Results Of the 422 participants enrolled in the study, most (58.1%) were males, with a mean age of 3.9 ± 0.8 years. Pain medication was prescribed to 62.8% (95% CI: 57.3-68.2) of the participants. About 63.3% (95% CI: 58.8%-68%) received inadequate analgesics. The type of painkillers administered also did not match the severity of the pain. Pediatric patients less than 1 month and between 1 month and 1 year (AOR = 2.891, 95% CI: 1.274-12.899 and AOR = 2.657, 95% CI: 1.350-5.175), respectively, and patients with severe and moderate levels of pain (AOR = 3.448, 95% CI: 1.902-6.251 and AOR = 5.345, 95% CI: 1.956-9.828), respectively, were found to have inadequate pain medication compared with their counterparts. Conclusion This study revealed that pain was hardly managed based on its severity. Overall, two-thirds of pediatric patients received inadequate pain medication. This indicates majority of patients experienced pain did not manage appropriately.
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Affiliation(s)
- Asmamaw Emagn Kasahun
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rahel Belete Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Maiandi S, Ghizzardi G, Edefonti V, Giacchero R, Lusignani M, Giannì ML. Is the equimolar mixture of oxygen and nitrous oxide (EMONO) associated with audiovisuals effective in reducing pain and side effects during peripheral venous access placement in children? Protocol for a single-centre randomised controlled trial from Italy. BMJ Open 2023; 13:e067912. [PMID: 37419632 PMCID: PMC10335544 DOI: 10.1136/bmjopen-2022-067912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/31/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Nurses frequently place a peripheral venous catheter during children's hospitalisation. Many studies suggest treatment of venipuncture-related pain. The administration of an equimolar mixture of oxygen and nitrous oxide (EMONO) is employed for pain control; however, no studies have analysed the association between EMONO and audiovisuals.The purpose of the study is to evaluate the effect of EMONO administration when combined with audiovisuals (EMONO+Audiovisual) versus EMONO alone on perceived pain, side effects and level of cooperation during peripheral venous access placement in children aged 2-5 years. METHODS AND ANALYSIS The first 120 eligible children admitted to the paediatric ward of the Lodi Hospital and presenting the indication for peripheral venous access will be enrolled. Sixty children will be randomly assigned to the experimental group (EMONO+Audiovisual) and 60 to the control group (EMONO alone).The Face, Legs, Activity, Cry, Consolability scale will be used to assess pain in the children aged 2-years old; pain in the children aged 3-5 years will be assessed using the Wong-Baker scale. The cooperation throughout the procedure will be measured using the Groningen Distress Rating Scale. ETHICS AND DISSEMINATION The Milan Area 1 Ethics Committee approved the study protocol (Experiment Registry No. 2020/ST/295). The trial results will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05435118.
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Affiliation(s)
- Stefano Maiandi
- Healthcare Professions Directorate - ASST di Lodi, Lodi, Italy
| | - Greta Ghizzardi
- Healthcare Professions Directorate - ASST di Lodi, Lodi, Italy
| | - Valeria Edefonti
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology, "G.A. Maccacaro," University of Milan, Milano, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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17
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Paul A, Demissie S, Schmidlein PJ, Romanos-Sirakis E. Pediatric and emergency medicine resident comfort assessing and treating pediatric pain across pediatric age groups. Pain Manag 2023; 13:343-350. [PMID: 37435688 DOI: 10.2217/pmt-2023-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Aim: Assess pediatric and emergency medicine (EM) resident comfort treating and assessing pediatric pain. Materials & methods: Pediatric and EM residents at a single institution (SIUH Northwell Health in New York) completed an anonymous survey 6 months into the academic year regarding comfort assessing and treating pediatric pain. Results: A total of 40 (16/24 EM and 24/24 pediatric) residents completed this survey: 20% (8/24) pediatric first year residents, 40% (16/40) pediatric second year and above, 20% (8/40) EM first year and 20% (8/40) EM second year and above. A 46% (11/24) pediatric and 12% (2/16) EM residents were comfortable assessing neonatal pain (p < 0.05). A 38% (9/24) pediatric residents were comfortable treating neonatal pain compared with 12% (2/16) EM residents (p < 0.05). Both resident groups reported increasing comfort assessing and treating pain with increasing patient age. Conclusion: Both residents groups reported limitations in comfort assessing and treating pediatric pain, especially in younger patients. Education for both groups is important to optimize pediatric pain management.
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Affiliation(s)
- Amy Paul
- Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, 10305 NY, USA
| | - Seleshi Demissie
- Department of Biostatistics, Staten Island University Hospital Northwell Health, Staten Island, 10305 NY, USA
| | - Patrick J Schmidlein
- Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, 10305 NY, USA
| | - Eleny Romanos-Sirakis
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Staten Island University Hospital, Northwell Health, Staten Island, 10305 NY, USA
- Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
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18
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Poonai N, Creene C, Dobrowlanski A, Geda R, Hartling L, Ali S, Bhatt M, Trottier ED, Sabhaney V, O'Hearn K, Jain R, Osmond MH. Inhaled nitrous oxide for painful procedures in children and youth: a systematic review and meta-analysis. CAN J EMERG MED 2023:10.1007/s43678-023-00507-0. [PMID: 37171705 DOI: 10.1007/s43678-023-00507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/02/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The objective of this study was to synthesize indication-based evidence for N2O for distress and pain in children. STUDY DESIGN We included trials of N2O in participants 0-21 years, reporting distress or pain for emergency department procedures. The primary outcome was procedural distress. Where meta-analysis was not possible, we used Tricco et al.'s classification of "neutral" (p ≥ 0.05), "favorable," or "unfavorable" (p < 0.05, supporting N2O or comparator, respectively). We used the Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate risk of bias and quality of evidence, respectively. RESULTS We included 30 trials. For pain using the Visual Analog Scale (0-100 mm) during IV insertion, 70% N2O (delta:-16.5; 95%CI:-28.6 to -4.4; p = 0.008; three trials; I2 = 0%) and 50% N2O plus eutectic mixture of local anesthetics (EMLA) (delta:-1.2; 95%CI:-2.1 to -0.3; p = 0.007; two trials; I2 = 43%) were superior to EMLA. 50% N2O was not superior to EMLA (delta:-0.4; 95%CI:-1.2 to 0.3; p = 0.26; two trials; I2 = 15%). For distress and pain during laceration repair, N2O was "favorable" versus each of SC lidocaine, oxygen, and oral midazolam but "neutral" versus IV ketamine (five trials). For distress and pain during fracture reduction (three trials), N2O was "neutral" versus each of IM meperidine plus promethazine, regional anesthesia, and IV ketamine plus midazolam. For distress and pain during lumbar puncture (one trial), N2O was "favorable" versus oxygen. For distress and pain during urethral catheterization (one trial), N2O was "neutral" versus oral midazolam. For pain during intramuscular injection (one trial), N2O plus EMLA was "favorable" versus N2O and EMLA alone. Common adverse effects of N2O included nausea (4.4%), agitation (3.7%), and vomiting (3.6%) AEs were less frequent with N2O alone (278/1147 (24.2%)) versus N2O plus midazolam (48/52 (92.3%)) and N2O plus fentanyl (123/201 (61.2%)). CONCLUSIONS There is sufficient evidence to recommend N2O plus topical anesthetic for IV insertion and laceration repair. Adverse effects are greater when combined with other sedating agents.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, ON, Canada.
- Division of Emergency Medicine, Western University, London, ON, Canada.
- Children's Health Research Institute, London Health Sciences Centre, London, ON, Canada.
- Division of Pediatric Emergency Medicine, Children's Hospital, London Health Sciences Centre, London, ON, Canada.
| | | | | | - Rishika Geda
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Maala Bhatt
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Evelyne D Trottier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Vikram Sabhaney
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Katie O'Hearn
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rini Jain
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Martin H Osmond
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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19
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Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy Diagnostic Criteria for Acute Needle Pain. THE JOURNAL OF PAIN 2023; 24:387-402. [PMID: 36243317 DOI: 10.1016/j.jpain.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
Needle procedures are among the most common causes of pain and distress for individuals seeking health care. While needle pain is especially problematic for children needle pain and associated fear also has significant impact on adults and can lead to avoidance of appropriate medical care. Currently there is not a standard definition of needle pain. A taxonomy, or classification system, for acute needle pain would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including needle pain. To accomplish this, a working group of experts in needle pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact and/or functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific needle pain. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of needle associated fear, are proposed to define the types of acute needle pain. PERSPECTIVE: This article presents a taxonomy for acute needle pain. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients undergoing needle procedures.
