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He EM, Arshad F, Li BSK, Brinda R, Ganesan A, Zhang L, Fehr S, Renavikar M, Rodriguez ST, Wang E, Rosales O, Caruso TJ. Awe Inducing Elements in Virtual Reality Applications: A Prospective Study of Hospitalized Children and Caregivers. Games Health J 2025; 14:159-166. [PMID: 39109578 DOI: 10.1089/g4h.2024.0050] [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: 04/05/2025] Open
Abstract
Background: Hospitalized pediatric patients and their caregivers often experience anxiety and fear, resulting in withdrawal and aggression. Despite virtual reality (VR) being a safe and effective anxiolytic, it is unknown what software design aspects contribute to its effectiveness. This prospective observational study evaluated which VR application elements increased awe, which is correlated with improved behavior and satisfaction. Methods: Patients aged 6 to 25 years and their caregivers at an academic pediatric hospital interacted with a custom VR application that compared design aspects, including environment, graphics fidelity, and presence of a motivational character. Outcomes investigated self-reported awe, vastness, accommodation, and engagement. Data were analyzed using repeated measure ANOVA tests and correlation analyses. Results: A total of 202 participants were enrolled, and 179 (88 pediatric patients, 91 adult caregivers) were included in the final analysis. A fictional environment was more effective at increasing awe in pediatric patients (P = 0.030) compared with a realistic environment. However, increased graphics fidelity was more effective at increasing awe in caregiver adults (P = 0.023) compared with low resolution graphics. Presence of a motivational character did not influence awe in either patients or caregivers (P = 0.432, P = 0.904, respectively). All measures of awe were positively correlated with application engagement (P < 0.005). Conclusion: In conclusion, when software developers design VR software for pediatric patients and their caregivers, fictional settings and increased graphic fidelity should be considered for pediatric patients and adults, respectively. Future studies will explore other VR elements in gameplay settings.
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Affiliation(s)
- Emily M He
- Stanford University School of Medicine, Stanford, California, USA
| | - Faaizah Arshad
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, Palo Alto, California, USA
| | - Brian S-K Li
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, Palo Alto, California, USA
| | - Ryan Brinda
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, Palo Alto, California, USA
| | - Avani Ganesan
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, Palo Alto, California, USA
| | - Lijin Zhang
- Stanford Graduate School of Education, Stanford, California, USA
| | - Sammy Fehr
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, Palo Alto, California, USA
| | - Meghana Renavikar
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, Palo Alto, California, USA
| | - Samuel T Rodriguez
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California, USA
| | - Ellen Wang
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California, USA
| | - Oswaldo Rosales
- Stanford Graduate School of Education, Stanford, California, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California, USA
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Evans C, Bercades G, Ambler G, Wilson M, Brew-Graves C, Baldini C, Begum-Ali N, Williams NR, Emberton M, Fenton M, Fancourt D, Samani M, Mythen M, Moonesinghe SR. Little Journey: a phase III randomised controlled trial of a psychological preparation and education smartphone application for management of paediatric perioperative anxiety compared with standard care in children undergoing ambulatory surgery - study protocol. BMJ Open 2025; 15:e090696. [PMID: 40010809 DOI: 10.1136/bmjopen-2024-090696] [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: 02/28/2025] Open
Abstract
INTRODUCTION Children having surgery, and their parents, commonly have anxiety in the preoperative period, and this may impact longer-term health and quality of life. Psychological preparation can be expensive and time-consuming, and the type and effectiveness of preparatory interventions are variable. The aim of this randomised controlled trial (RCT) is to evaluate the clinical effectiveness of a preoperative smartphone psychological preparation application with virtual reality (VR) capability (the 'Little Journey app' (LJ)), at reducing anxiety and its sequelae in children and their carers. METHODS AND ANALYSIS Multicentre, assessor-blinded, two-armed, parallel group, RCT in children aged between 3 and 12 years, undergoing ambulatory surgery and receiving their first general anaesthetic. Randomisation is one-to-one between an intervention and a control arm. Participants in the intervention arm are provided with access to the LJ app and a low-cost cardboard VR headset (to be used with a smartphone) to use in the weeks leading up to their operation. Children in the control arm receive the same VR headset and suggestions of unrelated VR games to play, but no access to the LJ app. To improve accessibility, smart devices are provided to children whose families do not have a smart phone, and the app content has been translated from English into multiple languages. Both groups receive standard perioperative care at the hospital where they are having treatment. The primary outcome measure is the modified Yale Preoperative Anxiety Scale-Short Form applied by independent blinded observers, immediately before induction of general anaesthesia. Secondary outcomes include process measures, psychological and socioeconomic outcomes for both children and parents/carers. The planned sample size was 304 participants, including an anticipated 15% attrition rate. An interim analysis was conducted when the trial was temporarily paused because of the COVID-19 pandemic, at which point 119 participants had been recruited. The trial steering committee and data monitoring committee recommended continuation of the trial, but the sample size was increased to 596 to account for differences between the previously anticipated and actual outcomes of recruited participants. ETHICS AND DISSEMINATION The study was approved by Surrey Borders-Research Ethics Committee 251219, and all participating sites were in England. Results will be presented in academic manuscripts and presentations and summarised for diverse audiences (including clinicians and patients/public) in podcasts, infographics and other multimedia formats. TRIAL REGISTRATION NUMBER NCT03797716.
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Affiliation(s)
- Christopher Evans
- Centre for Perioperative Medicine, Research Department of Targeted Intervention, University College London, London, UK
| | - Georgia Bercades
- Critical and Perioperative Care Theme, NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Gareth Ambler
- Applied Statistics, University College London, London, UK
| | - Matthew Wilson
- Health Services Research, University of Sheffield, Sheffield, UK
| | - Chris Brew-Graves
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Nazma Begum-Ali
- Surgical Interventional Group, University College London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
| | | | - Daisy Fancourt
- Department of Behavioural Science and Health, Department of Epidemiology and Public Health, University College London Research, London, UK
| | - Mohini Samani
- NIHR CRN West Midlands Young Persons Steering Group, Stafford, UK
| | - Monty Mythen
- Anaethesia, University College Hopital, London, UK
| | - Suneetha Ramani Moonesinghe
- Centre for Perioperative Medicine, Research Department of Targeted Intervention, University College London, London, UK
- Critical and Perioperative Care Theme, NIHR University College London Hospitals Biomedical Research Centre, London, UK
- National Institute for Health Research's Central London Patient Safety Research Collaboration, University College London Hospitals NHS Foundation Trust, London, UK
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Kudubes AA, Zengin H, Öztürk Ö, Bektas M. Safe Pediatric Surgery: Turkish Adaptation of the Road to My Surgery Preoperative Checklist. J Perianesth Nurs 2025:S1089-9472(24)00525-2. [PMID: 39863996 DOI: 10.1016/j.jopan.2024.10.016] [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: 05/21/2024] [Revised: 10/19/2024] [Accepted: 10/23/2024] [Indexed: 01/27/2025]
Abstract
PURPOSE This study was conducted to evaluate the Turkish adaptation of the Road to My Surgery Preoperative Checklist. DESIGN A methodological, correlational, and comparative study. METHODS This study was conducted with 125 children between July 2022 and December 2023. Data were collected using an information form and the Road to My Surgery Preoperative Checklist. To evaluate the data, various analyses were performed, including content validity analysis, Kuder-Richardson 20 analysis, intraclass correlation analysis, upper and lower 27% group analysis, and item-total score correlation. FINDINGS The Kuder-Richardson 20 reliability coefficient of the Road to My Surgery Preoperative Checklist was 0.715 and the intraclass correlation coefficient was 0.627. The item-total score correlation coefficients of the checklist items were between 0.099 and 0.836. A difference was found between the scale total mean scores of children in the upper 27% group and children in the lower 27% group (P < .005). CONCLUSIONS The Road to My Surgery Preoperative Checklist is a valid and reliable measurement tool for the Turkish sample.
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Affiliation(s)
- Aslı Akdeniz Kudubes
- Department of Pediatric Nursing, Bilecik Şeyh Edebali University Faculty of Health Sciences, Gülümbe, Bilecik, Turkey.
| | - Hamide Zengin
- Department of Pediatric Nursing, Eskişehir Osmangazi University, Faculty of Health Sciences, Odunpazarı, Eskişehir, Turkey.
| | - Özge Öztürk
- Department of Pediatric Surgery, Bilecik Training and Research Hospital, Gülümbe, Bilecik, Turkey.
| | - Murat Bektas
- Department of Pediatric Nursing, Dokuz Eylul University Faculty of Nursing, Balçova, İzmir, Turkey.
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Mathias EG, Pai MS, Kumar V, Narayanakurup D, Kulkarni M, Guddattu V, Bramhagen AC, Nayak BS, George A. Nonpharmacological interventions for managing postoperative pain and anxiety in children: a randomized controlled trial. Clin Exp Pediatr 2024; 67:677-685. [PMID: 39483045 PMCID: PMC11621737 DOI: 10.3345/cep.2023.01690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 11/03/2024] Open
Abstract
BACKGROUND Hospitalizations and surgical procedures are unpleasant for both children and their parents. Therefore, postoperative pain assessments and management are less commonly performed in younger children than in adults. PURPOSE To evaluate the effect of nonpharmacological interventions on postoperative pain and anxiety in children. METHODS In this randomized controlled trial, 160 children were randomly allocated to experimental (n=80) and control (n=80) groups. The children in the experimental group received age-appropriate distraction interventions for 3 postoperative days along with standard care. Children in the control group received standard care only. Each child was assessed for pain using EVENDOL pain scale, while their anxiety was measured using the modified Yale Preoperative Anxiety Scale. The Descriptive statistics (frequency, percentage, mean, and standard deviation) and repeated-measures analysis of variance were used to analyze the data. RESULTS The children in the experimental group showed significantly decreased pain, anxiety, and physiological parameters (heart rate, respiratory rate, and oxygen saturation) compared to those in the control group. Significant intergroup differences were noted in the mean and standard deviation values of the pain, anxiety, and physiological parameters. CONCLUSION The distraction interventions provided by nurses reduced the pain and anxiety levels and improved the postoperative recovery among children.
