Minimizing pediatric healthcare-induced anxiety and trauma

Management of critical care emergencies in children with autism spectrum disorder

BACKGROUND

Managing critical care emergencies in children with autism spectrum disorder (ASD) presents unique challenges due to their distinct sensory sensitivities, communication difficulties, and behavioral issues. Effective strategies and protocols are essential for optimal care in these high-stress situations.

AIM

To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD. The review focuses on key areas, including sensory-friendly environments, communication strategies, behavioral management, and the role of multidisciplinary approaches.

METHODS

A comprehensive search was conducted across major medical databases, including PubMed, Embase, and Cochrane Library, for studies published between 2000 and 2023. Studies were selected based on their relevance to critical care management in children with ASD, encompassing randomized controlled trials, observational studies, qualitative research, and case studies. Data were extracted and analyzed to identify common themes, successful strategies, and areas for improvement.

RESULTS

The review identified 50 studies that met the inclusion criteria. Findings highlighted the importance of creating sensory-friendly environments, utilizing effective communication strategies, and implementing individualized behavioral management plans. These findings, derived from a comprehensive review of current evidence, provide valuable insights into the best practices for managing critical care emergencies in children with ASD. Sensory modifications, such as reduced lighting and noise, visual aids, and augmentative and alternative communication tools, enhanced patient comfort and cooperation. The involvement of multidisciplinary teams was crucial in delivering holistic care. Case studies provided practical insights and underscored the need for continuous refinement of protocols.

CONCLUSION

The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD. Sensory-friendly adjustments, effective communication, and behavioral strategies supported by a multidisciplinary team are integral to improving outcomes. Despite progress, ongoing refinement of care practices and protocols is necessary. This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.

Thoracoscopic Repair of Recurrent CDH is Associated with a Significantly Lower Complication Rate and Shorter ICU and Hospital Stay: A Prospective, Propensity Score-Matched Analysis

Congenital diaphragmatic hernia (CDH) is a malformation that significantly impacts neonatal morbidity and mortality. Recurrence after surgical repair remains a potentially life-threatening long-term complication. Conventionally, recurrent CDH has been managed through open surgery. However, thoracoscopic repair (TR) represents a novel alternative for recurrent CDH as it has reduced the length of hospital stay and mortality rate in the primary CDH repair.A prospective, propensity score-matched analysis was conducted on pediatric patients who underwent recurrent CDH repair at the University Hospital Mannheim between 2013 and 2023, to compare the outcomes of laparotomy versus TR. Patients were categorized based on the surgical technique employed. Comparative analysis, including propensity scoring, encompassed outcome measures such as duration of ICU and hospital stays, rate of complications, and operative duration.In total, 703 patients were treated for CDH, of whom 69 children underwent laparotomy (56) or TR (16) for CDH recurrence. After propensity score matching, TR group demonstrated a significantly shorter duration of surgery (178 [93-311] versus 225 [113-450] min, p = 0.042), reduced ICU stay (0 [0-10] versus 1 (0-69) days, p = 0.011), and decreased overall hospital stay (6 [3-34] versus 12 [7-40] days, p = 0.001). Moreover, the postoperative complications were significantly lower in the TR group (21.43% versus 73.68%, p = 0.003).TR for recurrent CDH repair is associated with shorter operation times, reduced ICU and overall hospital stays, and fewer complications compared with laparotomy. These findings suggest that TR may be preferable for the management of recurrent CDH, warranting larger randomized controlled studies to confirm the long-term safety and efficacy of this approach.

Your baby has down syndrome: a reflexive thematic analysis of breaking the news to parents

The communication of a Down syndrome diagnosis to mothers is a pivotal moment that can impact their emotional well-being and the subsequent care for their child. This study aimed to explore maternal experiences with receiving a Down syndrome diagnosis. A total of 40 mothers participated, 42.5% received a prenatal diagnosis, 17.5% received the diagnosis during labor and delivery, and 40% received the information at the early postnatal period. Through reflexive thematic analysis, four key themes emerged: (1) About Who and How the News Was Delivered (2), About When the News Was Delivered (3), On Where the News Should Be Delivered (4), parents' positive experiences emerging from this, predominantly, negative episode. Our findings emphasize the need for improved training for healthcare professionals in delivering sensitive diagnoses, with an emphasis on empathy, accurate information, and support resources for families.

Clinical Reflections and the Lived Experience of Child Life Therapy at an Australian Centre

A cancer diagnosis in childhood is life changing for children and their families. Children may experience medical and physical side-effects, and both children and carers may suffer from distress and other psychological challenges. Supportive care interventions are vitally important in helping children and their families cope adaptively to ensure positive long-term adjustment. Child Life Therapy (CLT) is an allied health profession that involves evidence-based interventions that focus on supporting, educating, and empowering young people through their healthcare journey.

Is the state anxiety level of inpatient children associated with nursing care quality? A cross-sectional study

AIM

The aim of the research was to investigate the predictive effect of nursing care quality perceived by inpatient children aged 9 to 12 on state anxiety levels.

METHODS

The research was conducted with 201 inpatient children. Data were gathered using "The Scale for Evaluating the Quality of Care from Children's Point of View (psychosocial care, physical care, and information)" and "The State Anxiety Inventory for Children."

RESULTS

In the study, statistically significant, negative, and weak correlations were found between the sub-dimension mean scores of psychosocial care, physical care, information, and the mean scores of state anxiety levels. "Information" was found to have a statistically significant and negative predictive effect on state anxiety levels. It was found that the satisfaction of inpatient children with nursing care quality was related to their state anxiety levels, and particularly, the information provided by nurses significantly influenced their state anxiety levels.

CONCLUSION

Therefore, it was concluded that to minimize anxiety during children's hospitalization, nursing care quality should be improved in terms of psychosocial care, physical care, and information provision. Pediatric nurses providing care in the clinic should pay attention to meeting the care needs of children, as satisfying nursing care can reduce their state anxiety levels.

PRACTICE IMPLICATIONS

The study's findings underscore the critical role of nursing care quality in managing anxiety levels among pediatric inpatients. The negative correlations found between psychosocial care, physical care, and information provision with state anxiety levels underscore the significance of a holistic approach and family-centered care in nursing.

Effectiveness of social robots in improving psychological well-being of hospitalised children: A systematic review and meta-analysis

AIM

To evaluate the effectiveness of social robots in reducing pain, stress, and anxiety among hospitalised children.

BACKGROUND

Children are often subjected to painful medical procedures during hospitalisation, resulting in pain, stress and anxiety. This can have significant implications for a child's psychological and overall well-being. Therefore, it is essential to alleviate these emotions among hospitalised children.

METHODS

The review included studies involving hospitalised children ages 1-12 who underwent any medical procedure and received interventions involving social robots. Six databases were searched for articles published on the review topic. The search timeline was from January 2013 to January 2024. The included studies need to assess the effectiveness of the robots in improving primary outcomes such as pain, stress, distress, or anxiety levels. A meta-analysis of these variables was conducted.

RESULTS

The meta-analysis of 313 participants found that social robots had a standardised mean difference (SMD) of -0.10 (95 % CI: -0.41 to 0.22, P = 0.54) in reducing pain, indicating no significant effect. For stress and distress, with a total of 309 participants, the SMD was -0.33 (95 % CI: -0.62 to -0.03, P = 0.003), and for anxiety, including 335 participants, the SMD was -0.42 (95 % CI: -0.73 to -0.10, P = 0.09). These findings suggest that while social robots are not effective in reducing pain, however, they are effective in lowering stress and anxiety levels in hospitalised children undergoing painful medical procedures.