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Scribner-O'Pray M, Taylor ED, Krause E, Nickel A, Bergmann KR. Factors Associated With Low Procedural Pain Scores Among 1- to 5-Year-Old Patients Undergoing Facial Laceration Repair. Pediatr Emerg Care 2023; 39:135-141. [PMID: 35608526 DOI: 10.1097/pec.0000000000002744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our objectives were to quantify pain experienced by young children undergoing facial laceration repair and identify factors associated with low procedural pain scores. METHODS We conducted a prospective cohort study of children's distress among a convenience sample of children aged 1 to 5 years undergoing facial or scalp laceration repair in 2 pediatric emergency departments. We reviewed video recordings and documented pain scores at 15-second intervals using the Face, Leg, Activity, Cry, Consolability-Revised (FLACC-r) scale. We dichotomized FLACC-r into low/high scores (≤3 and >3) to evaluate practice variables. RESULTS We included 11,474 FLACC-r observations from 258 procedures in the analysis. Two-thirds of 3- to 5-year-olds completed their laceration repair without the use of restraint, sedation, or anxiolytics. Mean distress scores were low (≤2.5 out of 10) across all procedure phases for 2- to 5-year-old patients. One-year-old patients experienced significantly more distress than their older counterparts (mean ≤4.2 out of 10). Odds of having low FLACC scores (≤3) were greater for patients with an expert clinician (adjusted odds ratio [aOR]: 1.72; 95% confidence interval [CI], 1.05-2.84). Wound infiltration (aOR, 0.35; 95% CI, 0.13-0.93), patient observation of a needle (aOR, 0.21; 95% CI, 0.14-0.33), and restraint (aOR, 0.04; 95% CI, 0.02-0.06) were negatively associated with low FLACC score. CONCLUSION The majority of 3- to 5-year-old patients were able to undergo facial laceration repair without restraint, sedation, or anxiolytics and with low mean distress scores. Our findings suggest that children's risk of experiencing moderate and severe distress during facial and scalp laceration repair may be reduced by prioritizing wound closure by expert-level clinicians, ensuring effective lidocaine-epinephrine-tetracaine application, avoiding restraint, and concealing needles from patient view.
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Affiliation(s)
| | | | - Ernest Krause
- Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Amanda Nickel
- Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
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Yabeyu AB, Haile KT, Molore S. Community Pharmacy Professional's Knowledge, Attitude, and Practice with Regard to Pediatric Pain Management. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2023; 12:1-9. [PMID: 36688092 PMCID: PMC9850829 DOI: 10.2147/iprp.s391415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
Background Effective pain relief is an essential component of high-quality healthcare delivery, and pharmacists must be well versed in pain mechanisms, assessment, and management. This study examined community pharmacy professional's (CPPs) knowledge and attitude towards pediatric pain management in Community pharmacies (CPs) and Drug Retail Outlets (DRO) of Ambo and Ginchi towns, west central Ethiopia. Methods A cross sectional study was conducted in Ambo and Ginchi towns, the western part of the nation's capital. All voluntary CPPs working by CPs and DRSs in the towns of Ambo and Ginchi were included in the current study. SPSS version 25 was then used to process, analyze, and interpret the data. Results Among the 131 CPPs who were approached for the study, 104 agreed to participate and returned the questionnaire. CPPs mean knowledge score on pediatric pain management was 6.69 ±1.92, with a minimum score of 2 and a maximum score of 17. The majority of CPPs 82 (87.2%) in the study did not correctly answer half of the questions. Most of CPPs, 98 (94.3%), admitted they had no training in pain management, and 102 (98.2%) of the respondents said the same about pediatric pain management. The finding indicated that CPPs work experience in CP or DROs had impact on their knowledge about pediatric pain management and similarly, the mean knowledge score of pharmacists was higher than that of pharmacy technicians. Conclusion This study revealed that CPPs have inadequate knowledge and attitude to provide effective pediatric pain management service. To bridge the knowledge gap and effectively control pediatric pain, pharmacists who are actively practicing their profession are advised to continue their medical education and training.
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Affiliation(s)
- Abdella Birhan Yabeyu
- Department of Pharmacy, Ambo University, Ambo, Ethiopia,Correspondence: Abdella Birhan Yabeyu, Email
| | - Kaleab Taye Haile
- Department of Social Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Selamu Molore
- Department of Pharmacy, Ambo University, Ambo, Ethiopia
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Kristensen HN, Laugesen B, Stinson J, Haslund-Thomsen H. The Impact and Influence of Hospital Clowns on Hospitalized Children Undergoing Painful Procedures: A Mixed Methods Study. Glob Qual Nurs Res 2023; 10:23333936231186599. [PMID: 37538194 PMCID: PMC10395183 DOI: 10.1177/23333936231186599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023] Open
Abstract
Hospital clowns are widely used in pediatric settings. However, the field of pain and pain experience in children is complex and multifaceted. Therefore, the aim of this study was to expand knowledge on the impact and influence of hospital clowns on 4 to 15-year-old children's experiences of managing painful procedures and conditions. A convergent mixed method study was conducted integrating findings from three individual studies: a prospective non-blinded study and two focused ethnographic studies. The findings illuminated a child-clown interaction characterized by a close relationship evolving during a continuous, mutually focused attention, conceptualized as WE. This WE represent a responsive interaction between child and clown, which supported the child during the procedures, and generated three integrated findings: an age-differentiated approach; understanding the child's condition; and previous experiences as a part of the child's history. The WE approach strengthened the child's competences and ability to manage during painful procedures.
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Affiliation(s)
| | - Britt Laugesen
- Aalborg University Hospital, Denmark
- Aalborg University, Denmark
| | - Jennifer Stinson
- University of Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Situación actual y retos de los pediatras españoles en el manejo del dolor infantil. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mozo Del Castillo Y, Toledo Del Castillo B, Navarro Marchena L, Leyva Carmona M, Monfort Carretero L, Míguez Navarro MC, Marsinyach Ros I. Challenges and current status of children pain management in Spain. An Pediatr (Barc) 2022; 97:207.e1-207.e8. [PMID: 35970753 DOI: 10.1016/j.anpede.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Pain in children population is prevalent, but its proper diagnosis and management are frequently insufficient in pediatrics daily practice. Lack of knowledge of the professionals in charge is a recognized barrier to ensure an appropiate approach to pain in this population. Our present study reflects the current status of pain management and the challenges in diagnosis and treatment that pediatricians face in their daily work. This information is obtained from a survey made with a voluntary questionaire, desinged and distributed online by "Grupo Español para el Estudio del Dolor Pediátrico (GEEDP)" to pediatricians in Spain from october 2021 to march 2022. The final objective of the questionaire was to shed some light into the problem and find out which areas of pain management knowledge are in need of improvent.
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Affiliation(s)
| | - Blanca Toledo Del Castillo
- Unidad de Pediatría Interna Hospitalaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain
| | - Lucía Navarro Marchena
- Servicio de Atención Paliativa y Paciente Crónico Complejo, Hospital Infantil Sant Joan De Dèu, Barcelona, Spain
| | - Moisés Leyva Carmona
- Unidad de Cuidados Paliativos Pediátricos, Hospital Universitario Materno Infantil Torrecárdenas, Almería, Spain
| | - Laura Monfort Carretero
- Servicio de Atención Paliativa y Paciente Crónico Complejo, Hospital Infantil Sant Joan De Dèu, Barcelona, Spain
| | - María Concepción Míguez Navarro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain; Unidad de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Itziar Marsinyach Ros
- Unidad de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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The Perceptions of Children and Adolescents with Cancer Regarding Nurses’ Communication Behaviors during Needle Procedures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159372. [PMID: 35954729 PMCID: PMC9368135 DOI: 10.3390/ijerph19159372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 12/04/2022]
Abstract
Background: Communicating with children and adolescents with cancer during a needle procedure can prove challenging for healthcare professionals. Objective: Our aim was to explore the perceptions of children and adolescents with cancer regarding communication with nurses during needle procedures. Method: Thus was a qualitative phenomenological study. Data were gathered through seven in-depth interviews with a convenience sample of children and adolescents with cancer. Data were analyzed using a grounded theory approach to identify themes in the participants’ narratives. Results: The analysis revealed three themes describing participants’ experience: (1) nurses need to explain clearly what they are going to do while also allowing children to express their emotions without feeling coerced; (2) nurses need to be honest and approachable and relate to children as active participants in the treatment process; and (3) it is distressing to hear other children who are undergoing a needle procedure cry out in pain. Further application of the constant comparison method yielded a core theme: (4) the pressures faced by oncology nurses lead them to focus on the technical side of procedures at the expense of their young patients’ communication needs. Conclusions: We suggest that hospital managers need to ensure that oncology nurses have sufficient training in communication skills and are confident in their ability to respect and respond to the communication preferences and needs of patients.