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Affiliation(s)
- Edlin Glane Mathias
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
| | - Mamatha Shivananda Pai
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
| | - Vijay Kumar
- Department of Pediatric Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
| | - Dinesh Narayanakurup
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
| | - Malavika Kulkarni
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
| | | | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
| | - Anice George
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi district, Karnataka, India
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Vinay AP, Karna ST, Ahmad Z, Waindeskar V, Ahmed R, Kuttan KA. Utility of interactive videogame in allaying preoperative anxiety in pediatric surgical patients - A randomized controlled study. J Postgrad Med 2024; 70:198-203. [PMID: 39611402 PMCID: PMC11722718 DOI: 10.4103/jpgm.jpgm_465_24] [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: 07/25/2024] [Revised: 09/06/2024] [Accepted: 09/23/2024] [Indexed: 11/30/2024] Open
Abstract
INTRODUCTION Non-pharmacological distraction using video games (VG) is still under-explored in pediatric surgical patients. MATERIALS AND METHODS We conducted this randomized controlled study of 150 children, aged 4-12 years, scheduled for elective surgery in a tertiary care hospital to estimate the distractive effect of VG on immediate preoperative anxiety in children. In the intervention group (I), playing with VG was encouraged till anesthetic induction. The control group (C) received usual care with verbal reassurance. Modified Yale preoperative anxiety scale (mYPAS) score and presence of anxiety (mYPAS >30) were noted in the preoperative area (T1), at parental separation (T2), and anesthetic induction (T3). Parental separation anxiety score (PSAS) >3 was considered unacceptable parental separation. We used the Mann-Whitney test and t-test to find significance of intergroup mean difference of anxiety and logistic regression to find risk factors for immediate preoperative anxiety. RESULTS The mean m-YPAS (±SD) scores at T1 and T2 were 38 (±10.9) and 52.2 (±18.7) in group C and 46.5 (±13.5) and 33 (IQR: 28.3-65.5) in group I, respectively. The incidence of anxiety at T2 was higher in group C (81.3%) than in group I (59%). More children in group I (53/75) had acceptable separation than in group C (32/75) (P = 0.001). VG led to a 2.32 times lower risk of anxiety at T2 (P = 0.036). In children with acceptable separation, the incidence of anxiety was lower in group I (59%) than in group C (87%). CONCLUSION VG-based distraction effectively reduced preoperative anxiety in children undergoing elective surgeries.
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Affiliation(s)
- AP Vinay
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - ST Karna
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Z Ahmad
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - V Waindeskar
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - R Ahmed
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - KA Kuttan
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Gilboa Pras Y, Indursky A, Gilboa Pras S, Schaffer O, Niazov E, Zmora O. Infectious Diseases-Approved Virtual Reality Goggles for Common Procedures in Pediatric Surgical Patients. J Clin Med 2024; 13:5572. [PMID: 39337059 PMCID: PMC11432341 DOI: 10.3390/jcm13185572] [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: 07/19/2024] [Revised: 09/03/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objective: Virtual reality (VR) technology has been reported as effective in mitigating fear, anxiety, and pain in children undergoing various medical procedures. Our aim was to test the effectiveness of non-sponge-coated mobile phone-operated VR goggles approved by infectious diseases (ID) control in pediatric surgical patients. Methods: A prospective randomized trial in which pre-procedural and post-procedural heart rate, fear, and anxiety, and post-procedural pain were measured in pediatric surgical patients assigned to receive standard care versus standard care and VR goggles. The patients underwent line insertions, peripheral venipunctures for blood draws, drain removals, and wound care. Results: The control group and the intention-to-treat group were each randomly assigned twenty-four patients. Since eight patients who received VR goggles removed them prior to completion of the procedure, the study group included sixteen patients. In the study group, heart rate, fear, and anxiety scores were significantly lower after the procedure as compared to prior to the procedure. In the control group, these parameters were similar before and after the procedure. Post-procedural decrease in fear and anxiety was significant when comparing VR to control. However, despite better post-procedural physiological and emotional scores in the VR group as compared to control, the differences were not statistically significant. Pre-procedural anxiety was significantly higher in the study group. Conclusions: ID-approved VR goggles can reduce fear and anxiety associated with procedures commonly performed in pedicatric surgical patients. However, since increased baseline anxiety might be associated with VR, a higher benefit might be achieved if goggles were worn only by children who express a clear desire to use them.
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Affiliation(s)
- Yarden Gilboa Pras
- Faculty of Medicine and Health, Tel Aviv University, Tel Aviv 6997801, Israel; (Y.G.P.); (A.I.); (S.G.P.); (O.S.); (E.N.)
| | - Atara Indursky
- Faculty of Medicine and Health, Tel Aviv University, Tel Aviv 6997801, Israel; (Y.G.P.); (A.I.); (S.G.P.); (O.S.); (E.N.)
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin 7073001, Israel
| | - Shai Gilboa Pras
- Faculty of Medicine and Health, Tel Aviv University, Tel Aviv 6997801, Israel; (Y.G.P.); (A.I.); (S.G.P.); (O.S.); (E.N.)
| | - Ortal Schaffer
- Faculty of Medicine and Health, Tel Aviv University, Tel Aviv 6997801, Israel; (Y.G.P.); (A.I.); (S.G.P.); (O.S.); (E.N.)
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin 7073001, Israel
| | - Eleonora Niazov
- Faculty of Medicine and Health, Tel Aviv University, Tel Aviv 6997801, Israel; (Y.G.P.); (A.I.); (S.G.P.); (O.S.); (E.N.)
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin 7073001, Israel
| | - Osnat Zmora
- Faculty of Medicine and Health, Tel Aviv University, Tel Aviv 6997801, Israel; (Y.G.P.); (A.I.); (S.G.P.); (O.S.); (E.N.)
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin 7073001, Israel
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Mete İzci S, Çetinkaya B. The impact of digital storytelling for children during paediatric day surgery on anxiety and negative emotional behaviors: Randomized controlled trial. J Pediatr Nurs 2024; 77:e231-e241. [PMID: 38658306 DOI: 10.1016/j.pedn.2024.04.034] [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: 12/21/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The aim of the study was to examine the effectiveness of digital storytelling as a therapeutic care intervention in paediatric day surgery. DESIGN AND METHODS his study was conducted in a randomized controlled experimental design. Seventy-two voluntary children who were scheduled for day surgery and met the inclusion criteria for the study were included. Research data were collected using the Child's Descriptive Information Form, the Children's Emotional Manifestation Scale, and the State Anxiety Inventory for Children. The study group used digital storytelling to prepare for day surgery. RESULTS State anxiety scores decreased over time in the study group. The digital storytelling intervention was found to be effective in reducing anxiety scores. In the control group, state anxiety scores were highest on the day of the surgery. Children in the control group experienced higher levels of anxiety on the day of the surgery compared to those in the study group. The high anxiety levels in the control group continued at a higher level even two weeks after surgery. Children in the control group exhibited more negative emotional behaviors on the day of the surgery. CONCLUSION The digital storytelling intervention implemented in this research was found to be effective in reducing children's anxiety and negative emotional behaviors. PRACTICE IMPLICATIONS Digital storytelling should be applied and adapted to various other areas of paediatric surgery. Its utilization is significant for nurses working in the field of day surgery.
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Affiliation(s)
- Selver Mete İzci
- Pediatric Nursing, Institute for Health Sciences, Pamukkale University, Denizli,Turkey.
| | - Bengü Çetinkaya
- Faculty of Health Sciences, Department of Pediatric Nursing, Pamukkale University, Denizli,Turkey.
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Behera SK, Punn R, Menendez M, Be C, Moon S, Zuniga M, Stauffer KJ, Thorson K, Asi N, Lopez L. A Prospective Randomized Controlled Trial Using Virtual Reality in Pediatric Pre-intervention Echocardiograms to Decrease Child Anxiety and Fear. Pediatr Cardiol 2024:10.1007/s00246-024-03555-0. [PMID: 38916669 DOI: 10.1007/s00246-024-03555-0] [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: 04/22/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024]
Abstract
Virtual reality (VR) as a distraction tool decreases anxiety and fear in children undergoing procedures, but its use has not been studied during transthoracic echocardiograms (TTEs). We hypothesized that VR in children undergoing pre-intervention TTEs decreases anxiety and fear and increases TTE study comprehensiveness and diagnostic accuracy when compared with standard distractors (television, mobile devices). Patients (6-18 years old) scheduled for pre-intervention TTEs at Lucile Packard Children's Hospital in 2021 and 2022 were prospectively enrolled and randomized to VR and non-VR groups. Patients completed pre- and post-TTE surveys using the Children's Anxiety Meter-State (CAM-S) and Children's Fear Scale (CFS). Patients, parents, and sonographers completed post-TTE experience surveys. TTEs were reviewed by pediatric cardiologists for study comprehensiveness and compared with electronic medical records for diagnostic accuracy. Among 67 enrolled patients, 6 declined VR, 31 randomized to the VR group, and 30 to the non-VR group. Anxiety (average CAM-S difference 0.78 ± 1.80, p = 0.0012) and fear (average CFS difference 0.36 ± 0.74, p = 0.0005) decreased in both groups. There was no difference between groups in the change in anxiety and fear pre- and post-TTE (p = 0.96-1.00). TTE study comprehensiveness and diagnostic accuracy were high in both groups. Procedure time (time in the echocardiography room) was less for the VR group (48.4 ± 18.1 min) than the non-VR group (58.8 ± 24.4 min), but without a statistically significant difference (p = 0.075). VR is similar to standard distractors and may decrease procedure time. Patients, parents, and sonographers rated the VR experience highly and encouraged its use with future procedures.