CONCLUSION

This review highlights the efficacy of social robots when introduced to hospitalised children who are undergoing painful medical procedures. Nurses could consider integrating social robots into patient care protocols, which would yield advantages for anxious young children and their parents, as social robots help improving the child's psychological and overall well-being during medical procedures.

Development of an atraumatic care education model based on family-centered care to improve maternal behavior in reducing children's stress during hospitalization

PURPOSE

this study aimed to develop an atraumatic care education model based on family centered care to improve maternal behavior in minimizing hospitalization stress.

DESIGN AND METHODS

This study utilized a quantitative research design with a cross-sectional approach. A total of 120 mothers of hospitalized children were selected through purposive sampling. A self-designed questionnaire was administered, which included sections on nurse competency, maternal factors, service factors, and learning facilities. Data analysis was conducted using inferential statistics, specifically employing Smart PLS for structural equation modeling (SEM).

RESULTS

The results indicated that the atraumatic care education model, based on family-centered care, was directly influenced by nurse competency (t = 2.829, p = 0.005), maternal factors (t = 3.237, p = 0.001), service factors (t = 4761, p = 0.000), and learning facilities (t = 2.005, p = 0.046). However, none of these factors had a significant impact on maternal behavior in reducing child hospitalization stress (t = 0.970, 0.794, 0.039, 1.290; p = 0.333, 0.429, 0.969, 0.198). On the other hand, the atraumatic care education model based on family-centered care was found to directly influence maternal behavior in minimizing child hospitalization stress (t = 34.065, p = 0.000).

CONCLUSIONS

The atraumatic care education model based on family-centered care, includes four key variables: nurse competency, maternal factors, service factors, and learning facilities. This model can be used as a framework to enhance maternal behavior in reducing stress associated with child hospitalization.

PRACTICAL IMPLICATIONS

The findings suggest that the atraumatic care education model based on family-centered care, can be a valuable tool in improving maternal behavior and reducing stress during child hospitalization. Healthcare providers, especially pediatric nurses, should focus on enhancing their competency in delivering atraumatic care education, as well as addressing factors related to the mother, the quality of services, and the availability of learning resources.

Perioperative Staff's Experiences of Premedication for Children

PURPOSE

Providing perioperative care for children who express anxiety or react with negative anxiety-associated consequences can be a challenge. The use of premedication is established as an important intervention for young children before surgery, yet research into care providers' experiences of premedication is limited. The aim of this study was to explore perioperative staff's experiences of premedication for preschool-age children.

DESIGN

A descriptive inductive qualitative study was performed based on focus group discussions.

METHODS

A purposive sample of a team from the operating department with experience in anesthetizing and caring for children in the perioperative period was interviewed in small focus groups: five preoperative and postoperative care nurses, five nurse anesthetists, and five anesthesiologists. The transcribed text was categorized using qualitative content analysis.

FINDINGS

The content analysis revealed three themes: a matter of time, do not wake the sleeping bear, and on responsive tiptoes.

CONCLUSIONS

Care providers must adapt their work to the child's emotional state of mind and needs, allowing time for the child to trust and accept the premedication and for the premedication to reach its peak effect. Premedication provides light sleep preoperatively, which requires careful treatment of the child to avoid emotional reactions, and the postoperative path is most peaceful when the premedication supports a long duration of sedation. Our findings highlight the need for safety precautions and a permissive and flexible organization with the goal of achieving a smooth and safe journey for the child in the perioperative path.

Remote Care: The Future of Cochlear Implants

OBJECTIVE

The aims of this study were to 1) evaluate whether remote cochlear implant (CI) programming has comparable outcomes to traditional in-person CI management, 1) determine the effects of remote programming on family burden and associated costs, and 1) demonstrate feasibility and satisfaction of remote programming by patients and families for both the adult and pediatric CI populations.

STUDY DESIGN

Prospective study of one CI program.

PATIENTS AND INTERVENTION

Adult and pediatric patients with at least one CI underwent CI programming via in-person and remote visits.

MAIN OUTCOME MEASURES

CI programming parameters (impedances, neural response telemetry, upper and lower stimulation levels, datalogging), technology comfort self-report, visit burden and satisfaction, mental health and quality of life.

RESULTS

Fifteen pediatric participants (mean age: 4.17 yr; SD = 3.24) and 15 adult participants (mean age: 56.73 yr; SD = 21.11) were enrolled. In-person and remote programming sessions yielded comparable results for measuring CI programming parameters. Adult and parent participants were highly satisfied with remote programming and reported receiving excellent care. Listening effort was significantly less for the remote visit as compared to the in-person visit for adults. Burden of care to attend the in-person visit was greater for the pediatric population in terms of expenses incurred, unpaid time off work, and coordination of care for other children.

CONCLUSIONS

Remote programming is a feasible and effective service delivery model for the adult and pediatric CI population. Inclusion of remote services into postoperative CI protocols should be considered as a means of reducing barriers to hearing healthcare.

School Performance and Learning Challenges in Children and Adolescents with Congenital Heart Disease

Children with congenital heart disease are at risk for neurocognitive and neurodevelopmental challenges, learning disabilities, and psychosocial difficulties. Our narrative review draws literature-based evidence for the effect of congenital heart disease on school performance. We conducted a literature review and extracted relevant articles from Google Scholar, Medline, and PubMed. Evidence showcases that school performance is impacted directly by congenital heart disease. This seems to be underlined by different factors inherent to congenital heart disease, like inattention, language difficulties, and decreased fine and gross motor skills. Moreover, the operative and postoperative periods present various physical challenges that can hinder development, ultimately affecting daily activities and quality of life. The consequent stressors in childhood can have long-lasting effects, leading to an increased prevalence of anxiety and depression affecting patients as they transition into adolescence and adulthood and placing significant social and emotional burdens on their direct environment. Children with congenital heart disease face both direct and indirect challenges related to their disease. These challenges are most likely to be the source of poor school performance and learning, as suggested by the literature. Close monitoring, early interventions, and multidisciplinary care are essential to address these vulnerabilities and improve educational outcomes in children with congenital heart disease.

Technical Tips: Recommendations for Reducing Emotional Distress Through a Trauma Informed Approach to EEG Lead Placements in the Pediatric Population

When faced with challenging behaviors from pediatric patients, technologists can often feel unprepared. This can lead to poor appointment outcomes as well as unintended traumatic experiences for patients. It is important to understand the role the technologist plays in providing high-quality care that addresses behavioral concerns while minimizing trauma; however, training and education in this area of patient care is limited in the field of neurodiagnostics. This lack of training and education can deter technologists from working with the pediatric population. This article aims to address core reasons for displayed behaviors in pediatric patients as well as the risks associated with not addressing the behaviors during EEG lead placements. In an effort to continue striving for high-quality, family-centered care in the field of pediatric neurodiagnostics, proposed interventions such as the CARE process and distraction are outlined and discussed.

Emotional and psychosocial functioning in youngsters with a congenital heart disease (CHD) in comparison to healthy controls

OBJECTIVE

Due to their medical vulnerability, youngsters with congenital heart disease (CHD) may experience more overwhelming emotions than healthy peers. This multi-informant-based study aims to examine differences between these youngsters and their peers in psychosocial functioning, attachment and emotion regulation.

STUDY DESIGN

217 youngsters (8-18 years) with CHD (53.9 % boys, 46.1 % girls) were compared to 232 healthy controls (52.6 % boys, 47.4 % girls) matched for gender, age and education. Participants and parents completed online self-report questionnaires assessing psychosocial functioning (SDQ), attachment (ECR-RC), and maladaptive Emotion Regulation Strategies (ERS; FEEL-KJ).