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Carvalho JA, Souza DMD, Domingues F, Amatuzzi E, Pinto MCM, Rossato LM. Pain management in hospitalized children: A cross-sectional study. Rev Esc Enferm USP 2022; 56:e20220008. [PMID: 35652630 PMCID: PMC10111388 DOI: 10.1590/1980-220x-reeusp-2022-0008en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize pain management in hospitalized children. METHOD This is an observational, cross-sectional, retrospective and descriptive study of quantitative approach, carried out in a secondary hospital in the city of São Paulo, through analysis of 1,251 medical records of children admitted to the pediatric department. Data were tabulated and analyzed through descriptive statistics. RESULTS A total of 88.8% of children were assessed for pain with standardized instruments and 86% had analgesia prescribed. Among the assessments, 37.8% of the children had pain; of these, 26% had severe pain, greater in orthopedic conditions; 18.3% were not medicated, even with the presence of pain and prescribed analgesia; 4.3% had no analgesics prescribed; only 0.4% received non-pharmacological measures, and 40.3% had a report of reassessment. Professionals provided greater analgesia to children with surgical and orthopedic conditions compared to clinical conditions (p < 0.05). CONCLUSION Pain management in hospitalized children is ineffective, from initial assessments to reassessments after interventions, with prioritization of medication actions guided by professional judgment in the face of pain complaints.
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Affiliation(s)
- Joese Aparecida Carvalho
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| | - Danton Matheus de Souza
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| | - Flávia Domingues
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| | - Edgar Amatuzzi
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| | | | - Lisabelle Mariano Rossato
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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Payson A, Pulido A, San Martin S, Garlesky C, Garcia E, Reyes C, Reyes M, Leyenaar J. Inequities in Pain Assessment and Care of Hospitalized Children With Limited English Proficiency. Hosp Pediatr 2022; 12:561-568. [PMID: 35499379 DOI: 10.1542/hpeds.2021-006445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To examine inequities in pain assessment and management of hospitalized children with limited English proficiency (LEP) as assessed by (1) self-reported pain prevalence and intensity, and (2) nurse-documented pain assessments and analgesia. METHODS A cross-sectional survey of hospitalized children and parent proxies examined preferred language and pain prevalence, intensity, and etiology; subsequent electronic medical record chart review examined demographics, nurse-documented pain scores, and analgesia prescribed for children aged ≤21 years at a tertiary care children's hospital. The primary outcome was a difference of ≥3 points between self-reported and nurse-documented worst pain scores. Descriptive statistics, Fisher's exact tests, and multivariable logistic regression were used to identify differences in outcomes between children with and without LEP. RESULTS A total of 155 patients (50% children and 50% parental proxies) were interviewed (96% response rate). Of those, 60% (n = 93) reported pain in the previous 24 hours, most frequently because of acute illnesses. Of patients reporting pain, 65% (n = 60) reported a worst pain score of ≥3 points higher than nurse-documented scores; this discrepancy affected more patients with LEP (82%, n = 27) than English-proficient patients (55%, n = 33) (P = .01) with an adjusted odds ratio of 3.2 (95% confidence interval: 1.13-10.31). Patients with LEP were also less likely than English-proficient patients to receive medications at the time of their worst pain (60% vs 82%, P = .03), particularly opioid analgesia (9% vs 22%, P = .04). CONCLUSIONS Children with LEP were more likely to self-report pain scores that exceeded nurse-documented scores and received less medications, particularly opiates. This population may be particularly vulnerable to underassessment and inadequate management of pain.
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Affiliation(s)
- Alison Payson
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Anamaria Pulido
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | | | - Cindy Garlesky
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Erileen Garcia
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Clara Reyes
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Mario Reyes
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - JoAnna Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Andersson V, Bergman S, Henoch I, Simonsson H, Ahlberg K. Pain and pain management in children and adolescents receiving hospital care: a cross-sectional study from Sweden. BMC Pediatr 2022; 22:252. [PMID: 35513880 PMCID: PMC9074244 DOI: 10.1186/s12887-022-03319-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pain is a common symptom in children receiving hospital care. Adequate pain management in paediatric patients is of the utmost importance. Few studies have investigated children’s own experiences of pain during hospitalization. Aim To describe the prevalence of pain, self-reported pain intensity at rest and during movement, pain management and compliance with pain treatment guidelines in children and adolescents receiving hospital care. Furthermore, to examine self-reported statements about pain relief and how often staff asked about pain. Methods A quantitative, cross-sectional study with descriptive statistics as the data analysis method was conducted at a county hospital in western Sweden. Sixty-nine children/adolescents aged 6–18 years who had experienced pain during their hospital stay were included. A structured, verbally administered questionnaire was used to obtain pain reports. The participants were also asked what they considered alleviated pain and how often they told staff about pain. Patient demographics, prescribed analgesics and documentation of pain rating were obtained from medical records. Results Fifty children/adolescents (72%) experienced moderate to severe pain in the previous 24 hours. At the time of the interview 36% reported moderate to severe pain at rest and 58% during movement. Seven participants (10%) reported severe pain both at rest and during movement. About one-third were on a regular multimodal analgesic regimen and 28% had used a validated pain rating scale. Thirty children/adolescents (43%) reported that they had experienced procedural pain in addition to their underlying pain condition. Most of the children/adolescents (74%) reported that analgesics provided pain relief. Forty (58%) stated that various non-pharmacological methods were helpful. Conclusions Despite evidence-based guidelines, half of the children/adolescents experienced moderate to severe pain, highlighting the need for improvement. Pain levels should be assessed both at rest and during movement. Response to treatment should be evaluated to prevent undertreatment of pain. Compliance with guidelines and professional communication are of the utmost importance for pain management in children/adolescents. Non-pharmacological methods are a valuable part of a pain management strategy. This study shows that it is important to evaluate and improve pain care also outside specialised tertiary clinics.
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Affiliation(s)
- Viveka Andersson
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Medicine, Halland Hospital Varberg, Träslövsvägen 68, 432 37, 432 81, Varberg, SE, Sweden.
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden
| | - Ingela Henoch
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Angered Local Hospital, Gothenburg, Sweden
| | - Hanna Simonsson
- Department of Surgery, Halland Hospital Halmstad, Halmstad, Sweden
| | - Karin Ahlberg
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Trottier ED, Farley St-Amand B, Vincent M, Chevalier I, Autmizguine J, Tremblay S, Gouin S. Outpatient management of moderate cellulitis in children using high-dose oral cephalexin. Paediatr Child Health 2022; 27:213-219. [PMID: 35859686 PMCID: PMC9291389 DOI: 10.1093/pch/pxac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 02/25/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients.
Methods
In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution’s HD oral cephalexin guideline over a 2-year period. All children had standardized follow-up at a medical day hospital (MDH). Treatment was considered effective in the absence of treatment failure, defined as admission, switch to IV treatment or ED visit within 2 weeks of discharge from the MDH. Safety was ascertained by recording adverse events and severe complications at follow-up.
Results
A total of 123 children were treated as outlined in the guideline, including 117 treated with HD oral cephalexin. The success rate was 89.7% (105/117). Among 12 (10.3%) children who had treatment failure, 10 (8.5%) required admission, 1 (0.9%) received IV antibiotics at the MDH and 1 (0.9%) had a return visit to the ED without admission. No severe complications were reported; four abscesses required drainage and one patient had a rash. The mean number of visits per child at the MDH was 1.6 (SD 1.0).