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Affiliation(s)
- Sarina K Behera
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA.
- Pediatric Cardiology, Palo Alto Medical Foundation, 301, Industrial Road, Level 1, San Carlos, CA, 94070, USA.
| | - Rajesh Punn
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Christine Be
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Sandra Moon
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Michelle Zuniga
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Katie Jo Stauffer
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Kelly Thorson
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Nora Asi
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Leo Lopez
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
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Hussein HA, Kahloul M, Alhamaidah MF, Alkhfaji HJ. Anxiolytic and Sedative Properties of Melatonin Premedication in Pediatrics Undergoing Elective Cardiac Catheterization: A Randomized Placebo Study. Cureus 2024; 16:e56543. [PMID: 38646369 PMCID: PMC11027787 DOI: 10.7759/cureus.56543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Preoperative anxiety in children has been linked to various postoperative consequences, such as postoperative regressive behavioral issues, extended distress during the recovery period, eating disorders, and bedwetting. The current study aimed to investigate the efficacy of low-dose oral melatonin in alleviating preoperative anxiety among children in the Iraqi population. STUDY DESIGN A randomized, double-blinded comparative study was undertaken, involving children aged four to 14 years scheduled for elective cardiac catheterization under general anesthesia. The study comprised a total of 80 children. The involved individuals were randomly assigned to two groups, each with 40 subjects. Group A received 0.5 mg/kg melatonin as premedication, while Group B received a placebo. RESULTS The two groups demonstrated similarity in mean age, weight, cardiac disease, and gender distribution. Statistically significant reductions in anxiety scores were observed in the melatonin group compared to the placebo group. Particularly, children administered 0.5 mg/kg melatonin exhibited the most substantial anxiolysis and venipuncture compliance (P < 0.05). Additionally, children who were premedicated with melatonin experienced decreased cognition, maximum sedation, successful parental separation, and psychomotor impairment (P < 0.05). CONCLUSIONS Melatonin demonstrated an effective sedation level without significant side effects, making it a preferred choice due to its efficacy, safety, current availability, and cost-effectiveness compared to other anesthetic agents used in premedication procedures.
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Affiliation(s)
- Hussein A Hussein
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Sousse, Sousse, TUN
| | - Mohamed Kahloul
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Sahloul Teaching Hospital, University of Sousse, Sousse, TUN
| | - Majid F Alhamaidah
- Department of Anesthesiology, College of Health and Medical Technology, Al-Ayen Iraqi University, Thi-Qar, IRQ
| | - Hussein J Alkhfaji
- Department of Anesthesiology, College of Health and Medical Technology, Al-Ayen Iraqi University, Thi-Qar, IRQ
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Kwa ZY, Li J, Loh DL, Lee YY, Liu G, Zhu L, Pikkarainen M, He H, Mali VP. An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation. JMIR Form Res 2024; 8:e52337. [PMID: 38363589 PMCID: PMC10907943 DOI: 10.2196/52337] [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: 09/05/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. OBJECTIVE This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. METHODS Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. RESULTS The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. CONCLUSIONS ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404.
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Affiliation(s)
- Zhi Yin Kwa
- Department of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Jinqiu Li
- Nursing Department, Zhuhai Campus, Zunyi Medical University, Zhuhai, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dale Lincoln Loh
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Yang Yang Lee
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Guangyu Liu
- Integrated Health Promotion, Ministry of Health Office for Healthcare Transformation, Singapore, Singapore
| | - Lixia Zhu
- Hôpital Chinois de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Minna Pikkarainen
- Department of Health Technology and Rehabilitation and Department of Product Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, Oulu Business School, University of Oulu, Oulu, Finland
| | - Honggu He
- National University Health System, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vidyadhar Padmakar Mali
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
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Yeniay D, Tamdo An L, Yucak Ozdemir A, Ak An LO, Kay R SU. Effects of Videos and Therapeutic Music on Preoperative Anxiety and Postoperative Anxiety and Pain Levels in Boys Who Undergo Circumcision. J Perianesth Nurs 2023; 38:918-924. [PMID: 37589631 DOI: 10.1016/j.jopan.2023.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This purpose of this study was to investigate the effects of having boys aged 5 to 10 years who will undergo circumcision surgery watch informative videos and listen to therapeutic music on preoperative anxiety, and postoperative anxiety, pain, and nausea and vomiting. DESIGN This was a prospective and ranomized controlled study. MATERIALS AND METHODS The sample consisted of 90 boys aged 5 to 10 years who underwent circumcision surgery. The boys included in the study were randomly divided into 3 groups of 30 using a computer program. The first group (group V) watched the video; the second group (group M) listened to the music, and the third group (group C) was the control group with usual care. Boys and their parents were not blinded to the grouping. FINDINGS Heart rate.ßvalues were found to be statistically significantly lower compared to the control group at the 1st minute after local anesthesia in group V (P.ß=.ß.029), at the 5th minute after local anesthesia in group M (P.ß=.ß.030), and at the 10th minute after local anesthesia and after the surgery in both group V and group M (P.ß=.ß.001 and P.ß=.ß.010, respectively). Wong-Baker Faces Pain Rating Scale.ßscores of the control group measured at the 2nd postoperative hour were found to be significantly higher than those of group V (P.ß=.ß.018). Children's Fear Scale.ßscores of group V measured at the time of admission to the postoperative service were found to be significantly higher than those of group M and group C (P.ß<.ß.001). There was no significant difference between the groups in terms of additional analgesic use, nausea and vomiting percentages, and time to discharge. CONCLUSIONS The results of this study revealed that having boys aged 5 to 10 years who will undergo circumcision surgery watch informative videos and listen to therapeutic music did not have any significant effect on their postoperative pain, fear, and anxiety levels. Further large-scale studies, which will also include children who will not undergo circumcision surgery, are needed to generalize this study's results to larger populations.
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Affiliation(s)
- Dilek Yeniay
- Department of Anesthesiology and Reanimation, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey.
| | - Lke Tamdo An
- Department of Anesthesiology and Reanimation, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey
| | - Aysel Yucak Ozdemir
- Department of Pediatric Surgery, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey
| | - Lknur Okur Ak An
- Department of Radiology, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey
| | - Sel Uk Kay R
- Department of Anesthesiology and Reanimation, Hitit University, ..orum, Turkey
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Chow CHT, Poole KL, Xu RY, Sriranjan J, Van Lieshout RJ, Buckley N, Moffat G, Schmidt LA. Children's Shyness, Frontal Brain Activity, and Anxiety in the Perioperative Context. Behav Sci (Basel) 2023; 13:766. [PMID: 37754044 PMCID: PMC10525976 DOI: 10.3390/bs13090766] [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: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Although preoperative anxiety affects up to 75% of children undergoing surgery each year and is associated with many adverse outcomes, we know relatively little about individual differences in how children respond to impending surgery. We examined whether patterns of anterior brain electrical activity (i.e., a neural correlate of anxious arousal) moderated the relation between children's shyness and preoperative anxiety on the day of surgery in 70 children (36 girls, Mage = 10.4 years, SDage = 1.7, years, range 8 to 13 years) undergoing elective surgery. Shyness was assessed using self-report approximately 1 week prior to surgery during a preoperative visit (Time 1), preoperative anxiety was assessed using self-report, and regional EEG (left and right frontal and temporal sites) was assessed using a dry sensory EEG headband on the day of surgery (Time 2). We found that overall frontal EEG alpha power moderated the relation between shyness and self-reported preoperative anxiety. Shyness was related to higher levels of self-reported anxiety on the day of surgery for children with lower average overall frontal alpha EEG power (i.e., higher cortical activity) but not for children with higher average overall frontal alpha EEG power (i.e., lower cortical activity). These results suggest that the pattern of frontal brain activity might amplify some shy children's affective responses to impending surgery. Findings also extend prior results linking children's shyness, frontal brain activity, and anxiety observed in the laboratory to a real-world, ecologically salient environment.