RESULTS

Based on child's self-reports MANOVA's showed no significant differences between the groups in psychosocial functioning. However, based on parent reports, differences were found between the groups in psychosocial functioning for the total scales and overarching subscales. No differences were found between the groups for insecure attachment to either parent. However, youngsters with CHD and their fathers reported more use of self-devaluation compared to controls (p = .03). Other maladaptive ERS (giving up, withdrawal, rumination, aggressive actions) showed no differences.

CONCLUSIONS

Care interventions for children with CHD should address medical, emotional, and social needs, with a focus on multi-informant evaluations to support emotional well-being. Nurses are important partners in detecting psychosocial difficulties and providing family support. Patient- and family-centered care involves patients, parents and caregivers in the care plan, recognizing their key role, especially as youngsters often perceive their psychosocial health differently than their parents. Although differences were noted compared to the control group, the study's cross-sectional design limits conclusions on evolution with time.

The relation between clutter and visual fatigue in children with cerebral visual impairment

PURPOSE

Cerebral visual impairment (CVI) is a brain-based condition which can be exacerbated by clutter. This study aimed to explore the relation between clutter and visual fatigue in children with CVI and evaluate the effectiveness of clutter algorithm metrics in assessing visual clutter in photographs of children's play areas and the relation to visual fatigue.

METHODS

Visual clutter was measured using algorithmic metrics, subjective observations by a clinical researcher (who also observed visual fatigue) and a Qualtrics survey.

RESULTS

Seventy-two children (mean performance age = 7 years 4 months) were included. Visual fatigue was present in over 90% of children. Results revealed a relation between clutter and visual fatigue observations (rs = 0.29; p = 0.01) and between visual clutter observations from researchers and Qualtrics participants (rs = 0.32; p = 0.02). Certain metrics were correlated with visual clutter observations (rs ranging from -0.30 to 0.51, p-values ranging from <0.001 to 0.03), but not with visual fatigue.

CONCLUSIONS

Children with CVI presented with visual fatigue, particularly in cluttered environments. Therefore, parents, caregivers, teachers and clinicians should be attentive to visual fatigue signs, as early recognition and intervention can help address the child's needs more effectively. Algorithms that effectively quantify visual clutter are valuable tools that can be integrated to enhance the assessment of clutter and its relation with visual fatigue to advance CVI research methodology. However, a clinician is required to assess visual fatigue and to obtain detailed information on environmental clutter, which algorithms alone may not fully capture. Finally, we recognise that visual fatigue and the impact of clutter should be integrated into psychoeducation and the comprehensive assessment of individuals with CVI.

Community Caregivers' Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study

BACKGROUND

Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children's needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non-English-speaking immigrant populations.

OBJECTIVE

This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources.

METHODS

We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity.

RESULTS

We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies.

CONCLUSIONS

The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity.

An interpretative phenomenological analysis of the experience of a nature-based therapy intervention for children with long-term health conditions and associated psychological difficulties

Children and young people (CYP) with long-term health conditions (LTC) are at higher risk of developing mental health difficulties. Research suggests nature-based therapeutic interventions (NBTIs) may benefit CYP's wellbeing, but less is known about the impact on CYP with LTC. This study's objective was to explore how CYP with LTC and associated psychological difficulties experienced a NBTI and the impact on their wellbeing. Ten participants aged 10-13 attended a NBTI and took part in semi-structured interviews that explored how they made sense of their journey through the intervention, its impact on mental, physical wellbeing and sense of self. An interpretative phenomenological analysis of the interview data yielded four group experiential themes: 'Overcoming Illness-Identity', 'Freedom to Choose', 'Sense of Connection' and 'A Mindful Presence'. Participants reported improved self-esteem, a deepened sense of belonging with peers and nature, and enhanced emotion regulation. Clinical implications and directions for future research are discussed.

Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012-2017

BACKGROUND

Ambulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic disadvantage have higher rates of emergency admissions for ACSCs than their more affluent counterparts. Emergency admissions for ACSCs have been increasing, but few studies have assessed how changing socioeconomic conditions (SECs) have impacted this. This study investigates the association between local SECs and emergency ACS hospital admissions in children in England.

METHODS

We examined longitudinal trends in emergency admission rates for ACSCs and investigate the association between local SECs and these admissions in children over time in England, using time-varying neighbourhood unemployment as a proxy for SECs. Fixed-effect regression models assessed the relationship between changes in neighbourhood unemployment and admission rates, controlling for unmeasured time-invariant confounding of each neighbourhood. We also explore the extent to which this relationship differs by acute and chronic ACSCs and is explained by access to primary and secondary care.

RESULTS

Between 2012 and 2017, paediatric emergency admissions for acute ACSCs increased, while admissions for chronic ACSCs decreased. At the neighbourhood level, each 1% point increase in unemployment was associated with a 3.9% and 2.7% increase in the rate of emergency admissions for acute ACSCs, for children aged 0-9 years and 10-19 years, respectively. A 2.6% increase in admission rates for chronic ACSCs was observed, driven by an association in 0-9 years old. Adjustment for primary and secondary care access did not meaningfully attenuate the magnitude of this association.

CONCLUSIONS

Increasing trends in neighbourhood unemployment were associated with increases in paediatric emergency admission rates for ACSCs in England. This was not explained by available measures of differential access to care, suggesting policy interventions should address the causes of unemployment and poverty in addition to health system factors to reduce emergency admissions for ACSCs.

Using non-pharmacological interventions to manage medical procedure-induced anxiety in children: a framework to guide best practice

Medical procedure-induced anxiety in children can have short- and long-term negative effects. Research shows that children's anxiety can be affected by non-pharmacological interventions and adults' behaviours in a complex manner. This article presents a scoping review of the literature on non-pharmacological interventions to manage medical procedure-induced anxiety in children. Based on this review, the authors propose a framework comprising six strategies for effective non-pharmacological management of medical procedure-induced anxiety in children. A real-life, and anonymised, example is used to illustrate this framework in practice.

Impact of proxymetacaine on the dynamics of cyclopentolate in White 6- to 7-year-olds

PURPOSE

This study compared the efficacy of cyclopentolate hydrochloride at 10-, 20- and 30-min post-instillation in White 6- to 7-year-olds, with and without prior instillation of proxymetacaine hydrochloride. The primary aim was to determine if accurate autorefraction values can be obtained sooner than the current standard of 30-min post-cycloplegia. The secondary aim was to investigate whether proxymetacaine hydrochloride enhances the efficiency of cyclopentolate.

METHODS

Participants were 112 White 6- to 7-year-olds from the Child Eye Health Study. The right eye received 0.5% proxymetacaine hydrochloride and 1.0% cyclopentolate hydrochloride, and the left eye received only 1.0% cyclopentolate hydrochloride. Non-cycloplegic and cycloplegic refractive error (at 0, 10, 20 and 30 min) was measured using a binocular, open-field autorefractometer. Data were analysed through paired t-tests, concordance analysis, linear regression, equivalence testing and Bland-Altman analysis, using the 95% limits of agreement.

RESULTS

Mean spherical equivalent refraction (SER) (SD) in the right eye at 0-, 10-, 20- and 30-min post-instillation was 0.62 (1.45) D, 1.52 (1.80) D, 1.64 (1.81) D and 1.72 (1.80) D, respectively. Mean left eye SER (SD) were 0.68 (1.24) D, 1.42 (1.66) D, 1.56 (1.66) D and 1.68 (1.72) D, respectively. Bland-Altman analysis showed a high level of agreement, and equivalence testing confirmed that there was no clinically significant difference in SER at 20 and 30 min in both eyes (within ±0.50 D), with mean differences of 0.08 (0.23) D in the right eye and 0.13 (0.30) D in the left eye (p = 0.21). However, SER at 10 and 30 min were equivalent in the right eye only.