Conclusions
With a success rate of 89.7%, HD oral cephalexin seems effective and safe for the treatment of children with moderate cellulitis. Its use potentially reduces hospitalization rates for this condition and decreases the need for IV insertion.
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Affiliation(s)
- Evelyne D Trottier
- Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Beatrice Farley St-Amand
- Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Mélanie Vincent
- Department of Paediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Isabelle Chevalier
- Department of Paediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Julie Autmizguine
- Department of Paediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Department Pharmacology and Physiology, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Stéphanie Tremblay
- Department of Pharmacy, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Serge Gouin
- Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
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Uwimana P, Mukamana D, Babenko-Mould Y, Adejumo O. Exploring factors affecting the facilitation of nursing students to learn paediatric pain management in Rwanda: A descriptive qualitative study. PLoS One 2022; 17:e0263609. [PMID: 35171933 PMCID: PMC8849445 DOI: 10.1371/journal.pone.0263609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Nurse educators and nurse preceptors play a fundamental role in facilitating nursing students' acquisition and utilization of professional competencies. Previous studies about key elements for teaching and learning about pain in nursing education programs include students' personal characteristics and previous experiences; educators' knowledge, skills, and beliefs; learners' exposure to leaders in pain education; and curricular pain content and delivery approaches. These studies were mainly carried out in developed countries, with a context of educational and health care systems different from those of developing countries. The current study explores academics', clinical nurse preceptors', and nursing students' perceptions about factors influencing the facilitation of nursing students' competency for paediatric pain management in Rwanda. A qualitative descriptive exploratory design was used in this study that utilized in-depth interviews with six nurse educators and eight nurse preceptors, and focus group discussions with nineteen senior year nursing students. The study setting included five sites: two academic institutions and three clinical settings. Narratives from participants were transcribed verbatim and analysed using thematic analysis. The analysis yielded six themes describing factors that affected the facilitation of students' learning about paediatric pain management. The themes included student motivation, facilitators' attributes, collaboration between academics and clinicians, nurses' limited autonomy for decision-making regarding PPM practices, shortage of human and material resources, and educational qualification. Knowing these factors is essential as it provides an opportunity to design targeted interventions aimed to enhance the capacity of nurse educators and clinical nurse preceptors involved in teaching nursing students about paediatric pain management.
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Affiliation(s)
- Philomene Uwimana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Yolanda Babenko-Mould
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Oluyinka Adejumo
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Lin CH, Liaw JJ, Chen YT, Yin T, Yang L, Lan HY. Efficacy of Breast Milk Olfactory and Gustatory Interventions on Neonates’ Biobehavioral Responses to Pain during Heel Prick Procedures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031240. [PMID: 35162263 PMCID: PMC8834920 DOI: 10.3390/ijerph19031240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 01/27/2023]
Abstract
This study aimed to evaluate the efficacy of breast milk odor either alone or in combination with breast milk taste (via syringe-feeding) to alleviate neonates’ biobehavioral responses to pain during heel-prick procedures. This prospective randomized controlled trial recruited 114 neonates by convenience sampling from a newborn unit of a medical center in Taiwan. Neonates were randomly assigned to three groups: control (gentle touch + human voice), control + breast milk odor, and control + breast milk odor + breast milk taste. Heart rate, oxygen saturation, and voice recordings of crying were measured across heel-prick procedures: baseline, no stimuli (stage 0); during heel prick (Stages 1–4); and recovery (Stages 5–10). Generalized estimating equations and Kaplan–Meier survival analysis compared differences in changes between groups for heart rate, oxygen saturation, and time to crying cessation. Changes in mean heart rate and oxygen saturation in neonates receiving breast milk odor or breast milk odor + breast milk taste were significantly less than those at the corresponding stage for the control group. Among neonates receiving breast milk odor or breast milk odor + breast milk taste, hazard rate ratios for crying cessation were 3.016 and 6.466, respectively. Mother’s breast milk olfactory and gustatory interventions could stabilize the biobehavioral responses to pain during heel prick procedures in neonates.
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Affiliation(s)
- Chiao-Hsuan Lin
- Department of Nursing, Tri-Service General Hospital, Taipei 11490, Taiwan; (C.-H.L.); (T.Y.)
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Yu-Ting Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Ti Yin
- Department of Nursing, Tri-Service General Hospital, Taipei 11490, Taiwan; (C.-H.L.); (T.Y.)
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Luke Yang
- Department of Social Work, Hsuan Chuang University, Taipei 30092, Taiwan;
| | - Hsiang-Yun Lan
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan;
- Correspondence:
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Ding Y, Yin H, Wang S, Meng Q, Yan M, Zhang Y, Chen L. Effectiveness of clown intervention for pain relief in children: A systematic review and meta-analysis. J Clin Nurs 2022; 31:3000-3010. [PMID: 34985166 DOI: 10.1111/jocn.16195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/20/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pain is common in children receiving medical procedures, and there is a lack of adequate awareness and management. In addition, children who undergo medical procedures involving pain may also experience stress, crying and prolonged hospitalisation. Clown intervention is a promising nonpharmacological intervention. However, studies on the effectiveness of clown intervention in pain management have reported conflicting findings. OBJECTIVE To evaluate the effectiveness of clown intervention in relieving pain in children, as well as its effects on cortisol levels, crying duration and length of hospital stay. DESIGN Systematic review and meta-analysis of randomised controlled studies. DATA SOURCES PubMed, Web of Science (SCI), Embase, PsycINFO, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang Data and SinoMed were systematically searched from inception date to December 31, 2020. REVIEW METHODS Two reviewers independently used the Cochrane risk of bias tool to assess the risk of bias of the included studies. Meta-analysis was conducted when data were available, otherwise, a narrative description was provided. Data were analysed using Review Manager 5.3. The review process is reported according to PRISMA. RESULTS Nine studies including 852 children met the inclusion criteria. The results showed that compared with standard care, clown intervention was beneficial for relieving pain. Further subgroup analysis showed that it was more effective with children aged 2-7 years. The duration of crying after the procedure and the length of stay were shortened, but there was no significant difference in cortisol levels. CONCLUSION Clown intervention may be a promising way to relieve acute pain in children, especially those aged 2-7 years. It also seems to shorten the duration of crying and the length of hospital stays, but the effect on cortisol levels is still uncertain. More high-quality randomised controlled trials are needed to confirm these results and take into account different age groups, cultural backgrounds and specific populations.
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Affiliation(s)
- Yiwen Ding
- School of Nursing, Jilin University, Changchun, China
| | - Huiru Yin
- School of Nursing, Jilin University, Changchun, China
| | - Shuo Wang
- School of Nursing, Jilin University, Changchun, China
| | - Qiuyan Meng
- School of Nursing, Jilin University, Changchun, China
| | - Mingli Yan
- School of Nursing, Jilin University, Changchun, China
| | - Yining Zhang
- First Hospital of Jilin University, Changchun, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China.,Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China
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Matula ST, Irving SY, Deatrick JA, Steenhoff AP, Polomano RC. The Prevalence, Intensity, Assessment, and Management of Acute Pain in Hospitalized Children in Botswana. Pain Manag Nurs 2022; 23:548-558. [PMID: 34987004 DOI: 10.1016/j.pmn.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is very limited clinical and observational data on acute pain experienced by children in sub-Saharan Africa. AIMS To report the prevalence and intensity of acute pain, pain management practices, and describe associations between acute pain outcomes, children's and parents or guardian's demographics in hospitalized children aged 2 months to 13 years in Botswana. DESIGN A descriptive correlational prospective observational study using five repeated cross-sectional samples. SETTINGS Two referral hospitals in Botswana. PARTICIPANTS The sample size included 308 children and 226 parents or guardians. Data were collected between November 2018 and February 2019 from children, their parents or guardians (<7 years child), and the health record for pain documentation and treatment. MEASURES Pain was measured using Faces Pain Scale-Revised for children ≥7 years, revised Face, Legs, Activity, Cry, Consolability scale for children <7 years and numeric rating scale for parents or guardians. RESULTS There are 1,290 data points for children of which 1,000 were children <7 years and 999 data points for parents or guardians of children <7 years were used in analysis. Fifty percent of children <7 years were in pain using the revised Face, Legs, Activity, Cry, Consolability scale, whereas parents indicated 46% to be in pain. The pain prevalence for children ≥7 years was estimated at 54%. Pain was documentated at a rate of 54 % on the health records. Acetaminophen was most common analgesic across all age groups. Univariate associations of child <7 years pain intensity was statistically significant (p ≤ .05) for weight, diagnosis, residence, and parent relationship. Parents reported pain intensity was statistically significant (p ≤ .05) for child sex, weight, diagnosis, residence, surgery, parent or guardian age and education. Only age and surgery were significant for children ≥7 years. CONCLUSIONS Acute pain prevalence and intensity among hospitalized children in Botswana is low.