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Affiliation(s)
- Cheryl H. T. Chow
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
| | - Kristie L. Poole
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
| | - Richard Y. Xu
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jhanahan Sriranjan
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ryan J. Van Lieshout
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | | | - Louis A. Schmidt
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
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Chen YJ, Wang CJ, Chen CW. Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:2494-2504. [PMID: 35672942 DOI: 10.1111/jocn.16394] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS To synthesise and evaluate the effectiveness of virtual reality interventions in preoperative children. BACKGROUND Children consider operations as a predictable threat and stressful event. Children's anxiety before an operation increases as the time draws closer. Children could understand the operating room environment and process before the operation using virtual reality, which may reduce their anxiety before an operation. DESIGN A systematic review and meta-analysis of randomised controlled trials following the Cochrane method were conducted. METHOD CINAHL, Cochrane Library, Embase, Joanna Briggs Institute, MEDLINE and PubMed databases were searched for randomised controlled trials published before February 2021. A random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals was performed. Conduction of the review adheres to the PRISMA checklist. RESULTS Of 257 articles screened, six interventions involving 529 participants aged 4-12 years were included in the analysis. All study evidence levels were B2/Level 2, the quality was medium to high on the modified Jadad scale, with a low risk of bias. The results revealed that virtual reality significantly reduced preoperative anxiety in children (SMD: -0.91, 95% CI: -1.43 to -0.39, p = .0006). Furthermore, virtual reality significantly improved children's compliance with anaesthesia (SMD: 3.49, 95% CI: 1.32 to 9.21, p = .01). CONCLUSION Children who used virtual reality before an operation felt more familiar with the operating room environment and understood the preoperative preparation procedures. Virtual reality effectively reduced children's anxiety and improved their compliance with anaesthesia. RELEVANCE TO CLINICAL PRACTICE This systematic review and meta-analysis investigated the effect of virtual reality on preoperative anxiety in children and the findings supported its positive effects. The results could provide a reference for incorporating virtual reality into preoperative preparation guidelines.
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Affiliation(s)
- Yen-Ju Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Cheng-Ju Wang
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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14
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Luengo TD, Rivas AB, Loureido E, Vargas E. Reducing preoperative anxiety in parents of surgical patients. Heliyon 2023; 9:e15920. [PMID: 37215828 PMCID: PMC10195889 DOI: 10.1016/j.heliyon.2023.e15920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Aims and objectives To investigate preoperative anxiety in parents of paediatric surgical patients, testing whether the provision of information (using video and story books) regarding the surgical process can impact on reducing anxiety. Analyse if any personal factors influence the reduction of anxiety. Background Attending a surgical theatre generates anxiety, especially in the case of children. The effect of different preoperative intervention procedures in children that attempt to reduce their anxiety level have been studied a great deal. However, although their parents also suffer high levels of anxiety, potential intervention to reduce their levels has not received the same attention. Study design Randomised Clinical trial. Methods One hundred and twenty-five parents of children (8-12 y.o.) undergoing surgery in a public hospital were randomly assigned to the control group CG (34 individuals) or one of the 3 experimental groups EG (91). In this Randomised Controlled Study, children and parents of the experimental groups were provided with a story book, a video with additional information of nursing, or both. Prior to the surgical intervention, the State Anxiety, S-A, and Trait Anxiety, T-A, of the parents and children were measured using the STAI and STAIC questionnaires respectively. Data collection was carried out for 12 months starting in October 2016. Results Parents' S-A in the control group was higher than in the experimental groups. A linear model explains the parents' S-A using as regressors: children S-A, age and T-A of the parents, and children age. Conclusions Providing information about the surgical process (through stories or videos) to which a child is going to be subjected can reduce the anxiety of the parents. Relevance to clinical practice Given their close connection to the patient and the potential effects on the children of their psychological situation, healthcare professionals should consider paying greater attention to communicating with the parents.
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Affiliation(s)
- Trinidad Díaz Luengo
- Medicine and Nursing School, Dpt. of Medicine, University of Oviedo, Spain
- Área del Bloque Quirúrgico y Esterilización, Hospital Universitario Cabueñes, Gijón, Spain
| | - Ana Belén Rivas
- Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento Enfermería. Facultad Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Elena Loureido
- Hospital Universitario Central de Asturias, Operating Room Service, Oviedo, Spain
| | - Emilio Vargas
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid(UCM), Madrid, Spain
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15
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Suleiman‐Martos N, García‐Lara RA, Membrive‐Jiménez MJ, Pradas‐Hernández L, Romero‐Béjar JL, Dominguez‐Vías G, Gómez‐Urquiza JL. Effect of a game-based intervention on preoperative pain and anxiety in children: A systematic review and meta-analysis. J Clin Nurs 2022; 31:3350-3367. [PMID: 35075716 PMCID: PMC9787560 DOI: 10.1111/jocn.16227] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/27/2021] [Accepted: 01/02/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological. AIMS To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients. METHODS A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication. RESULTS 26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded. CONCLUSIONS Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients. RELEVANCE TO CLINICAL PRACTICE In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients' emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.
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16
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Tas FQ, van Eijk CAM, Staals LM, Legerstee JS, Dierckx B. Virtual reality in pediatrics, effects on pain and anxiety: A systematic review and meta-analysis update. Paediatr Anaesth 2022; 32:1292-1304. [PMID: 35993398 PMCID: PMC9804813 DOI: 10.1111/pan.14546] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Medical procedures are often accompanied by pain and anxiety in pediatric patients. A relatively new technique to reduce pediatric pain and anxiety is virtual reality. Virtual reality is both applied as a distraction tool and as an exposure tool to prepare patients for medical procedures. Research into the application of virtual reality in medical settings is rapidly evolving. This meta-analysis is an update of the meta-analysis of Eijlers et al. investigating the effectiveness of virtual reality as an intervention tool on pain and anxiety in pediatric patients undergoing medical procedures. METHODS We searched the databases Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and PsycINFO. For each of these databases, different search strategies were developed. The search period from the meta-analysis from Eijlers et al., reaching until April 2018, was extended to December 2020. Pain and anxiety outcomes during medical procedures were compared for virtual reality and standard care conditions for various medical procedures. RESULTS The search yielded 1824 articles, of which 13 met our inclusion criteria. Combined with 13 articles of Eijlers' review study, this resulted in 26 articles. Virtual reality was applied as distraction (n = 23) during medical procedures or as exposure (n = 4) before medical procedures. The effect of virtual reality distraction was mostly studied in patients during venous access (n = 10). The overall weighted standardized mean difference for virtual reality distraction was -0.67 (95% CI, -0.89 to -0.45; p < .001) on patient-reported pain (based on 21 studies) and -0.74 (95% CI, -1.00 to -0.48; p < .001) on patient-reported anxiety (based on 10 studies). The effect of virtual reality as an exposure tool on patient-reported anxiety was significant too (standardized mean difference = -0.58; 95% CI, -1.15 to -0.01; p < .05). DISCUSSION The current updated systematic review and meta-analysis indicates that virtual reality is a useful tool to reduce pain and anxiety in pediatric patients undergoing a range of medical procedures as it significantly decreases pain and anxiety outcomes when compared to care as usual.
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Affiliation(s)
- Floris Q. Tas
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Cynthia A. M. van Eijk
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Lonneke M. Staals
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Jeroen S. Legerstee
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Bram Dierckx
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
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Carroll SL, Sykes BW, Mills PC. Moving toward Fear-Free Husbandry and Veterinary Care for Horses. Animals (Basel) 2022; 12:2907. [PMID: 36359031 PMCID: PMC9653666 DOI: 10.3390/ani12212907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 07/30/2023] Open
Abstract
Husbandry and veterinary procedures have the potential to generate fear and stress in animals. In horses, the associated responses can pose a significant safety risk to the human personnel involved in the procedure, as well as to the animal itself. Traditionally, physical restraint, punishment, and/or threat of an aversive, have been the most common strategies used to achieve compliance from the horse. However, from a welfare perspective, this is less than ideal. This approach also has the potential for creating a more dangerous response from the horse in future similar situations. When caring for companion animals, and captive animals within zoological facilities, there has been a steady transition away from this approach, and toward strategies aimed at reducing fear and stress during veterinary visits and when undertaking routine husbandry procedures. This review discusses the current approaches to horse care and training, the strategies being used in other animal sectors, and potential strategies for improving human safety, as well as the horse's experience, during husbandry and veterinary procedures.
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Affiliation(s)
- Sharon L. Carroll
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
| | - Benjamin W. Sykes
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand
| | - Paul C. Mills
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
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Brown S, Cordner P, Weir KA, Machingura T. A systematic scoping literature review on the use of child life therapy (CLT) in the perioperative setting. J Perioper Pract 2022; 32:244-259. [PMID: 34380354 DOI: 10.1177/17504589211005714] [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: 11/17/2022]
Abstract
BACKGROUND Children and their caregivers often experience anxiety related to a perioperative admission. A systematic scoping review was conducted to map the evidence for child life therapy, including the professional background of treating clinicians. METHODS A scoping review was conducted using the Arksey and O'Malley methodology. Six databases: PubMed, CINAHL, PsychINFO, Cochrane Library, EMBASE and Web of Science were searched. RESULTS After reviewing 578 titles and abstracts, and 55 full texts, 11 studies were retained. Included studies were randomised controlled trials (n = 5), retrospective studies (n = 3), descriptive studies (n = 1) and clinical studies (n = 2). Child life therapy was effective for anxiety, anaesthetic induction quality, child cooperation and parental satisfaction. Professions delivering interventions included Child Life Therapists, nurses and a multidisciplinary team. CONCLUSION There is emerging evidence for child life therapy which may be used to guide delivery of paediatric procedural support in perioperative settings. Further studies are needed to inform practice.