CONCLUSIONS

Accurate autorefraction values can be obtained 20-min post-instillation of 1.0% cyclopentolate in white children aged 6-7 years, potentially reducing clinical testing times. Proxymetacaine pre-instillation allows for reliable measurements as early as 10-min post-instillation of cyclopentolate. Further research is needed to validate these findings in non-White populations and to determine the safe discharge time post-proxymetacaine instillation.

Assessing the Use and Acceptability of Virtual Reality to Assist Coping in Children Undergoing Clinical Procedures

PURPOSE

Virtual reality is used as a distraction tool during medical procedures that can cause anxiety and pain. We assessed the usefulness, engagement, value and feasibility of virtual reality to help children cope with routine clinical procedures.

DESIGN AND METHODS

Quality improvement study. Children, 4-16 years old, were given the option to use virtual reality during their procedure in oncology, immunology or diabetes clinics, or during an induction of general anesthesia. The emotional state of the child was documented using the children's emotional manifestation scale. We assessed feedback from patients, parents, and clinicians.

RESULTS

Across all clinics, children responded positively to the virtual reality and 80% would choose to use virtual reality again for health-related procedures. Parents and clinicians, respectively, reported that virtual reality helped children tolerate the procedure (82% and 87%), engaged children well (82% and 89%) and was a valuable tool (85% and 98%). Clinicians (90%) endorsed the feasibility of using virtual reality during procedures.

PRACTICE IMPLICATIONS

This project demonstrated that virtual reality can be implemented as a useful, engaging and feasible tool to help children tolerate a variety of routine medical procedures. However, ensuring comfortable fit of virtual reality devices and diversifying the visual content is necessary.

The parent-doctor-child triangle: a structural equation modeling-based study in pediatric outpatient clinics in Indonesia

PURPOSE

Parental satisfaction is essential for evaluating pediatric care quality and influences healthcare practices and performance. Pediatric patients frequently experience anxiety, affecting their and their parents' satisfaction. Nurses play a key role in reducing anxiety and improving care interactions. Meeting parents' expectations shapes long-term outcomes and impacts the hospital's reputation. While instruments such as the Child ZAP (Zufriedenheit in der Arztpraxis) provide comprehensive measures of satisfaction, their use in Indonesia has not been explored. This study aimed to validate the Child ZAP and offer insights to improve pediatric care quality in Indonesia.

METHODS

A cross-sectional study was conducted with 139 mothers whose children were older than 5 years and received treatment at private hospitals. Structured questionnaires were analyzed using partial least squared-structural equation modeling in SmartPLS 4, and a disjoint two-stage method was used to test dimensionality.

RESULTS

All hypotheses were significant (p<.05), demonstrating strong support. All Child ZAP dimensions, treated as lower-order constructs, effectively measured parents' satisfaction as a higher-order construct. Overall parental satisfaction significantly influenced behavioral intention and mediated its relationship with Child ZAP. The mother's and the child's age served as moderating factors. The research model exhibited strong predictive power, underscoring pediatric nurses' pivotal role in improving communication among parents, physicians, and children to ensure quality care.

CONCLUSION

The Child ZAP instrument effectively evaluates parental satisfaction by examining how children interact and communicate with medical staff. It assesses doctors' engagement with children and their communication skills, highlighting nurses' essential role in providing family-centered pediatric care.

A preparation program for psychological safety of hospitalized adolescents

INTRODUCTION

The study aimed to investigate the impact of an information-based preparation program on the psychological safety of adolescents admitted to pediatric wards, emphasizing the importance of enhancing patient safety.

METHODS

This quasi-experimental study was conducted among 98 adolescents admitted to pediatric wards at Namazi Hospital, managed by Shiraz University of Medical Sciences, in 2021. The participants were randomly assigned to either an intervention group or a control group using an electronic randomization table. The intervention group received an information-based preparation program, while the control group followed routine care. Adolescents completed the Psychological Safety Questionnaire after admission and at discharge. Data were analyzed using SPSS (Version 22), with a significance level of 0.05.

RESULTS

The mean psychological safety scores before the intervention were 136.73 ± 17.30 in the control group and 141.03 ± 16.34 in the intervention group, with no significant difference between the two groups (p = 0.20). After the intervention, the mean scores were 136.65 ± 19.01 in the control group and 145.50 ± 14.05 in the intervention group. A comparison of the mean psychological safety scores showed a significant difference between the two groups after the intervention (p = 0.01).

CONCLUSIONS

The findings of this study indicate that the information-based preparation program positively affected the psychological safety of hospitalized adolescents. Therefore, it is recommended that nurses incorporate this method into therapeutic programs for hospitalized adolescents to enhance their psychological safety effectively.

The use of immersive virtual reality for managing physical and psychological distress in children and adolescents with cancer undergoing chemotherapy via implanted vascular access device needle insertion: A systematic review

PURPOSE

Children and adolescents undergoing cancer treatment often endure distressing procedures, leading to pain and anxiety. Immersive virtual reality (VR) is a novel distraction technique for distress management, but research in pediatric oncology remains limited. This systematic review aims to assess the effectiveness of IVR intervention utilizing advanced head-mounted displays, in alleviating physical and psychological distress among Children and Adolescents diagnosed with malignancies undergoing chemotherapy treatment via Implantable Venous Access Device/Port (IVAD/P) (P) needle insertion. Additionally, the study evaluates the usability and acceptability of the IVR intervention among healthcare professionals, patients, and their parents.

METHOD

A thorough database search (PubMed, Medline, Embase, CINHAL, and APA Psycinfo) identified seven relevant quantitative studies published until April 2024.

RESULTS

In five studies, VR significantly reduced physical distress, especially pain, though the other two showed positive trends without statistical significance. For psychological distress, two studies reported significantly lower levels in the VR group, while three showed promising but statistically insignificant results. Children and adolescents, as well as healthcare professionals, found VR user-friendly and expressed willingness to use it again.

CONCLUSIONS

The review suggests that immersive VR has significant potential as a distraction method for children and adolescents undergoing CMT via IVAD/P. It shows promise in reducing physical and psychological distress and is well-received by patients and healthcare professionals.

Assessment of Psychological Impact among Hospitalized Children; Single Centre Study

Background: The goal of the contemporary hospital setting is to give patients suffering from a range of diseases a secure and therapeutic space. Aim: Psychosocial and mental health assessment among hospitalized children between 7 to 12 years of age. Methods: This Cross-Sectional Study was carried out at the Children's Hospital Faculty of Medicine for 1-year duration. Results: Higher statistically significant positive results were found in cases than in control regarding all Vanderbilt subscales except in the conduct subscale. Higher results were found in chronic cases than control in all subscales except for oppositional defiant disorder results. Conclusion: Hospitalized Children, due to chronic or acute conditions, are at a higher risk for Psychosocial and mental health disorders such as depression, anxiety, ADHD, PTSD, and pain in comparison with healthy children.

Imaging Outcomes of MRI After CT in Pediatric Spinal Trauma: A Single-center Experience

BACKGROUND

Imaging has an essential role in the diagnostic workup of suspected pediatric spinal trauma. The most suitable imaging method is still being debated and needs to be considered regarding the patient, injury, and local resources. Magnetic resonance imaging (MRI) is often performed after computed tomography (CT) in case of neurological symptoms or suspected ligamentous disruption. However, it is unclear if the MRI yields significant additional value after CT if the spinal cord injury is not suspected and if the MRI could be used as the sole imaging modality in an emergency department. This study aimed to assess the diagnostic value of emergency MRI after CT in suspected spinal trauma in children and adolescents.