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Affiliation(s)
- Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana.
| | - Sharon Y Irving
- Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing, University of Pennsylvania, Nurse Practitioner, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andrew P Steenhoff
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana
| | - Rosemary C Polomano
- University of Pennsylvania, Philadelphia, Pennsylvania; School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania
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Carvalho JA, Souza DMD, Domingues F, Amatuzzi E, Pinto MCM, Rossato LM. Manejo da dor em crianças hospitalizadas: Estudo transversal. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0008pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: Caracterizar o manejo da dor em crianças hospitalizadas. Método: Estudo observacional do tipo transversal, com abordagem quantitativa, de caráter retrospectivo e descritivo, realizado em um Hospital secundário do Município de São Paulo, por meio de análise de 1.251 prontuários de crianças internadas na divisão pediátrica. Os dados foram tabulados e analisados por meio de estatística descritiva. Resultados: Um total de 88,8% das crianças foi avaliado para dor com instrumentos padronizados e 86% tinham analgesia prescrita. Dentre as avaliações, 37,8% das crianças apresentaram dor; dessas, 26% apresentaram dor intensa, maior nas afecções ortopédicas; 18,3% não foram medicadas, mesmo com presença de dor e analgesia prescrita; 4,3% não tinham analgésicos prescritos; apenas 0,4% receberam medidas não farmacológicas e 40,3% tinham registro de reavaliação. Os profissionais propiciaram maior analgesia a crianças com afecções cirúrgicas e ortopédicas em comparação às afecções clínicas (p < 0,05). Conclusão: O manejo da dor em crianças hospitalizadas mostra-se ineficaz, desde as avaliações iniciais até as reavaliações após intervenções, com priorização de ações medicamentosas guiadas pelo julgamento profissional frente a queixa álgica.
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Ogunyinka I, Yusuff K, Erah PO, Oshikoya K, Faponle F, Ungo-Kore H, Oreagba I, Yakasai A, Idoko A, Ileoma S, Umar A. Community Pharmacists' Knowledge and Attitudes Towards Pediatric Pain Management in Nigeria. Risk Manag Healthc Policy 2021; 14:4595-4607. [PMID: 34795543 PMCID: PMC8593593 DOI: 10.2147/rmhp.s329387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Community pharmacists (CPs) frequently attend to pediatric patients with pain but limited data exist regarding their knowledge of and attitude to effective management of pediatric pain in Nigeria. Thus, this study aimed to evaluate the knowledge of and attitude to pediatric pain management among CPs in Nigeria. PATIENTS AND METHODS A validated and pilot-tested questionnaire, the Community Pharmacists Survey on Pediatric Pain, was administered to 517 eligible participants at the 38th Annual National Conference of the Association of Community Pharmacists of Nigeria. Independent samples t-test and one-way analysis of variance were used for inferential statistical analyses. RESULTS CPs with additional higher academic qualifications and clinically related additional academic degrees had significantly higher mean knowledge scores relative to first degree only holder counterpart (t= 4.33, p< 0.05, Eta2=0.05) and those without clinically related second degrees (t= 6.34, p< 0.05, Eta2=0.27). Pain knowledge among the study cohort also varied significantly by age group, years of practicing community pharmacy, ownership structure of premises, geographical location of practice and previous exposure to pain management training (F(4370)=2.858, p=0.025, Eta2=0.03; F(3371)=3.985, p=0.008, Eta2=0.03; F(2372)=3.643, p=0.027, Eta2=0.02; F(5369)=4.497, p=0.01, Eta2=0.06; F(2372)=3.587, p=0.029, Eta2=0.02), respectively. CONCLUSION Community pharmacists' knowledge of and attitude to pediatric pain management in Nigeria appeared sub-optimal, and requires regular targeted educational intervention to fill the identified gaps, improve service delivery and patient outcomes.
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Affiliation(s)
- Ibrahim Ogunyinka
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Kazeem Yusuff
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Patrick O Erah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Kazeem Oshikoya
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, Lagos State University, Ikeja, Lagos, Nigeria
| | - Folayemi Faponle
- Department of Anaesthesia and Intensive Care Unit, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Hussein Ungo-Kore
- Department of Pharmaceutics and Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Ibrahim Oreagba
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Anthony Idoko
- Directorate of Education and Training, Pharmacists Council of Nigeria, Idu, Abuja, Nigeria
| | - Solape Ileoma
- Department of Pharmacy, Lagos Island Maternity Hospital, Lagos, Nigeria
| | - Aminu Umar
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
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Jain N, Juneja P, Masih U, Bhushan AKB, Bhaduaria US, Badjatya K. Efficacy of external cold and a vibrating device in reducing pain and anxiety during local anaesthesia. J Family Med Prim Care 2021; 10:4017-4022. [PMID: 35136761 PMCID: PMC8797120 DOI: 10.4103/jfmpc.jfmpc_305_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aim: To evaluate and compare the efficacy of external cold and a vibrating device in reducing the pain and anxiety amidst children receiving maxillary infiltration anaesthesia over conventional methods. Method: A sum of thirty subjects aged between 5 and 10 years who had undergone dental procedures requiring maxillary infiltration were enrolled in the current split-mouth randomised control study. The control intervention constitutes infiltration of 1.8 mL of 2% lignocaine in addition to 1:100,000 adrenaline (Lox, Neon Laboratories Mumbai, India) whereas, the experimental group used external cold and a vibrating device (Buzzy®, MMJ Labs, Atlanta, GA, USA) in annexation to the control protocol. Simultaneous to LA administration, pulse rate was employed as an objective measure and the subjective measure was recorded using RMS Pictorial Scale (RMS-PS) for the child’s discomfort. To document the child’s pain as anticipated by the dentist the revised face, limbs, arms, cry and consolability (FLACC-R) scale was employed. Result: Lower pain sensation and anxiety was recorded in the experimental group using Buzzy when compared to control. Conclusion: External cold in adjacent with vibrations might be efficient in lowering pain as well as anxiety in children experiencing infiltration dental anaesthesia though further research work is requisite with a larger sample size.
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Affiliation(s)
- Nivedita Jain
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Preene Juneja
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Updesh Masih
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - A K Bharath Bhushan
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Upendra Singh Bhaduaria
- Department of Public Health Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Khushboo Badjatya
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
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Tchou MJ, Schondelmeyer AC, Alvarez F, Holmes AV, Lee V, Lossius MN, O'Callaghan J, Rajbhandari P, Soung PJ, Quinonez R. Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value. Hosp Pediatr 2021; 11:1179-1190. [PMID: 34667087 DOI: 10.1542/hpeds.2021-006037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children. METHODS A study team composed of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research. The study team surveyed national pediatric hospitalist LISTSERVs for suggestions, condensed similar responses, and performed a literature search of articles published in the previous 10 years. Using a modified Delphi process, the team completed a series of structured ratings of feasibility and validity and facilitated group discussion. The sum of final mean validity and feasibility scores was used to identify the 5 highest priority recommendations. RESULTS Two hundred seven respondents suggested 397 preliminary recommendations, yielding 74 unique recommendations that underwent evidence review and rating. The 5 highest-scoring recommendations had a focus on the following aspects of hospital care: (1) length of intravenous antibiotic therapy before transition to oral antibiotics, (2) length of stay for febrile infants evaluated for serious bacterial infection, (3) phototherapy for neonatal hyperbilirubinemia, (4) antibiotic therapy for community-acquired pneumonia, and (5) initiation of intravenous antibiotics in infants with maternal risk factors for sepsis. CONCLUSIONS We propose that pediatric hospitalists can use this list to prioritize quality improvement and scholarly work focused on improving the value and quality of patient care for hospitalized children.