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Affiliation(s)
| | - Phillipa Cordner
- Occupational Therapy Department, Gold Coast Hospital and Health Service, Southport, Australia
| | - Kelly A Weir
- Menzies Health Institute Queensland and Allied Health Sciences, Griffith University, Southport, Australia
- Allied Health Research, Allied Health Services, Gold Coast Hospital and Health Service, Southport, Australia
| | - Tawanda Machingura
- Bond University, Robina, Australia
- School of Applied Psychology, Griffith University, Gold Coast Campus, Southport, Australia
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Liu W, Xu R, Jia J, Shen Y, Li W, Bo L. Research Progress on Risk Factors of Preoperative Anxiety in Children: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9828. [PMID: 36011459 PMCID: PMC9407918 DOI: 10.3390/ijerph19169828] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Preoperative anxiety has adverse effects on children and negative impacts on postoperative rehabilitation. Anesthesiologists can accurately identify children with preoperative anxiety, and individualized intervention can effectively improve their psychological state and clinical prognosis. However, a comprehensive summary of the current available evidence has yet to be conducted. Searches were conducted in Medline databases from inception to March 2022. Primary studies that reported preoperative anxiety in children and its attendant effects on postoperative recovery and prognosis were screened and included. Among the 309 publications identified, 12 related studies (n = 3540 patients) met the eligibility criteria. The incidence of preoperative anxiety in children in the included studies ranged from 41.7% to 75.44%. While 16 influencing factors were identified, only 5 factors had a significant impact on preoperative anxiety in children: younger age (n = 8), parental anxiety (n = 7), negative previous hospitalizations (n = 3), less sociableness (n = 2), and surgical setting (n = 1). The current scoping review identified risk factors for preoperative anxiety in children. Healthcare workers should identify and manage preoperatively anxious children. There are still some factors that are controversial, and large-scale clinical studies are needed.
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Affiliation(s)
- Weiwei Liu
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Rui Xu
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ji’e Jia
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Yilei Shen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Ahmadipour M, Sattari H, Nejad MA. Incidence and risk factors related to anxiety of children and adolescents before elective surgery. Eur J Transl Myol 2022; 32. [PMID: 35546729 PMCID: PMC9295168 DOI: 10.4081/ejtm.2022.10449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
The goal of this study was to evaluate the preoperative anxiety in children and adolescents and to identify some of the risk factors associated with the incidence of anxiety in 9–18 years old group. Children and adolescents 9–18 years old hospitalized the night before elective surgeries were analyzed in terms of incidence and severity of anxiety using the State-Trait Anxiety Inventory (STAI) measure. Of the 164 patients, 111 (67.6%) suffered from preoperative anxiety. The incidence of anxiety in children aged 9–12 was 2.88 times the anxiety of those aged 12–18 (OR = 2.88) (1.65, 5.98). Moreover, the incidence of anxiety in only children was 0.65 times that of children with siblings (OR = 0.78) (0.11,2.93), and in patients with a history of hospitalization, the incidence was 1.85 times the stress in children without hospitalization history (OR = 1.85)(1.31,3.99); finally, the incidence of anxiety in children of higher socioeconomic status was lower compared with those of lower socioeconomic status (OR = 0.13) (0.08,0.35). Having close frend or family in the healthcare staff decreased the prevalence (OR = 0.64 (0.23,1.79) and severity of anxiety (47.02 ± 5.48 vs. 54.18 ± 7.18) (P-value = 0.001). There was no relationship between gender and the incidence of anxiety (OR = 1). Incidence of preoperative anexiety in foriner was1.72 times of persion patients (OR=1.72) (0.99,4.25). The severity of anxiety was lower in boys (46.22 ± 6.68) compared with girls (52.55 ± 7.52) (P-value = 0.002) and lower in patients of medium-to-high socioeconomic status (43.64 ± 5.45) compared with those with lower socioeconomic status (49.66 ± 6.49) (P-value = 0.003). There was no relationship between being an only child and severity of anxiety (P-value = 0.54) (48.31 ± 5.05 vs. 48.12 ± 6.81). However, anxiety was more severe in patients with a history of hospitalization (50.55 ± 4.64) (49.2 ± 6.23) (P-value = 0.09). Severity of anexiety was not dependent to nationality of patients(P-value = 0.6) .Taken together, our data suggest that various methods should be used to reduce anxiety and associated complications, regarding the high prevalence of anxiety in mentioned groups of children and adolescents.
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Affiliation(s)
- Maryam Ahmadipour
- Faculty of Medicine, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman.
| | - Hossein Sattari
- Medical school of Kerman University of. Medical sciences, Kerman.
| | - Mehdi Ahmadi Nejad
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman.
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21
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Caner N, Erdem E, Seyfeli MYA, Turan C, Ketenci İ, Öztürk A. Children's Perioperative Multidimensional Anxiety Scale (CPMAS): Turkish Validity and Reliability Study. J Perianesth Nurs 2022; 37:894-899. [DOI: 10.1016/j.jopan.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/15/2022]
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22
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Le-Madison A. Caring for children and families: Top 5 things I learned. Nursing 2022; 52:58-59. [PMID: 35452045 DOI: 10.1097/01.nurse.0000827132.57843.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Asia Le-Madison
- Asia Le-Madison is an RN in the Neonatal Intensive Care Unit at UC Davis Medical Center in Sacramento, CA
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23
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Sriranjan J, Chow CHT, Poole KL, Hassan R, Mirabelli J, Buckley N, Van Lieshout RJ, Schmidt LA. Children's shyness and frontal electroencephalogram delta-beta correlation in the pediatric surgical setting. Dev Psychobiol 2022; 64:e22275. [PMID: 35452540 DOI: 10.1002/dev.22275] [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] [Received: 02/26/2021] [Revised: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022]
Abstract
The prospect of surgery is a unique psychologically threatening context for children, often leading to experiences of preoperative anxiety. Recent research suggests that individual differences in children's temperament may influence responses to the surgical setting. In the present study, we examined whether individual differences in shyness were related to differences in frontal electroencephalogram (EEG) delta-beta correlation, a proposed neural correlate of emotion regulation and dysregulation, among children anticipating surgery. Seventy-one children (36 boys, Mage = 10.3 years, SDage = 1.7 years) undergoing elective surgery self-reported on their own shyness, and their parents also reported on their child's shyness. Using a mobile, dry sensor EEG headband, frontal EEG measures were collected and self- and observer-reported measures of state anxiety were obtained at the children's preoperative visit (Time 1) and on the day of surgery (Time 2). A latent cluster analysis derived classes of low shy (n = 37) and high shy (n = 34) children using the child- and parent-reported shyness measures. We then compared the two classes on frontal EEG delta-beta correlation using between- and within-subjects analyses. Although children classified as high versus low in shyness had higher self- and observer-reported state anxiety across both time periods, frontal EEG delta-beta correlation increased from T1 to T2 only among low shy children using a between-subjects delta-beta correlation measure. We discuss the interpretation of a relatively higher delta-beta correlation as a correlate of emotion regulatory versus dysregulatory strategies for some children in a "real-world," surgical context.
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Affiliation(s)
- Jhanahan Sriranjan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl H T Chow
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Kristie L Poole
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Raha Hassan
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - James Mirabelli
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Louis A Schmidt
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
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24
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Pahwa B, Kurwale N, Agrawal D. Evaluation of periprocedural anxiety during Gamma Knife Radiosurgery (GKRS) Frame fixation for brain lesions. Clin Neurol Neurosurg 2022; 217:107242. [DOI: 10.1016/j.clineuro.2022.107242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
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25
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Novel Way to Improve Satisfaction, Comprehension, and Anxiety in Caregivers: A Randomized Trial Exploring the Use of Comprehensive, Illustrated Children's Books for Pediatric Surgical Populations. J Am Coll Surg 2022; 234:263-273. [PMID: 35213488 DOI: 10.1097/xcs.0000000000000057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgery generates anxiety and stress, which can negatively impact informed consent and postoperative outcomes. This study assessed whether educational, illustrated children's books improve comprehension, satisfaction, and anxiety of caregivers in pediatric surgical populations. METHODS A prospective randomized trial was initiated at a tertiary care children's hospital. All patients ≤ 18 years old with caregiver and diagnosis of 1) uncomplicated appendicitis (English or Spanish speaking); 2) ruptured appendicitis; 3) pyloric stenosis; 4) need for gastrostomy tube; or 5) umbilical hernia were eligible. Conventional consent was obtained followed by completion of 17 validated survey questions addressing apprehension, satisfaction, and comprehension. Randomization (2:1) occurred after consent and before operative intervention with the experimental group (EG) receiving an illustrated comprehensive children's book outlining anatomy, pathophysiology, hospital course, and postoperative care. A second identical survey was completed before discharge. Primary outcomes were caregiver apprehension, satisfaction, and comprehension. RESULTS Eighty caregivers were included (55: EG, 25: control group [CG]). There were no significant differences in patient or caregiver demographics between groups. The baseline survey demonstrated no difference in comprehension, satisfaction, or apprehension between groups (all p values NS). After intervention, EG had significant improvement in 14 of 17 questions compared with CG (all p < 0.05). When tabulated by content, there was significant improvement in comprehension (p = 0.0009), satisfaction (p < 0.0001), and apprehension (p < 0.0001). CONCLUSION The use of illustrated educational children's books to explain pathophysiology and surgical care is a novel method to improve comprehension, satisfaction, and anxiety of caregivers. This could benefit informed consent, understanding, and postoperative outcomes.