METHODS

The imaging data and medical records of patients 17 years of age and younger with emergency spinal CT and MRI over 8 years were retrospectively reviewed. The primary study outcome was the diagnostic accuracy of the 2 imaging modalities in detecting surgically treated spinal injuries.

RESULTS

The study population consisted of 100 patients. Computed tomography and magnetic resonance imaging demonstrated all 7 surgically treated injuries, although one of the injuries was initially missed with CT. Magnetic resonance imaging revealed more injuries, but none of the injuries visible on CT required surgical fixation. Magnetic resonance imaging was able to exclude unstable injuries in patients who had highly suspicious or unequivocal findings on CT.

CONCLUSIONS

Magnetic resonance imaging and computed tomography were both highly accurate in detecting unstable pediatric spinal injuries requiring surgical treatment. Magnetic resonance imaging seems not to reveal additional unstable injuries after adequately interpreted spinal CT.

LEVEL OF EVIDENCE

Level III-retrospective observational study.

Empowerment-based Teddy Bear Clinic for Pre-school Children: A Student-led Educational Project

Nurses are at the forefront of providing health education for the general public and are leaders in developing health education programs for all ages. Research has shown that the pediatric population often experience anxiety surrounding common medical procedures. However, evidence-based health education has been shown to enhance self-management, increase knowledge, and decrease anxiety in the pediatric population. One such successful evidence-based health education approach designed for the pediatric population is the Teddy Bear Clinic. The purpose of this article is to report on the efficacy of a nursing student-led Teddy Bear Clinic designed to increase the awareness of common medical equipment and procedures in the pre-school pediatric population. This quality improvement project used a program evaluation design to assess the children's knowledge of common medical procedures and equipment. Participants were a convenience sample of 16 children aged 3-5 years old, attending one daycare center in a large city in Atlantic Canada. Findings showed that after participation in the clinic, the pre-schoolers reported a high level of knowledge of common medical equipment and procedures. This project shows that a Teddy Bear Clinic run by senior nursing students can promote community partnerships and enhance health knowledge in pre-school children.

The Relationship Between Perceived Parenting Practices and Anxiety in Adults With Congenital Heart Disease

BACKGROUND

Patients with congenital heart disease (CHD) and their parents face challenges throughout their lives that can lead to anxiety lasting into adulthood. We aim to assess the association between perceived parenting practices and anxiety beyond paediatric medical-surgical histories in adults with CHD.

METHODS

A cross-sectional study of adults with CHD was conducted at the Montreal Heart Institute (MHI). Perception of parental practices during childhood was retrospectively assessed with the use of validated self-report questionnaires, and anxiety in adulthood was assessed with the use of the Hospital Anxiety and Depression Scale. Sociodemographic and medical information were collected from a questionnaire and medical records. Hierarchic multiple linear regression was conducted.

RESULTS

Of the 223 participants, the mean age was 46 ± 14 years and 59% were female. Perceived parenting practices explained more variance (11%) in the anxiety score than paediatric medical-surgical history (2%). In our final model, anxiety was significantly associated with age, parental history of anxiety, and positive parenting practices, but not with overprotection.

CONCLUSIONS

Parenting practices are associated with anxiety in adults with CHD beyond paediatric medical-surgical history and sociodemographic. Positive parenting practices may be protective against anxiety in adulthood. Longitudinal studies are needed to determine causality.

The factors associated with paediatric medical post-traumatic stress: A systematic review

We examined and synthesised existing literature on factors associated with paediatric medical-related posttraumatic stress among children and their parents. Children experiencing a broad spectrum of medical conditions, diseases and injuries were of interest. A search of relevant literature concerning PMTS in children and their parents, as well as factors associated with PMTS, was conducted using Medline, PubMed and Scopus. Only studies published in English between January 2018 and November 2023 were included. Twelve articles met inclusion criteria. A broad range of correlates of PMTS were identified for children and parents, which were thematically organised into six key areas: hospital practices and environments; the parent-child relationship; parental mental wellbeing; psychological factors; sociodemographic factors; and the physical consequences of the condition. Bearing in mind constraints on causal inference due to the design of the included studies, knowledge of the factors associated with PMTS may enable clinicians to identify at-risk children and parents, with a view to intervention.

The perception of healthcare professionals, through their own personal experiences, of the use of music therapy in hospitalised children and adolescents

BACKGROUND

Music therapy is an emerging and useful methodology for improving patient environments within healthcare fields. However, although it has been shown that music therapy interventions with hospitalised children and adolescents have been used for decades with positive effects, there are currently very few studies that specifically describe the perspectives of healthcare professionals regarding the value of music therapy when applied in these patients.

OBJECTIVES

To describe the insights of healthcare professionals regarding music therapy, both on a personal level and in terms of its usefulness in the care of hospitalised children and adolescents.

DESIGN

This was a qualitative descriptive-exploratory study with focus groups.

PARTICIPANTS

Eighteen healthcare professionals.

METHODS

In January 2023, two focus groups, containing nine healthcare professionals each, were created to collect data regarding their experiences concerning the effect of music therapy on hospitalised children and adolescents. Before recording their opinions, all these professionals participated in an interactive music therapy session. The thematic analysis in this work was performed using MAXQDA® software.

RESULTS

Two main categories emerged: (a) the effects of music therapy on healthcare professionals, and (b) the benefits of music therapy to patients (children and adolescents).

CONCLUSIONS

Music therapy was valued positively by healthcare professionals who described the benefits its use has for hospitalised children and adolescents. They also expressed positive viewpoints regarding the use of music therapy to improve their own self-knowledge and self-care.

IMPLICATIONS TO PRACTICE

Healthcare professionals may utilise music therapists to improve patient outcomes and reduce the negative effects of hospitalisation.

The Impact of Parents' Subjective Preparedness on Their Children's Post-Traumatic Symptoms Following Surgery

The role of parental factors in the emergence of post-traumatic stress symptoms (PTSSs) following pediatric surgeries is well recognized, but the specific influence of parents' subjective preparedness for their child's surgery has not been explored. In a study involving 253 children hospitalized in a pediatric surgery ward, parents completed a demographic questionnaire during their child's stay, which included the question, "As a parent, have you been prepared for the surgical intervention your child is undergoing?" Four months post-surgery, the same parents were interviewed using two questionnaires that evaluated their children's post-traumatic symptoms. Our findings indicate that in emergency surgical settings, children whose parents felt prepared experienced significantly fewer PTSSs compared to children whose parents did not feel prepared. In contrast, for elective surgeries, parental subjective perception of preparedness did not significantly impact the children's PTSSs. We conclude that for emergency surgical procedures, addressing parents' subjective preparedness could be crucial. Further research is necessary to develop targeted interventions that leverage this insight to minimize the risk of PTSSs in children undergoing emergency surgeries.

A national survey of children's experiences and needs when attending Canadian pediatric emergency departments

BACKGROUND

Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition.

METHODS

514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020.

RESULTS

Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect.

INTERPRETATION

While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.

Amateur dubbing as a healthcare activity in the pediatric hospital setting: a pilot project

BACKGROUND

Dubbing is a mode of audiovisual translation (AVT) usually performed by experienced dubbing actors for professional purposes. Nowadays, thanks to advances in technology, everybody can create personal dubbed versions of audiovisual content for humorous and parodic as well as therapeutic and pedagogical purposes. The aim of this pilot project was to investigate the potential and applicability of amateur dubbing within the hospital setting, targeting children and adolescents.