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Affiliation(s)
- Michael J Tchou
- Section of Hospital Medicine, Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Francisco Alvarez
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Alison V Holmes
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Vivian Lee
- Division of Hospital Medicine, Children's Hospital Los Angeles and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michele N Lossius
- Pediatric Hospital Medicine, Department of Pediatrics, University of Florida Shands Children's Hospital, Gainesville, Florida
| | - James O'Callaghan
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Prabi Rajbhandari
- Division of Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Paula J Soung
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ricardo Quinonez
- Section of Pediatric Hospital Medicine, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Senger A, Bryce R, McMahon C, Baerg K. Cross-sectional study of pediatric pain prevalence, assessment, and treatment at a Canadian tertiary hospital. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:172-182. [PMID: 34616998 PMCID: PMC8489950 DOI: 10.1080/24740527.2021.1961081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Painful experiences are common among hospitalized children. Long-term negative biopsychosocial consequences of undertreated pain are recognized. Aims The study benchmarks pain prevalence, assessment, and treatment as first steps to improve pain care in a Canadian tertiary hospital. Methods Single-day audits were undertaken on the pediatric ward (PW), pediatric emergency department (ED), and maternal services (MS). Participants (child or caregiver proxy) reported hospital pain experiences in the preceding 24 h; medical records were reviewed for assessment and treatment. Results Among 84 participants, pain prevalence ranged from 75% to 88%; mean pain intensity ranged from 5.7 to 6.5/10. Prevalence of moderate to severe pain was 78% on PW, 65% in ED, and 55% on MS; needle pokes were the most frequent cause of worst pain. Documentation of pain assessment varied by setting (PW, 93%; ED, 13%; MS, 0%). Documented maximum pain scores were significantly lower compared to participant report (mean difference 4.5/10, SD 3.1, P < 0.0001). A total 29% (6/21) of infants with heel lance or injection received breastfeeding or sucrose, and 29% (7/24) of participants receiving other needle procedures had documented or reported topical lidocaine use. All participants on MS underwent needle procedures. Conclusions Pain is experienced commonly by infants and children in PW, ED, and MS. Pain assessment documentation is not routine and underestimates participant report. Evidence-based pain management strategies are underutilized. An institution-wide quality improvement approach is required to address pain care. Pain assessment and needle pain prevention and treatment should be prioritized in these pediatric acute care and newborn care settings.
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Affiliation(s)
- Alex Senger
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rhonda Bryce
- Clinical Research Support Unit, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Casey McMahon
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Krista Baerg
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Saskatchewan Health Authority-Saskatoon, Saskatoon, Saskatchewan, Canada
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Karlsson K, Johnson E, Nilsson S. The Children's Action-Reaction Assessment Tool (CARAT) as an observational technique for assessing symptom management: An initial validation study with children aged 3-7 years undergoing needle procedures. J SPEC PEDIATR NURS 2021; 26:e12334. [PMID: 33821544 DOI: 10.1111/jspn.12334] [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: 09/25/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE For many children, needle procedures are fearful events that are often painful. The first step in symptom management is to assess the child's pain and fear, and the next step is to use coping strategies to provide symptom relief for children who experience or feel pain and fear during procedures. The Children's Action-Reaction Assessment Tool (CARAT) is built on action-reaction strategies. This study aimed to determine the inter-rater reliability of the CARAT when used during needle procedures with 3- to 7-year-old children. DESIGN AND METHODS: We used a quantitative approach in which 21 children were observed by two independent observers during needle procedures to evaluate the inter-rater reliability of the CARAT. Data were analysed with descriptive statistics, and the observation scores were calculated with an intraclass correlation coefficient (ICC) test on SPSS for Windows, version 25. RESULTS The completed CARAT indicated the use of action-reaction strategies. Neither action nor reaction strategies were frequently used. The parents were seldom involved in the procedure. The inter-rater reliability showed a sufficient correlation between the observers. PRACTICE IMPLICATIONS: This study showed promising results for the inter-rater reliability of the CARAT, which can be used to facilitate care for children. The observational tool can be used to assess the use of action-reaction strategies in conjunction with needle procedures in children aged 3-7 years.
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Affiliation(s)
- Katarina Karlsson
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Hatfield, Pretoria, South Africa
| | - Stefan Nilsson
- Institute of Health and Care Sciences and the University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kurudirek F, Arikan D, Sarialioğlu A. Effects of therapeutic clowning on pain and anxiety during venous blood sampling in Turkey: Randomised controlled trial. J SPEC PEDIATR NURS 2021; 26:e12352. [PMID: 34216423 DOI: 10.1111/jspn.12352] [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: 04/09/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The research aim was to investigate the effects of therapeutic clowning on pain and fear during the process of venous blood sampling in children. DESIGN AND METHODS This study was conducted in a randomised controlled trial from January to March 2020. The study population consisted of children from 7 to 12 years of age who came to the research centre for blood sampling. The research sample consisted of 166 children (83 in the intervention group and 83 in the control group) who met the research criteria and came to the research centre on a specific date through probable sampling. For the data collection, a questionnaire form, the Visual Analogue Scale and the Children's Fear Scale were used. Therapeutic clowning was used in this process for the intervention group. There was no intervention for children who were in the control group. The calculation of percentage distribution and means, χ2 test, analysis of variance analysis in repeated measures and least significant difference and independent t-test were used to analyse the data. RESULTS The results of the research indicated that children in the intervention group had significantly lower pain and fear than children in the control group (p < .001). Therapeutic clowning seems to effectively reduce pain and fear during venous blood sampling for children from 7 to 12 years of age. Our results support using therapeutic clowns which is an inexpensive, safe, and effective method for lowering children's pain and fear during venous blood sampling. PRACTICE IMPLICATIONS The use of therapeutic clowns could become the standard of care in blood sampling for children from 7 to 12 years of age in hospitals. Therapeutic clowning, which is an easy-to-use, low-cost and practical method to provide better communication and cooperation with the family and the child, can be used as a complementary therapy in all nursing areas, especially in the field of paediatrics. Nurses could be encouraged to be trained on the use of therapeutic humour based upon a standardised approach and offered guidance on how to apply entertaining methods such as clowns. Therapeutic clowning can be examined in other applications in nursing care in light of these results.
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Affiliation(s)
- Fatma Kurudirek
- Department of Child Health and Diseases Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
| | - Duygu Arikan
- Department of Child Health and Diseases Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
| | - Arzu Sarialioğlu
- Department of Child Health and Diseases Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
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Quintero-Castellanos JM, Hernández Á, Parra T. Pain prevalence in infants and preschool children in a Colombian hospital. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The pain prevalence in hospitalized infants and preschool children has not been accurately identified in high-income countries, and in low and medium-income countries it has not been extensively studied. The assessment instruments are limited.
Objective: To describe the prevalence and management of pain in infants and preschool children during the first 24 hours of hospitalization in a third level institution in Colombia, using the CRIES scale.
Methods: An observational study was conducted during the first 24 hours of hospitalization. Demographic information was recorded, pain was assessed at admission, after 4, and 24 hours using the CRIES scale. Pharmacological therapy was also documented.
Results: 250 children between one month and 5 years old were studied. The pain prevalence at admission was 12 %. The pain prevalence per subgroups was higher among the surgical patients, as compared to the clinical patients (35.9 % vs. 7.6 %). The pharmacological analysis revealed that 70.8 % of patients received treatment; the most widely used medications were oral acetaminophen and intravenous dipyrone.
Conclusions: Pain prevalence was lower than the levels described for the general pediatric population. This result may be due to the sensitivity of the CRIES instrument, or to a particular pain behavior. Further studies are needed to identify the sensitivity of the assessment instruments in early life and to accurately investigate any associated phenomena.