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26
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Perioperative Pediatric Anxiety: A Cry for Universal Scale Adoption. Pediatr Qual Saf 2022; 7:e542. [PMID: 35369415 PMCID: PMC8970096 DOI: 10.1097/pq9.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
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27
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Intervention to Reduce Anxiety Pre- and Post-Eye Surgery in Pediatric Patients in South Korea: A Preliminary Quasi-Experimental Study. CHILDREN 2022; 9:children9010065. [PMID: 35053690 PMCID: PMC8774770 DOI: 10.3390/children9010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
In this study, we aimed to identify the effect of preoperative information on postoperative anxiety among children undergoing one-day eye surgery. We utilized a nonequivalent control group and a pretest–posttest quasi-experimental design. The participants were 15 children in the experimental group and 15 children in the control group. Preoperative information was provided to the experimental group in the waiting room. Anxiety level was measured using the Children’s Emotional Manifestation Scale and pulse rate. For pulse rate, there were no statistically significant differences between the groups. In the behavioral anxiety response, there were statistically significant differences between the experimental and control groups (Z = −4.15, p < 0.001). The results suggest that the provision of preoperative information can be an effective intervention for reducing postoperative anxiety and improving the health of children undergoing surgery.
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28
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Haslund-Thomsen H, Bauditz SJ, Kristensen HN. Familiar in the Unfamiliar - Children's, Parents', and Healthcare Professionals' Experiences of Procedure-Related Anesthesia in the Pediatric Oncological Ward. J Pediatr Nurs 2021; 61:40-46. [PMID: 33744621 DOI: 10.1016/j.pedn.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore children's, parents', and healthcare professionals', experiences of anesthesia related to pediatric oncological treatment performed at the pediatric oncology ward. DESIGN AND METHODS The study was a qualitative study. 11 children and 12 parents were recruited for individual or dyadic interviews and two focus groups with a total of 12 healthcare professionals were recruited through purposeful and convenience sampling procedures. RESULTS Thematic analysis generated one main theme, the familiar in the unfamiliar, and two subthemes, the room creates an atmosphere and relational continuity. CONCLUSIONS Changing the physical environment and composition of the team positively influenced the experience of anesthesia in pediatric cancer treatment for both children, parents, and healthcare professionals. Familiarity was important for all involved and familiarity was associated with continuity related to the physical environment, as well as the relational and procedural professional continuity. Parents expressed that they never felt good about anesthesia as there were feelings of leaving your child's life into the hands of others. However, familiarity in trusting relationships with healthcare professionals helped to moderate these aspects. PRACTICE IMPLICATIONS Familiarity should be considered important with continuity in trusting relations and collaborations between nurses and families, as well as between healthcare staff. Pediatric oncology ward is a preferred safe familiar setting for procedure-related anesthesia. Parents and children value individualized flexible nursing care, that takes the child's and parents habits and preferences into account during procedure-related anesthesia in pediatric oncological treatment.
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Affiliation(s)
- Helle Haslund-Thomsen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark; Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Denmark.
| | - Stinne Just Bauditz
- Department of Pediatrics, Aalborg University Hospital, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Denmark.
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29
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Talabi AO, Sowande OA, Mosaku KS, Owojuyigbe AM, Amosu LO, Adejuyigbe O. Effect of parental presence on anxiety during induction of anaesthesia in children undergoing elective day case surgery. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00106-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical operation and anaesthesia induction are fearful events which may interfere with the smooth conduct of anaesthesia and postoperative recovery in children. Indeed, the fear of needles, syringes and unknown hospital environment often compound their anxiety. Various modalities such as use of clowns, music, low intensity light in the induction room, pharmacological agents and parental presence during induction of anaesthesia have been utilized with the aim of gaining the cooperation of the children during induction. However, their use has yielded conflicting results. This prospective study was conducted among children whose ages were between 2 and 15 years. They were randomized into parental presence and parental absence (un-accompanied) or control groups. The anxiety levels of children and parents in both groups were compared at baseline, separation and during induction of anaesthesia.
Results
The ages of the children ranged between 2 and 15 years with a mean age of 6.78 ± 2.50 years. The mean age of patients in the parental presence at induction (PPIA) was 7.14 ± 3.68 years while in the control group was 6.42 ± 3.31 years. The difference was not statistically significant, p < 0.05. The mean anxiety score of patients in the PPIA at reception, separation and induction of anaesthesia were 26.6 ± 9.2, 38.4 ± 18.3 and 54.1 ± 22.8 compared to 27.3 ± 8.04, 41.4 ± 21.7 and 58.6 ± 23.1 in the control group respectively, p < 0.05. The mean anxiety score of parents in the PPIA at reception, separation and induction of anaesthesia were 52.2 ± 6.7, 51.7 ± 7.8 and 51.9 ± 7.9 compared to 53.0 ± 6.5, 52.4 ± 6.2 and 52.9 ± 7.9 in the control group respectively, p < 0.05. Among the cohort of preschool age group, children in the control group were more anxious at induction compared to the PPIA group, p = 0.01. As the age increases, the anxiety state of the children decreases, t = − 0.398, p < 0.001. The mean score of parental satisfaction in the PPIA and the control groups were comparable, 8.1 ± 7.1 vs 7.3 ± 1.1 respectively, p = 0.395.
Conclusion
The presence of parents during induction of anaesthesia did not influence the anxiety states of children in our study. Anxiety at induction tends to reduce as the age of patients increases.
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30
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Bumin Aydın G, Sakızcı Uyar B. Mothers Level of Education and Preoperative Informative Story Book Reading Helps Reduce Preoperative Anxiety in Children in Turkey. J Pediatr Nurs 2021; 60:e19-e23. [PMID: 33622643 DOI: 10.1016/j.pedn.2021.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to evaluate the use of a standard story book, compared to an informative story book, as preoperative preparation to relieve anxiety. DESIGN AND METHODS A total of 120 children with ASA I-II, aged 6-8 years, scheduled to undergo elective adenoidectomy, tonsillectomy, and adenotonsillectomy were enrolled in this randomized controlled study. The control group received a non-medical, colorful story book, while the intervention group received an informative story book appropriate for their age. The book was either read by literate children or the mothers of illiterate children. The book was read aloud at least once before the surgery while they were together. The patients' baseline anxiety level was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) immediately after entering the preoperative holding area (T0). Mothers' anxiety level was assessed using the State and Trait Anxiety Inventory (STAI). Information about the reader, how many times the book was read, the age and education level of the mother, and the presence of a surgical history in the patients' siblings was obtained from the mother through a questionnaire. After premedication with oral midazolam, patients' anxiety level was assessed while entering the operation room (T1). RESULTS The intervention group had significantly lower mYPAS scores at T0 and T1 than the control group. Those who read the intervention book ≥3 times had significantly lower mYPAS values than those who read 2 times or less. Mothers with a low education level had higher anxiety levels in both groups. CONCLUSIONS Repeatedly informing children by reading an informative story book and higher education level of mothers are the most important factors for relieving preoperative anxiety in children. PRACTICE IMPLICATIONS Reducing preoperative anxiety is an important factor for children and their families.
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Affiliation(s)
- Gözde Bumin Aydın
- University of Health Sciences, Dışkapı Yıldırım, Beyazıt Training and Education Hospital, Anesthesiology and Reanimation Clinic, Turkey.
| | - Bahar Sakızcı Uyar
- University of Health Sciences, Dışkapı Yıldırım, Beyazıt Training and Education Hospital, Anesthesiology and Reanimation Clinic, Turkey
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31
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Massie J, Skinner A, McKenzie I, Gillam L. A practical and ethical toolkit for last-minute refusal of anesthetic in children. Paediatr Anaesth 2021; 31:834-838. [PMID: 33949034 DOI: 10.1111/pan.14201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/23/2023]
Abstract
Children's fear of a procedure, including the anesthetic, is a common issue that operating theatre staff face. This fear is generally mitigated by preesthetic preparation and information sharing. Last-minute refusal of a procedure creates unique difficulties for the anesthetist and proceduralist. Refusal for a procedure raises issues of whether the dissent is binding, and if not, how best to get the child to theatre without creating moral injury. In this case review of a young adolescent who refuses to go to the operating theatre, we explore practical and ethical options to resolve the situation. We discuss respect for persons (including assent and consent), best interests, truth-telling, harm minimization, and restraint. The importance of a postevent debrief is discussed. We also assess the value of a clinical ethics service with team members embedded in clinical teams.
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Affiliation(s)
- John Massie
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Adam Skinner
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ian McKenzie
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lynn Gillam
- Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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32
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Kurniasari E, Agustini N. Factors related to anxiety before surgery in children in urological operating rooms. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 43. [PMID: 37184329 DOI: 10.4081/pmc.2021.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to determine the factors associated with preoperative anxiety in school-age children and adolescents at one of top hospital in the capital city of Indonesia. This study used analytical cross-sectional study. The selection of respondents used proportional stratified random sampling with a total of 86 respondents consisting of 43 school age children and 43 adolescents. Data analysis employed was the Chi-Square and Independent TTest. The results showed that anxiety was being experienced by 54.7% of respondents. In this study, it was found that there was a significant relationship (p<α) among children anxiety before surgery and age, family presence, previous operating experience and patient waiting time. Meanwhile, there was no significant relationship between gender and anxiety level before surgery in children. The results of this study can be used as the basis and reference for the hospital in making policies regarding efforts to manage anxiety before surgery in children. Accordingly, nurses could make appropriate nursing care interventions in preoperative patients to overcome preoperative anxiety experienced by schoolage children and adolescents.