METHODS

The project was carried out at Meyer Children's Hospital in Florence (Italy). Like other non-pharmacological activities, amateur dubbing was designed to make hospitalization a less traumatic experience for young patients and promote their general well-being. A research team (including psychologists, dubbing actors and a linguist) developed a theoretically sound and replicable set of procedures that combine new technologies with traditional pain management methods.

RESULTS

The amateur dubbing workshops, carried out from January 2017 until the end of December 2019, involved 297 children and adolescents (male=29.8%; female=70.2%), aged 6-17, from different wards (i.e. Oncology, Neuropsychiatry, Pediatric Unit, Diabetology, Neurology, Surgery, etc.). This pilot project has proven to be a positive experience for all the patients and their families, in terms of the children's well-being, quality of life and socialization (i.e. expression of emotions, distraction and reduction of distress).

CONCLUSIONS

Amateur dubbing as a healthcare activity has resulted in interesting recreational and psychological implications and benefits. Clearly, its implementation as a type of non-pharmacological technique needs to be further refined.

Development of a Multivariable Risk Prediction Tool to Predict Adverse Outcomes among Children with Type 1 Diabetes: A Pilot Study

Background

Children and adolescents with type 1 diabetes mellitus (T1DM) are frequently hospitalised for severe hypoglycaemia, hyperglycaemia, and diabetic ketoacidosis (DKA). While several risk factors have been recognised, clinically identifying these children at high risk of acute decompensation remains challenging.

Objective

To develop a risk prediction model to accurately estimate the risk of acute healthcare utilisation due to severe hypoglycaemia, hyperglycaemia, and DKA in children and adolescents with T1DM.

Materials and Methods

Using a retrospective dataset, baseline demographic and clinical data were collected from patients (<18 years) seen at a regional paediatric diabetes clinic from 1 January 2018 to 1 January 2020. The outcome was the number of emergency department presentations or hospital admissions for severe hypoglycaemia, hyperglycaemia, and DKA across the study period. Variables that were significant in univariate analysis were entered into a multivariable model. Receiver operator characteristic (ROC) curves assessed the model's discrimination and generated cut-offs for risk group stratification (low, medium, and high). Kaplan-Meier survival analysis measured time to acute healthcare utilisation across the risk groups.

Results

Our multivariable risk prediction model consisted of five predictors (continuous glucose monitoring device, previous acute healthcare utilisation, missed appointments, and child welfare services involvement and socioeconomic status). The model exhibited good discrimination (area under the ROC = 0.81), accurately stratified children into low-, medium-, and high-risk groups, and demonstrated significant differences between median time to healthcare utilisation.

Conclusion

Our model identified patients at an increased risk of acute healthcare utilisation due to severe hypoglycaemia, hyperglycaemia, and DKA.

Assessing child satisfaction and expectations for developing a child-friendly environment at the pediatric department in a general hospital in Qatar

BACKGROUND

"Patient-centered" care positions the patient at the core and emphasizes fulfilling their unique needs, preferences, and values. This approach is particularly significant in the context of children. Although widely recognized as necessary, this approach is not universally implemented. The children find themselves in hospital wards where they are required to follow protocols and systems designed primarily for adults. In the appropriate atmosphere, children often express themselves more effectively through words, body language, and play, leading to a richer understanding of their needs. There is growing recognition of the importance of addressing children's concerns regarding hospital environments.

AIM

This study investigates children's satisfaction with the physical aspect of the hospital environment. Insights from this exploration could provide valuable input for creating hospital environments centered around children's needs and preferences.

METHODS

This mixed-methods study involves children aged 6-14 years with parental consent from a premiere healthcare provider in the state of Qatar. The survey used nine items to gauge satisfaction with the existing hospital environment as a "child-friendly hospital" and another nine items to explore their expectations for such environments. The Mann-Whitney U and Kruskal-Wallis tests as well as thematic analyses were employed to assess the statistical significance of differences in satisfaction levels and children's expectations of the hospital's physical environment.

RESULTS

A total of 398 children participated in the study. Of them, 40.3% were aged 6-8 years; 60.3% had experienced two to five hospital visits; 55.8% of children participated during their outpatient service visit; and 31.7% were Asian. Children's satisfaction levels with various aspects of the hospital environment-including its physical appearance, signage, lounge, consultant rooms, corridors, bedrooms, TV content, toys, and staff uniforms-were in the range of 42.9%-59%. The children expressed a desire for a hospital environment that is spacious, colorful, attractive, and filled with cartoon characters and toys in the children's hospital from the front lounge to the inpatient units.

CONCLUSION

The findings underline the importance of considering the perspectives of children in evidence-based healthcare design. The study reveals that children's satisfaction with the hospital environment is generally average or below average. Ultimately, a "child-friendly hospital environment" integrates children's rights into healthcare to significantly improve outcomes.

If we know better, why don't we do better? A rapid quality improvement project to increase utilization of comfort measures to reduce pain and distress in children in a COVID-19 mass vaccination clinic

INTRODUCTION

Many evidence-based tools exist to address pain and distress associated with injections; however, there remains a large gap between the knowledge of these tools and their utilization. Our hospital began a quality improvement (QI) project prior to COVID-19, with the goal of increasing the utilization of Comfort Promise measures during needle procedures. When COVID-19 vaccinations were approved, our mass vaccination clinics provided an opportunity to rapidly increase utilization across the institution. The primary aim was to increase the percentage of comfort measures (CM) offered with COVID-19 vaccinations.

METHODS

Through this QI project, nurses and other professionals implemented CMs during COVID mass vaccination clinics. Clinics occurred in 3 age-based waves. Waves served as Plan-Do-Study-Act (PDSA) cycles. Families completed post-vaccination surveys to determine what CMs were offered and intention for future use with vaccinations.

RESULTS

Uptake of CMs (PainEase, ShotBlockers, Comfort Positioning, Alternative Focus, Topical Lidocaine, and Breastfeeding/Sucrose) throughout the waves increased and generally remained stable. CMs also seemed to decrease pain/distress with vaccinations (70.5 to 88.7%), and children/caregivers intended to use some combination for future vaccinations (82.5 to 98.5%).

CONCLUSIONS

Fast-paced mass vaccination clinics provided an ideal opportunity to significantly increase utilization of CMs. Across age groups CMs yielded high satisfaction and interest in future utilization. Clinic nurses returned to their own sub-specialties and became change agents.

IMPLICATIONS

If all healthcare providers can work together to achieve consensus while incorporating comfort measures into daily practice, sustained change with incorporation of these evidence-based tools can be achieved. Future directions are discussed.

The infant-doctor relationship: an examination of infants' distress reactions in the presence of a doctor

Fear of doctors is a common source of distress among infants; however, the underlying sources of this distress are unknown. To investigate the doctor-infant relationship, the behaviors of 61 healthy infants (176-617 days old) were observed in a simulated examination room. Their behaviors and electrocardiograms were recorded. Two groups of infants were analyzed: those who cried and those who did not. When an experimenter dressed in the doctor's attire entered the room, all 9 infants who were crying (14.8% of all infants) stopped crying, all infants gazed at the experimenter, and their mean heart rate (HR) decreased. After the auscultation started, 29.5% of all infants cried, and the HRs of infants who cried were higher than those of infants who did not cry. During the auscultation, 80.0% of infants who cried averted from the experimenter, while 34.4% of infants who did not cry. Within 5 s of gazing at the stethoscope, the number of infants who cried increased from 3 to 12, and their mean HR also increased. Our findings suggest that the fear of doctors is not due to the appearance of doctors but rather to specific actions performed by doctors, such as auscultation. Infants may regard a doctor's appearance as a source of interest. Furthermore, a stethoscope is a possible trigger for infants' crying. These behavioral observations suggest the potential for patient-centered care for infants.