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Lee HN, Bae W, Park JW, Jung JY, Hwang S, Kim DK, Kwak YH. Virtual reality environment using a dome screen for procedural pain in young children during intravenous placement: A pilot randomized controlled trial. PLoS One 2021; 16:e0256489. [PMID: 34464411 PMCID: PMC8407539 DOI: 10.1371/journal.pone.0256489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/03/2021] [Indexed: 12/05/2022] Open
Abstract
We assessed the feasibility and potential efficacy of a virtual reality (VR) environment using a dome screen as a distraction method in young children during intravenous (IV) placement in the pediatric emergency department. This randomized controlled pilot study enrolled children aged 2 to 6 years who underwent IV placement into either the intervention group or the control group. Children in the intervention group experienced VR using a dome screen during IV placement. The child’s pain intensity was measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at four time points of IV placement: immediately after arrival to the blood collection room (base); immediately after the child laid down on the bed (preparation); when the tourniquet was applied (tourniquet); and the moment at which the needle penetrated the skin (venipuncture). The guardian’s satisfaction and rating of the child’s distress were assessed using a 5-point Likert-type questionnaire. We recruited 19 children (9 in the intervention group and 10 in the control group). Five children in the control group were excluded from the analysis because of missing video recordings (n = 3), failed first attempt at IV placement (n = 1), and the child’s refusal to lie on the bed during the procedure (n = 1). No side effects of VR were reported during the study period. Although the average FLACC scale score at each time point (preparation, tourniquet, venipuncture) was lower in the intervention group than the control group, the difference was not statistically significant (2.3, interquartile range [IQR]: 2.0–3.0; vs. 3.3, IQR: 2.7–6.7, P = 0.255). There were no statistically significant differences between the groups in the guardian’s satisfaction and anxiety or his/her rating of the child’s pain and anxiety. The guardians and emergency medical technicians reported satisfaction with the use of VR with a dome screen and considered it a useful distraction during the procedure. VR using a dome screen is a feasible distraction method for young children during IV placement. A larger clinical trial with further development of the VR environment and study process is required to adequately evaluate the efficacy of VR using a dome screen.
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Affiliation(s)
- Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woori Bae
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Krunkaityte U, Razlevice I, Lukosiene L, Macas A, Malcius D. Efficacy of postoperative pain management using patient-controlled wound infusion method after laparotomy in children: Three cases. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jolly T, Mansuri Z, Trivedi C, Adnan M, Cohen SP, Vu TN. Are Psychotropic Medications Effective in Chronic Pain Management in Children and Adolescents? A Meta-Analysis of Randomized Control Trials. J Pain Res 2021; 14:1915-1924. [PMID: 34194243 PMCID: PMC8238552 DOI: 10.2147/jpr.s310381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Data defining and subsequently guiding the use of psychotropic medications in children and adolescents is sparse. We conducted a meta-analysis of randomized control trials to examine the effectiveness of psychotropic medications in children and adolescents with chronic pain. Methods We conducted a comprehensive literature search from published studies, and annual scientific sessions of psychiatry conferences. We identified double-blind, randomized control trials (RCTs) in which psychotropic medications were compared to placebo. Data was collected for the total number of patients, baseline characteristics, and changes in pain score. Meta-analysis was performed using a random effect model evaluating average change in pain score and the number of patients with a reduction in pain score for both groups. Pooled data are expressed as standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI). Results We found 5 studies that included amitriptyline (n=2), citalopram (n=1), buspirone (n=1) and duloxetine (n=1). In the pooled analysis for the difference in the average change in pain score, 4 RCTs with 395 patients were included. After 12–13 weeks of therapy, reductions in pain score were significantly greater in the psychotropic drug group as compared to placebo (SMD: −0.77, 95% CI −1.54, 0.0001, p= 0.05). For the analysis on the number of patients with a reduction in pain, data were available for 445 patients (224-medication group, 221-placebo group). More patients in the psychotropic drug group experienced a meaningful reduction in pain score at 12–13 weeks of therapy compared to placebo (OR 1.66, 95% CI 1.08–2.54, p= 0.02). Conclusion The results of this meta-analysis demonstrate significant analgesic efficacy of psychotropic medications in the management of children with chronic pain. This review is limited by the small number of studies included for analysis. There is a pressing need for more robust clinical trials to further investigate these promising findings.
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Affiliation(s)
- Taranjeet Jolly
- Department of Psychiatry & Behavioral Health, Penn State University College of Medicine, Inpatient Child and Adolescent Psychiatry, Pennsylvania Psychiatric Institute, Harrisburg, PA, USA
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Chintan Trivedi
- Psychiatry Department, St. David's Medical Center, Austin, TX, USA
| | - Mahwish Adnan
- Department of Psychiatry, Mercy Hospital and Medical Center, Lincolnwood, IL, USA
| | - Steven P Cohen
- Department of Anesthesiology & Critical Care medicine, Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - To-Nhu Vu
- Department of Anesthesia & Pain Medicine, Penn State University College of Medicine, Hershey, PA, USA
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Anxiety and Mood Disorders Impacting Physician Opioid Prescribing in the Pediatric Hospital Setting. J Clin Psychol Med Settings 2021; 28:757-770. [PMID: 33564959 DOI: 10.1007/s10880-021-09763-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 12/18/2022]
Abstract
This research examined whether pediatric inpatients without an anxiety/mood disorder are more likely to receive opioids in response to pain compared to patients diagnosed with a mental health condition. Research questions were tested using cross-sectional inpatient electronic medical record data. Propensity score matching was used to match patients with a disorder with patients without the disorder (anxiety analyses: N = 2892; mood analyses: N = 1042). Although patients with anxiety and mood disorders experienced greater pain, physicians were less likely to order opioids for these patients. Analyses also disclosed an interaction of anxiety with pain-the pain-opioid relation was stronger for patients without an anxiety disorder than for patients with an anxiety diagnosis. Instead, physicians were more likely to place non-opioid analgesic orders to manage the pain of patients with anxiety disorders. Findings imply that pain management decisions might be influenced by patient's mental health.
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Osmanlliu E, Trottier ED, Bailey B, Lagacé M, Certain M, Khadra C, Sanchez M, Thériault C, Paquin D, Côtes-Turpin C, Le May S. Distraction in the Emergency department using Virtual reality for INtravenous procedures in Children to Improve comfort (DEVINCI): a pilot pragmatic randomized controlled trial. CAN J EMERG MED 2020; 23:94-102. [PMID: 33683617 DOI: 10.1007/s43678-020-00006-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Intravenous (IV) procedures cause pain and distress in the pediatric emergency department (ED). We studied the feasibility and acceptability of virtual reality distraction for patient comfort during intravenous procedures. METHODS Children were randomized to a control (standard care) or intervention group (standard care + virtual reality). Thresholds for feasibility and acceptability (primary outcomes) were determined through a priori established criteria. The level of procedural pain (principal clinical outcome) and distress, as well as memory of pain at 24 h were collected and reported as medians (Q1, Q3) for each group. RESULTS 63 patients were enrolled, with a high rate of recruitment (78.8%) and game completion (90.3%). Patients, parents and, healthcare providers reported high satisfaction levels. There were no serious adverse events. Five of the 30 patients (16.7%) exposed to virtual reality reported mild side effects. Self-reported procedural pain (verbal numerical rating scale: 3 (1, 6)/10 vs 3 (1, 5.5)/10, p = 0.75) was similar between groups. Further exploratory clinical measures were reported for the intervention and control groups, respectively: self-rated distress during the procedure (Child Fear Scale: 1 (0, 2)/4 vs 2 (0, 3)/4); distress evaluated by proxy during the procedure (Procedure Behavior Check List: 8 (8, 9)/40 vs 10 (8, 15)/40); memory of pain at 24 h (VNRS: 2 (1, 3)/10 vs 4 (2, 6.5)/10). CONCLUSION The addition of virtual reality to standard care is feasible and acceptable for pain and distress management during IV procedures in the pediatric ED. Occasional mild, self-resolving side effects were observed in the intervention group. Self-reported pain during the procedure was similar between groups. CLINICALTRIALS. GOV IDENTIFIER NCT03750578.