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Gold JI, Annick ET, Lane AS, Ho K, Marty RT, Espinoza JC. "Doc McStuffins: Doctor for a Day" Virtual Reality (DocVR) for Pediatric Preoperative Anxiety and Satisfaction: Pediatric Medical Technology Feasibility Study. J Med Internet Res 2021; 23:e25504. [PMID: 33730687 PMCID: PMC8094020 DOI: 10.2196/25504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/06/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background Preoperative anxiety is a common occurrence among children and is associated with a host of maladaptive postoperative behaviors. Consequently, increased attention has been placed on interventions to reduce preoperative anxiety and its associated outcomes. Child Life preparation prior to surgery includes evidence-based practices such as age-appropriate distraction and therapeutic play. Virtual reality (VR) is a promising addition to the Child Life toolbox to address anxiety prior to surgery. The current study evaluates the implementation and feasibility of a VR experience, “Doc McStuffins: Doctor for a Day Virtual Reality Experience” (DocVR), developed by Disney Junior in collaboration with Children’s Hospital Los Angeles, to target pediatric preoperative anxiety. Objective The primary aim of this study was to examine the feasibility and efficacy of DocVR for preoperative anxiety. A secondary aim was to improve patient, caregiver, and health care provider satisfaction with the preoperative experience. Methods In this study, 51 patients (age 6-14 years) scheduled for surgery in the ambulatory surgery center and the main operating room at Children’s Hospital Los Angeles were approached to participate in Disney’s DocVR experience. The patients played the DocVR experience for an average of 18 minutes (3-55 minutes). Irrespective of surgical procedure, patients and their families were eligible, as long as they had no known marked cognitive or visual impairments that would interfere with completing the survey and engaging in the DocVR experience. Results Patients who tried the DocVR experience (n=51) responded overwhelmingly positively to both the VR technology and to the game itself. Patients experienced a statistically significant decrease in anxiety following DocVR game play (Z=–3.26, P=.001). On the Facial Affective Scale, the percentage of patients who chose the face with the most positive facial expression to represent their affect increased from 23% (12/51) pre-VR to 49% (25/47) post-VR. Furthermore, 97% (38/39) of patients reported feeling more comfortable at the hospital, and 74% (28/38) reported feeling less scared at the hospital after playing the game. The game was enjoyed by 94% (46/49) of patients, and 88% (30/34) of patients reported feeling both “Interested” and “Involved” in the game. Conclusions DocVR is a feasible and beneficial VR experience to relieve pediatric preoperative anxiety and improve satisfaction in the preoperative area. The VR experience resulted in a decrease in overall anxiety and an increase in overall positive affect during the preoperative time. Patients also responded positively to the game, confirming their interest in the content and affirming the quality of the DocVR experience. The positive response to the game indicates that DocVR has the potential to make the overall preoperative experience less anxiety-producing and more comfortable, which leads to improved patient satisfaction. Naturally, improved patient outcomes lead to improved caregiver and health care provider satisfaction.
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Affiliation(s)
- Jeffrey I Gold
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Erin T Annick
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Arianna S Lane
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Katherine Ho
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Ryan T Marty
- Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Juan C Espinoza
- Division of General Pediatrics, Department of Pediatrics, The Saban Research Institute at Children's Hospital Los Angeles, The West Coast Consortium for Technology & Innovation Pediatrics, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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34
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Huang YL, Xu N, Huang ST, Wang ZC, Cao H, Yu XR, Chen Q. Impact of Music Therapy on Preoperative Anxiety and Degree of Cooperation With Anesthesia Induction in Children With Simple Congenital Heart Disease. J Perianesth Nurs 2021; 36:243-246. [PMID: 33653616 DOI: 10.1016/j.jopan.2020.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/22/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the impact of music therapy (MT) on preoperative anxiety and degree of cooperation with anesthesia induction in children with simple congenital heart disease (CHD). DESIGN A randomized controlled clinical study. METHODS Ninety children were randomly assigned to the MT and control groups. The MT groups underwent a preoperative 30-minute session of MT, whereas the control group did not listen to any music and had the same amount of quiet time. The modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) was used to evaluate the patients' preoperative anxiety on entering the anesthesia waiting area (T1), 10 minutes after entering the waiting area (T2), and during the initiation of anesthesia induction (T3); the degree of cooperation with anesthesia induction was assessed using the Induction Compliance Checklist. The mean arterial blood pressure (MAP) and heart rate (HR) at T1, T2, T3, and T4 (the time of successful anesthesia) were also recorded. FINDINGS One child was excluded from the MT group, and one was excluded from the control group. No difference was found in the mYPAS-SF score, MAP, or HR between the two groups at T1. The mYPAS-SF scores of the MT group were significantly lower than those of the control group at T2 and T3. At T2, T3, and T4, the MAP and HR of the MT group were lower than those of the control group. A statistically significant difference was found in the Induction Compliance Checklist score between the two groups. CONCLUSIONS MT can reduce preoperative anxiety and improve the degree of cooperation with anesthesia induction.
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Affiliation(s)
- Ya-Li Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Xian-Rong Yu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
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Getahun AB, Endalew NS, Mersha AT, Admass BA. Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:485-494. [PMID: 33364873 PMCID: PMC7751437 DOI: 10.2147/phmt.s288077] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
Background Anesthesia and surgery are common sources of anxiety and stressful experiences in children. This unpleasant sensation depends on several factors. This study aimed to determine the magnitude of preoperative anxiety and associated factors in pediatrics patients at the University of Gondar Comprehensive Specialized Hospital North West Ethiopia 2020. Methods An institutional-based cross-sectional observational study was conducted from March to September 2020 at the University of Gondar Comprehensive Specialized Hospital. After obtaining ethical approval from the institutional review board. All consecutive ASA physical status I & II boys and girls with the age of 2–12 years scheduled for a variety of elective (general, urologic, ENT, ophthalmic and other surgical) operations were included. The level of anxiety was measured using the Modified Yale Preoperative Anxiety Scale short form (m-YPAS-SF) observational tool. Parental anxiety was assessed using Spielberger’s short version of state-trait anxiety. Binary logistic regression analysis was performed to identify the association between preoperative children’s anxiety and independent variables. The strength of the association was present by adjusted odds ratios. Results The magnitude of preoperative anxiety in children in the operation room was 75.44% (95% confidence interval (CI): 68.36, 81.34). Age (AOR: 3.83; 95% CI: 1.58, 9.30), previous surgery and anesthesia (AOR: 6.73, 95% CI: 1.25, 36.19), outpatient surgery (AOR: 5.16, 95% CI: 1.32, 20.23) and parental anxiety (AOR: 3.26, 95% CI: 1.30, 20.23) were significantly associated with preoperative children anxiety. Conclusion The magnitude of preoperative anxiety in pediatric patients was considerably high in our setup. Younger age, previous surgery and anesthesia, outpatient surgical setting, and parental anxiety were the independent risk factors for preoperative anxiety. Therefore, the operating staff should assess the child’s anxiety and should consider appropriate anxiety reduction methods during the preoperative visit of pediatric patients and their families.
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Affiliation(s)
- Amare Belete Getahun
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nigussie Simeneh Endalew
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abraham Tarekegn Mersha
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Biruk Adie Admass
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Agbayani CJ, Fortier M, Kain Z. Non-pharmacological methods of reducing perioperative anxiety in children. BJA Educ 2020; 20:424-430. [PMID: 33456927 PMCID: PMC7807851 DOI: 10.1016/j.bjae.2020.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - M.A. Fortier
- University of California, Irvine, Irvine, CA, USA
| | - Z.N. Kain
- University of California, Irvine, Irvine, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
- Yale University School of Medicine, New Haven, CT, USA
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Fronk E, Billick SB. Pre-operative Anxiety in Pediatric Surgery Patients: Multiple Case Study Analysis with Literature Review. Psychiatr Q 2020; 91:1439-1451. [PMID: 32424544 DOI: 10.1007/s11126-020-09780-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pre-operative anxiety affects millions of pediatric surgery patients each year and can have both short and long-term adverse effects in the post-operative period. As a result, it is particularly important for healthcare providers and others involved in the child's care, such as the parents, to be aware of interventions that can be used to reduce the onset of pre-operative anxiety and, thus, the likelihood of negative post-operative changes. The purpose of this paper is to familiarize the reader with the issue of pre-operative anxiety through a review of the literature and analysis of case studies. First, the paper looks at the causes of pre-operative anxiety and its effect on the development of maladaptive behavioral, emotional, and physiological changes. It then discusses the ways pre-operative anxiety can be measured and current methods for reducing the post-operative adverse outcomes associated with it. After doing so, it proposes the need for additional research and the use of precision medicine by physicians.