Reasons, experiences and expectations of women with delayed medical care for ectopic pregnancies in Chinese urban edges: a qualitative study

OBJECTIVE

To explore the experiences of patients with ectopic pregnancies with delayed medical care, with the goals to promote timely access to care, reduce subsequent physical and psychological impacts, and provide recommendations for improved management of ectopic pregnancies.

DESIGN

A qualitative study.

SETTING

A 1000-bed urban edge hospital located in the suburban area of Guangzhou, China, between December 2022 and February 2023.

PARTICIPANTS

21 patients with delays in seeking medical care for ectopic pregnancy.

PRIMARY AND SECONDARY OUTCOME MEASURES

Semistructured, in-depth, face-to-face interviews were conducted to understand the experience and expectations of these women.

RESULTS

Three main themes emerged, including delaying medical care, physical and psychological experiences, and expectations of their healthcare providers. Each of these main themes had several subthemes. The central theme of reasons for delaying medical care had five subthemes, including lack of knowledge on early symptoms of ectopic pregnancy, family dynamics and circumstances, traditional fertility ideology and intentions, avoidance of medical treatment behaviour, and medical delays. The main theme of physical and psychological experiences had two subthemes, including learnings from the experiences and negative impacts of the experiences. The main theme of expectations of their healthcare providers included three subthemes that were reducing the length of outpatient examinations and waiting times, increasing public understanding of early symptoms of ectopic pregnancy and increasing male awareness of safe contraceptive methods.

CONCLUSIONS

A lack of knowledge about the early symptoms of ectopic pregnancy was the main reason for delays in seeking medical care and had a dual impact on patients' physical and mental health, affecting their recovery and future healthcare. A collective effort from patients, families, healthcare providers and medical institutions is required for better medical education, family support, specialised professional training and local fertility policy to decrease the incidence of delayed medical care and achieve satisfactory pregnancy outcomes.

Current and Future Applications of Arterial Spin Labeling MRI in Cerebral Arteriovenous Malformations

Arterial spin labeling (ASL) has emerged as a promising noninvasive tool for the evaluation of both pediatric and adult arteriovenous malformations (AVMs). This paper reviews the advantages and challenges associated with the use of ASL in AVM assessment. An assessment of the diagnostic workup of AVMs and their variants in both adult and pediatric populations is proposed. Evaluation after treatments, whether endovascular or microsurgical, was similarly examined. ASL, with its endogenous tracer and favorable safety profile, offers functional assessment and arterial feeder identification. ASL has demonstrated strong performance in identifying feeder arteries and detecting arteriovenous shunting, although some studies report inferior performance compared with digital subtraction angiography (DSA) in delineating venous drainage. Challenges include uncertainties in sensitivity for specific AVM features. Detecting AVMs in challenging locations, such as the apical cranial convexity, is further complicated, demanding careful consideration due to the risk of underestimating total blood flow. Navigating these challenges, ASL provides a noninvasive avenue with undeniable merits, but a balanced approach considering its limitations is crucial. Larger-scale prospective studies are needed to comprehensively evaluate the diagnostic performance of ASL in AVM assessment.

Nurse-led Preoperative Education With Home-based Internet Resources for Pediatric Patients and Their Parents

The majority of pediatric patients and their parents experience fear and anxiety related to their surgical experience. Traditionally, anesthesia providers addressed this anxiety with pharmacologic therapy, such as benzodiazepines, to provide amnesia and anxiolysis. However, this approach has been questioned due to the potential for developmental neurotoxicity, among other drawbacks. Further, the pharmacological approach does not remove preexisting anxiety that the child and parent experience before arrival and during check-in. Pediatric and parental preparation before surgery is an important step that continues to be inconsistently addressed, particularly in lower-resource community hospitals where the majority of routine pediatric outpatient procedures occur. This care gap provides an opportunity for preanesthesia nurses to intervene with valid, evidence-based preoperative education tools aimed at pediatric patients and their parents. Providing these resources before the day of surgery allows time for child-directed, at-home practice as often as the parent(s) and patient choose. Use of available resources from a leading children's hospital, nurses can create a tailored, developmentally appropriate preoperative education plan for pediatric patients and their parents, providing families with the power to create a positive surgical experience.

Regional anesthesia for pain control in children with solid tumors-a review of case reports

Introduction

Around seventy percent of all childhood cancer patients suffer from severe pain. This pain can arise from various sources, including tumors themselves, pain caused by metastasizing tumor cells or as the outcome of therapy meant to deal with tumors. If managed inadequately, such pain can lead to many hazardous sequelae. However, there are extreme cases when pain does not respond to standard treatment. For such cases, regional anesthesia or nerve blocks are utilized as the utmost pain control measure. Blocks are used to treat pain in patients who no longer respond to conventional opioid-based treatment or whose worsened condition makes it impossible to receive any other therapy. The data regarding the use of regional anesthesia for such cases in the children population is limited.

Methods

For this review we searched for case reports in Scopus and PubMed from inception to 2023. The descriptive search items included terms related to childhood cancer and the description of each block. The inclusion criteria for review include children (0-18 years old) receiving oncology-related surgical procedures or palliative care. The data collection was limited to solid tumor-related cases only. We analyzed a total of 38 studies that included case reports and one retrospective study.

Results and discussion

It was concluded that nerve blocks, although rarely performed, are a safe and efficient way of pain control in children with solid tumors. The major settings for block performance are postoperative pain control and palliative care. We observed that block indication and its outcomes depend on unique health circumstances in which they should be performed. Patients with similar diagnoses had differing outcomes while receiving the same block treatment.

Topical anesthetics for needle-related pain in adults and children (TOPIC): a mini-review

Purpose

Healthcare professionals (HCP) perform various needle procedures that can be distressing and painful for children and adults. Even though many strategies have been proven effective in reducing distress and pain, topical anesthetic use before needle procedures is uncommon. However, there are limited studies in the existing literature comparing specifically liposomal lidocaine and tetracaine hydrochloride topical creams.

Source

This systematic review analyzed studies on the use of two anesthetic creams, Liposomal Lidocaine (Maxilene®) and Tetracaine hydrochloride (Ametop™), in children and adults undergoing a needle-related procedure. Databases searched: PubMed, CINAHL, ClinicalTrials. Only randomized controlled trials (RCT) and Controlled Clinical Trials (CCT) studies were included. Cochrane Collaboration's Risk of Bias assessment tool was used. Strictly minimally invasive procedures were included to standardize different skin needle interventions.

Principal findings

Only one study with 60 participants was available to be included in this review. No statistically significant difference was found in the mean pain score among both interventions. The outcomes of self-reported distress during cannulation and on HCP satisfaction were not reported. However, physiological characteristics associated with stress/anxiety and on cannulation success rate were reported and did not show statistical significance.

Conclusion

Little to no evidence regarding the most efficient cream between liposomal lidocaine and tetracaine hydrochloride for pain management during needle-related procedures was found. Further studies, particularly RCT with larger sample sizes and standardized outcome measures, are needed to confirm the relative efficacy of either anesthetic cream.

A Systematic Review and Meta-Analysis on the Management and Outcome of Isolated Skull Fractures in Pediatric Patients

BACKGROUND

The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF).

MATERIALS AND METHODS

This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered.

RESULTS

A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies.

CONCLUSIONS

Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.