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Affiliation(s)
- Esli Osmanlliu
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Evelyne D Trottier
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Benoit Bailey
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Maryse Lagacé
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.,CHU Sainte-Justine Research Centre, Université de Montréal, Montréal, Canada
| | - Mélanie Certain
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Christelle Khadra
- CHU Sainte-Justine Research Centre, Université de Montréal, Montréal, Canada.,Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Marisol Sanchez
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Corinne Thériault
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - David Paquin
- Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
| | - Casey Côtes-Turpin
- Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
| | - Sylvie Le May
- CHU Sainte-Justine Research Centre, Université de Montréal, Montréal, Canada.,Faculty of Nursing, Université de Montréal, Montréal, Canada
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Ajayi TA, Salongo L, Zang Y, Wineinger N, Steinhubl S. Mobile Health-Collected Biophysical Markers in Children with Serious Illness-Related Pain. J Palliat Med 2020; 24:580-588. [PMID: 33351729 DOI: 10.1089/jpm.2020.0234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Context: There is an ongoing established need to develop engaging pain assessment strategies to provide more effective individualized care to pediatric patients with serious illnesses. This study explores the acceptability of wireless devices as one option. Objective: To evaluate the ability of wrist-wearable technology to collect physiological data from children with serious illnesses. Methods: Single-site prospective observational study conducted between September 2017 and September 2018 at Rady Children's Hospital, San Diego, California, inpatient wards. Pediatric patients with diagnoses of cancer and sickle cell disease admitted to the hospital for acute-on-chronic pain and taking opioid pain medications were asked to complete two 24-hour continuous monitoring periods with the Empatica E4 wristband. Results: Data collected from the device correlated with manually obtained vital signs. Children responded favorably to wearing the device. Participants with reported subjective pain versus no pain had average heart rate increased by 16.4 bpm, skin temperature decreased by 3.5°C, and electrodermal activity decreased by 0.27. Conclusions: This study shows the possibility of collecting continuous biophysical data in a nonobtrusive manner in seriously ill children experiencing acute-on-chronic pain using wearable devices. It provides the framework for larger studies to explore the utility of such data in relation to metrics of pain and suffering in this patient population.
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Affiliation(s)
- Toluwalase A Ajayi
- Scripps Research Translational Institute, La Jolla, California, USA.,Pediatric Department, Rady Children's Hospital, San Diego, California, USA.,Division of Palliative Medicine, Scripps Health, La Jolla, California, USA
| | - Leia Salongo
- University of California, Los Angeles, Los Angeles, California, USA
| | - Yunyue Zang
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Nathan Wineinger
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Steven Steinhubl
- Scripps Research Translational Institute, La Jolla, California, USA
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Friedrichsdorf SJ, Goubert L. [Pediatric pain treatment and prevention for hospitalized children]. Schmerz 2020; 35:195-210. [PMID: 33337532 DOI: 10.1007/s00482-020-00519-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. OBJECTIVES To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. METHODS This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable "Factsheet Pain in Children: Management" and reviews best evidence and practice. RESULTS Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind-body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. CONCLUSION Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Center of Pain Medicine, Palliative Care and Integrative Medicine, University of California at San Francisco (UCSF), Benioff Children's Hospitals in Oakland and San Francisco, Kalifornien, USA.
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgien
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Andersen RD, Olsson E, Eriksson M. The evidence supporting the association between the use of pain scales and outcomes in hospitalized children: A systematic review. Int J Nurs Stud 2020; 115:103840. [PMID: 33360247 DOI: 10.1016/j.ijnurstu.2020.103840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Systematic use of pain intensity scales is considered a prerequisite for treatment of pain in hospitalized children, but already a decade ago, attention was called to the lack of robust evidence supporting the presumed positive association between their use and desired outcomes. OBJECTIVES To re-evaluate the evidence supporting the association between the use of pain scales and patient and process outcomes in hospitalized children. DESIGN Systematic literature review. DATA SOURCES The online databases PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched from inception to April 15, 2020. REVIEW METHODS We performed single screening of all records followed by duplicate screening of full texts of interest with a disagreement procedure in place. Studies where the authors evaluated outcomes from the use of self-report or behavioral-based pain scales in children 0-18 years in a hospital setting were included. Emergency care settings were excluded. RESULTS In a majority of the 32 included studies, complex interventions that included one or more pain scales were evaluated. Process outcomes (e.g., documentation) were most frequently studied. Interventions were commonly associated with improved documentation of pain assessment, while the effect on pain management documentation was inconsistent. However, improvements in process outcomes did not necessarily result in better patient outcomes. In regard to patient outcomes (e.g., pain intensity, side effects, or satisfaction with treatment), some authors reported reduced pain intensity on group level, but the effect on other functional outcomes, child and parent satisfaction, and aspects of safety were inconsistent. Methodological issues, e.g., weak study designs and small samples, biased the results, and it was not possible to determine how pain scales contributed to the overall effects since they were studied as part of complex interventions. CONCLUSIONS Although both a theoretically founded understanding of pain and clinical experience suggest that the use of pain scales will make a difference for hospitalized children with pain, there is still limited evidence to support this notion. As pain scales have been almost exclusively studied as an aspect of complex interventions, research that determines the active ingredient(s) in a complex intervention and their joint and individual effects on outcomes that are meaningful for the child (for example reduced pain intensity or improved function) are urgently needed. Tweetable abstract: Limited #research supports association between use of pediatric #pain scales and patient outcomes @_randida @PainPearl.
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Affiliation(s)
- Randi Dovland Andersen
- Department of Child and Adolescent Health Services and Department of Research, Telemark Hospital Trust, P.O. Box 2900 Kjørbekk, Skien 3710, Norway; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden.
| | - Emma Olsson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden; Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro 701 82, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden; Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro 701 82, Sweden
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Poonai N, Kumar K, Coriolano K, Thompson G, Brahmbhatt S, Dzongowski E, Stevens H, Gupta P, Miller M, Elsie S, Ashok D, Joubert G, Lim R, Bütter A, Ali S. Hyoscine butylbromide versus acetaminophen for nonspecific colicky abdominal pain in children: a randomized controlled trial. CMAJ 2020; 192:E1612-E1619. [PMID: 33257343 DOI: 10.1503/cmaj.201055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Less than two-thirds of children with abdominal pain in the emergency department receive analgesia. We sought to determine whether hyoscine butylbromide was superior to acetaminophen for children with nonspecific colicky abdominal pain. METHODS We randomly allocated children aged 8-17 years with nonspecific colicky abdominal pain who presented to the pediatric emergency department of London Health Sciences Centre, London, Ontario to receive hyoscine butylbromide, 10 mg given orally, or acetaminophen, 15 mg/kg given orally (maximum 975 mg). We considered the minimal clinically important difference for the primary outcome (self-reported pain at 80 min) to be 13 mm on a 100 mm visual analogue scale. Secondary outcomes included administration of rescue analgesia, adverse effects and pain score less than 30 mm at 80 minutes. RESULTS A total of 236 participants (120 in the hyoscine butylbromide group and 116 in the acetaminophen group) were included in the trial. The mean visual analogue scale scores at 80 minutes were 29 mm (standard deviation [SD] 26 mm) and 30 mm (SD 29 mm) with hyoscine butylbromide and acetaminophen, respectively (adjusted difference 1, 95% confidence interval -7 to 7). Rescue analgesia was administered to 4 participants (3.3%) in the hyoscine butylbromide group and 1 participant (0.9%) in the acetaminophen groups (p = 0.2). We found no significant differences in rates of adverse effects between hyoscine butylbromide (32/116 [27.6%]) and acetaminophen (28/115 [24.3]) (p = 0.5); no serious adverse effects were observed. The proportion with a pain score less than 30 mm at 80 minutes was 66 (55.0%) with hyoscine butylbromide and 63 (54.3%) with acetaminophen (p = 0.9). INTERPRETATION Hyoscine butylbromide was not superior to acetaminophen in this setting. Both agents were associated with clinically important pain reduction, and either can be considered for children presenting to the emergency department with nonspecific colicky abdominal pain. Trial registration: Clinicaltrials.gov, no. NCT02582307.
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Affiliation(s)
- Naveen Poonai
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta.
| | - Kriti Kumar
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Kamary Coriolano
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Graham Thompson
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Shaily Brahmbhatt
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Emily Dzongowski
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Holly Stevens
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Priti Gupta
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Michael Miller
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Sharlene Elsie
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Dhandapani Ashok
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Gary Joubert
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Rod Lim
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Andreana Bütter
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Samina Ali
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
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