How to support children to develop and express their coping preferences around minor invasive medical procedures: children's and parents' perspectives

Invasive medical procedures in hospitals are major sources of stress in children, causing pain and fear. Non-pharmacological interventions are indispensable in effective pain and fear management. However, these interventions must be personalized to be effective. This qualitative study aims to gain insight into children's and parents' experiences, needs, and wishes related to supporting children to develop and express their coping preferences for dealing with pain and fear during minor invasive medical procedures in order to decrease pain and fear. A qualitative study using thematic analysis was performed. Data were collected through semi-structured interviews with children and parents who had undergone at least five minor invasive medical procedures in the last year. Nineteen children (8-18 years) and fourteen parents were interviewed individually. The experiences, needs, and wishes expressed in the interviews could be classified into one overarching theme, that of the personal process, and two content-related sub-themes: feeling trust and gaining control. The personal process was divided into two different phases, that of developing and of expressing coping preferences. Children and parents both reported it as a continuous process, different for every child, with their own unique needs. Children and parents expected personalized attention and tailored support from professionals.     Conclusion: Professionals must combine clinical skills with child-tailored care. In the process of searching for and communicating about coping preferences, children's unique needs and personal boundaries will thereby be respected. This gives children and parents increased trust and control during invasive medical procedures. What is Known: • Untreated pain and stress caused by medical procedures can have severe and important short- and long-term consequences for children. Personalized non-pharmacological interventions are an essential element of procedural pain management. What is New: • A personalized coping strategy is important for children when undergoing medical procedures. Each individual child has a personal way of expressing their own coping strategy. Children and their parents need information and the space to develop and express their individual coping preferences. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures.

Barriers to Seeking Medical Care Among Youth Victims of Sexual Violence

PURPOSE

Youth victims of sexual violence often experience physical health problems but are unlikely to receive medical care. However, victims' reasons for not accessing medical care have been understudied. We examined barriers to seeking medical care among youth victims who contacted the National Sexual Assault Online Hotline.

METHODS

We used archival data about one-on-one chat sessions with youth victims between June 2018 and February 2020. Hotline staff described victims' reasons for not accessing medical care via an online assessment. We coded and qualitatively examined these reasons using data about 520 victims with physical health concerns who had not received medical care.

RESULTS

Victims' barriers were rooted in individual beliefs and contextual realities reflected in three categories: (1) perception that medical care was not needed, (2) anticipated consequences of seeking medical care, and (3) inability to physically access medical care. Victims who perceived care as unnecessary did not understand the health implications of abuse or minimized their need for care. Anticipated consequences included privacy and control over disclosure, stigmatization, retaliation from the perpetrator, family disruptions, and retraumatizing medical treatment. Victims unable to physically access care were uncertain how to access care independently, lacked social support, or were prevented from care by the perpetrator.

DISCUSSION

Medical treatment can ameliorate acute health concerns and increase safety, but youth victims perceived numerous barriers to care. Several barriers implied unintended consequences of child maltreatment policies, including mandatory reporting. Trauma-informed policy and practice are critical for improving victims' access to medical care and other support services.

Exploring reported distress before and pain during needle insertion into a venous access port in children with cancer

BACKGROUND

Venous access port is commonly used during cancer treatment in children, yet little is known about how children experience such needle insertion procedures.

AIM

To study distress before and pain after venous access port needle insertion among children and adolescents with cancer. A second aim was to explore associations between their self-report of procedure-related distress and pain with proxy reports by parents and nurses.

METHOD

The sample included 43 children/adolescents, aged 1-16 years with cancer, treated at two Norwegian university hospitals. The patient, parent(s), and the nurse performing the procedure completed developmentally appropriate 11-point distress and pain scales before and immediately after the venous access port procedure. Data were analysed using descriptive statistics and non-parametric correlations.

ETHICAL ISSUES

The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Regional Committee for Medicine and Health Research and the data protector officer at the hospitals.

RESULTS

For the youngest children (1-5 years), the median distress proxy score was 8 (range 0-9) and pain proxy score 4 (range 0-10). Median distress and pain scores for children aged 6-12 years were 3 (range 0-9) and 1 (range 0-10), respectively, and for the adolescents (age 13-16) 0 (range 0-6) and 1 (range 0-5), respectively. Patients' self-reported distress and pain correlated highly with parents' (distress: rho = 0.83, p < 0.001, pain: rho = 0.92, p < 0.001) and with nurses' proxy ratings (distress: rho = 0.89, p < 0.001, pain: rho = 0.88, p < 0.001).

CONCLUSION

There were individual age differences in experienced distress/pain associated with venous access port needle insertion, with a trend for younger children to experience higher levels of distress/ pain than the older children. Children's self-report of distress/ pain concurred with both parental and nurse proxy reports.

Scoliosis Bracing: Details Make the Difference

Effective bracing for idiopathic scoliosis is influenced by factors such as age, skeletal maturity, and curve attributes, with success reliant on patient adherence and engagement. The purpose of this paper is to highlight strategies for successful treatment. Using standardized, effective communication detailing patient data, including radiographic measurements, supports clear communication between orthopaedic surgeon, orthotist, and patient. Consistent orthotist visits are important to ensure correct brace fit by evaluating aspects like tightness, comfort, and deformity correction. Monitoring growth metrics like height and weight can signal necessary adjustments. An initial in-brace x-ray facilitates early refinements with subsequent imaging based on growth stages. Adherence monitors augment treatment by tracking brace-wear patterns. Weaning protocols, aiming to reduce brace wear gradually while curbing curve progression, are influenced by factors such as curve size, brace comfort, and skeletal maturity markers. Overcoming barriers like physical discomfort and self-consciousness is pivotal for effective treatment. Emphasizing resilience, choice, and emotional support ensures enhanced patient commitment and satisfaction, leading to the best possible outcomes. Key Concepts•Increased time in brace leads to success in a dose-response fashion.•Effective, convenient methods of communication between the orthotist and orthopaedic surgeon are key to optimizing patient outcomes.•Adherence monitors can bolster patient engagement and autonomy and improve outcomes.•Patient support sources and psychologically informed techniques can diminish perceived barriers to brace wear.

Social Determinants of Health in Pediatric Ophthalmology Patients: Availability of Data in the Electronic Health Record and Association With Clinic Attendance

Purpose

To characterize the availability of social determinants of health data in the electronic health record of pediatric ophthalmology patients and to examine the association of social determinants of health with attendance at scheduled operating room and clinic visits.

Methods

This was a retrospective cohort study of pediatric ophthalmology patients seen at The Hospital for Sick Children between June 1, 2018, and May 23, 2022. Data were collected on demographics, diagnosis, and management-plan. The χ2 tests and multivariable regression were used to examine associations between social determinants of health and attendance at scheduled operating room and clinic visits.

Results

The cohort consisted of 26,102 study subjects with 31,288 unique eye-related diagnoses representing 57 unique ICD-10 codes. Availability of data in the electronic health record ranged from 100% for sex, age and postal code to 0.1% for ethnic group. Female sex (P = 0.004) and urbanicity (P = 0.05) were associated with higher operating room visit cancellations. Female sex (P = 0.002), age group 0-13 (P ≤ 0.001), low-medium neighborhood income quintile (P ≤ 0.001), residence of Northern Ontario (P ≤ 0.001), and urbanicity (P ≤ 0.001) were associated with higher clinic visit cancellations and no-shows.

Conclusions

At a major tertiary-care hospital in Canada, key social determinant data such as ethnicity are not consistently available in the electronic health record of pediatric ophthalmology patients. Female sex, younger age, and living in a rural area or neighborhood with low-medium income quintile may be predictors of missed visits and require further study.

Translational Relevance

This study highlights a need for improved documentation of social determinants of health variables in electronic health records.

Virtual reality vs. buzzy®. efficacy in pain and anxiety management during pediatric venipuncture. Systematic review and meta-analysis

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.