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Affiliation(s)
- Emily Fronk
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Stephen Bates Billick
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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Lim J, Kim WJ. Dramatic Decrease in Ocular Deviation 1 Day before Surgery in Patients with Intermittent Exotropia. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:361-366. [PMID: 33099557 PMCID: PMC7597611 DOI: 10.3341/kjo.2020.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the clinical characteristics of patients with intermittent exotropia who exhibited a dramatic decrease in ocular deviation 1 day before surgery. Methods This study retrospectively enrolled patients with intermittent exotropia who underwent surgery between December 2013 and December 2019. Those who exhibited a decrease in ocular alignment ≥10 prism diopters (PD) at the last examination (1 day before surgery) compared with the largest previous angle of deviation were included. A monocular occlusion test was performed to re-confirm the largest angle of ocular deviation. Results Among 547 patients with intermittent exotropia, 10 (six females; mean age, 8.6 years) exhibited a dramatic decrease in ocular deviation before impending surgery. The mean largest angle of deviation was 31.0 PD (range, 20 to 50 PD) at distance and 34.5 PD (range, 20 to 55 PD) at near. The mean control scores using the LACTOSE (Look and Cover then Ten Seconds of Observation Scale for Exotropia) scoring system were 2.5 at distance, 1.8 at near, and 4.3 when combined. Mean ocular deviation prior to the impending surgery decreased to 7.4 PD (range, 0 to 10 PD) at distance and 6.2 PD (range, -10 to 10 PD) at near. The largest angle of ocular deviation was re-confirmed using the monocular occlusion test in all patients. All patients underwent surgery as planned, and none exhibited postoperative overcorrection. Conclusions A relatively small number of patients with intermittent exotropia exhibited a dramatic decrease in ocular alignment 1 day before surgery but demonstrated a relatively better level of control. The monocular occlusion test was helpful in re-confirming the largest angle of ocular deviation.
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Affiliation(s)
- Jinam Lim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Won Jae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Emerson ND, Bursch B. Communicating with Youth about Pain: Developmental Considerations. CHILDREN-BASEL 2020; 7:children7100184. [PMID: 33076255 PMCID: PMC7602494 DOI: 10.3390/children7100184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. METHODS This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. RESULTS Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. CONCLUSION Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.
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Marquez JL, Wang E, Rodriguez ST, O'Connell C, Munshey F, Darling C, Tsui B, Caruso J, Caruso TJ. A retrospective cohort study of predictors and interventions that influence cooperation with mask induction in children. Paediatr Anaesth 2020; 30:867-873. [PMID: 32452092 DOI: 10.1111/pan.13930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncooperative pediatric mask induction is linked to perioperative anxiety. Although some risk factors for uncooperative inductions have been reported, there are no large cohort studies that identify intrinsic patient characteristics associated with cooperation. AIM The primary aim was to identify patient characteristics associated with cooperative mask inductions. The secondary aim was to determine whether preoperative interventions were associated with increased cooperation. METHODS This retrospective cohort study included patients 2-11 years old and ASA class I-IV who underwent mask induction. Our primary outcome of interest was cooperation with mask induction, which was correlated against the Induction Compliance Checklist. The variables analyzed for association with cooperation were age, sex, ASA class, class of surgery, preferred language, and race. Interventions examined for association with induction cooperation included premedication with midazolam, exposure to distraction technology, parental presence, and the presence of a Child Life Specialist. Multivariate mixed-effects logistic regression was used to assess the relationship between patient characteristics and cooperation. A separate multivariate mixed-effects logistic regression was used to examine the association between preoperative interventions and cooperation. RESULTS 9692 patients underwent 23 474 procedures during the study period. 3372 patients undergoing 5980 procedures met inclusion criteria. The only patient characteristic associated with increased cooperation was age (OR 1.20, p-value 0.03). Involvement of Child Life Specialists was associated with increased cooperation (OR 4.44, p-value = 0.048) while parental/guardian presence was associated with decreased cooperation (OR 0.38, p-value = 0.002). CONCLUSION In this cohort, increasing age was the only patient characteristic found to be associated with increased cooperation with mask induction. Preoperative intervention by a Child Life Specialists was the sole intervention associated with improved cooperation.
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Affiliation(s)
- Juan L Marquez
- Department of Preventive Medicine, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ellen Wang
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Samuel T Rodriguez
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chloe O'Connell
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Farrukh Munshey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Curtis Darling
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ban Tsui
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Makary MS, da Silva A, Kingsbury J, Bozer J, Dowell JD, Nguyen XV. Noninvasive Approaches for Anxiety Reduction During Interventional Radiology Procedures. Top Magn Reson Imaging 2020; 29:197-201. [PMID: 32472820 DOI: 10.1097/rmr.0000000000000238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Periprocedural anxiety is a major cause of morbidity, particularly for interventional radiology procedures that often depend on conscious sedation. Management of anxiety and pain during image-guided procedures has traditionally relied on pharmacologic agents such as benzodiazepines and opioids. Although generally safe, use of these medications risks adverse events, and newer noninvasive, nonpharmacologic techniques have evolved to address patient needs. In this review, we explore the roles of hypnosis, structured empathic attention, anodyne imagery, music, video glasses, and mobile applications in reducing procedural anxiety and pain with the goal of improving patient satisfaction, operational efficiency, and clinical outcomes.
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Affiliation(s)
- Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alexandre da Silva
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - James Kingsbury
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jordan Bozer
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Xuan V Nguyen
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
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Arze S, Lagos C, Ibacache M, Zamora M, González A. Incidence and risk factors of preoperative anxiety in Spanish-speaking children living in a Spanish-speaking country. Paediatr Anaesth 2020; 30:792-798. [PMID: 32343016 DOI: 10.1111/pan.13899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 04/01/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most research on preoperative anxiety has focused on non-Latino populations. A study performed in the USA found that children from Spanish-speaking Latino families experienced higher anxiety than children from English-speaking families. AIMS To report the incidence and level of preoperative anxiety in native Spanish-speaking children living in their home country and to assess risk factors associated with higher anxiety levels. METHODS Data were collected from 204 children aged 2-12 undergoing elective surgery in a Chilean hospital. Patients' demographic data, surgery-related information, and self-reported parental anxiety were collected. Children's anxiety was measured using the Modified Yale Preoperative Anxiety Scale. An anxiety score greater than 30 indicated significant anxiety. The main outcome for analyzing risk factors was children's anxiety level in the operating room. RESULTS Significant preoperative anxiety was observed in 41.7% (95% CI: 34.8%-48.8%) of patients, with median anxiety score of 26.6 (IQR, 23.4-46.6). A significant positive correlation was observed between self-reported parental anxiety in the preoperative holding room and children's anxiety in the operating room (r = .153, P = .02), with a higher median difference when mothers are present in anesthesia induction (36.8 vs 30.7, respectively; P = .006). Linear regression analysis found previous negative surgical experience to be associated with higher anxiety levels in the operating room (β = 16.057, P = .014). CONCLUSIONS Spanish-speaking children undergoing elective surgery in their home country experienced significant rates of preoperative anxiety. Parental anxiety and previous negative surgical experience were risk factors associated with higher anxiety levels.
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Affiliation(s)
- Santiago Arze
- Division of Anesthesia, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Lagos
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Ibacache
- Division of Anesthesia, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maximiliano Zamora
- Division of Anesthesia, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro González
- Division of Anesthesia, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Retrospective Review of the Safety and Efficacy of Virtual Reality in a Pediatric Hospital. Pediatr Qual Saf 2020; 5:e293. [PMID: 32426648 PMCID: PMC7190243 DOI: 10.1097/pq9.0000000000000293] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/26/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Virtual reality (VR) is an emerging tool for anxiety and fear reduction in pediatric patients. VR use is facilitated by Certified Child Life Specialists (CCLS) at pediatric hospitals. The primary aim of this study was to retrospectively review the safety of VR by analyzing adverse events after the utilization of VR under CCLS supervision. Secondary objectives were to characterize the efficacy of VR in enhancing patient cooperation, describe the integration of VR into Child Life services, and identify interventions that accompanied VR. Methods The Stanford Chariot Program developed VR applications, customized VR interfaces, and patient head straps, and distributed these to CCLS. Chart review analyzed VR utilization through CCLS patient notes. Inclusion criteria were all patients ages 6 to 18-years-old who received a Child Life intervention. Results From June 2017 to July 2018, 31 CCLS saw 8,098 patients, 3,696 of which met age criteria with pre- and post-intervention cooperation data. Two hundred thirteen patients received VR with an accompanying intervention, while 34 patients received only VR. Adverse events were rare, and included increased anxiety (3.8%, n=8), dizziness (0.5%, n=1), and nausea (0.5%, n=1). Patients were more likely to be cooperative after receiving VR (99.5%, n=212) compared to pre-intervention (96.7%, n=206, p=0.041). VR use was most common in the perioperative setting (60%, n=128), followed by outpatient clinics (15%, n=32). Conclusion VR is safe in pediatric patients with appropriate hardware, software, and patient selection. Side effects were rare and self-limited. VR appears to be associated with improvements in cooperation.
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Matthyssens LE, Vanhulle A, Seldenslach L, Vander Stichele G, Coppens M, Van Hoecke E. A pilot study of the effectiveness of a serious game CliniPup® on perioperative anxiety and pain in children. J Pediatr Surg 2020; 55:304-311. [PMID: 31761458 DOI: 10.1016/j.jpedsurg.2019.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION/AIM Children experience important anxiety before surgery. Anxiety and pain are positively correlated. Serious gaming is a non-pharmacological intervention to prepare children and parents for an operation. We aimed to evaluate the effectiveness of the serious game CliniPup® on anxiety and pain in children undergoing ambulatory surgery. METHOD A prospective randomized controlled pilot trial in 72 children aged 5 to 11 years old scheduled for day-care surgery (general surgery, dentistry, otorhinolaryngology, urology) was performed. Participants were randomly assigned into 3 groups: A (CliniPup®), B ("Empty game" without educational information), or C (no game, oral information at the outpatient clinic, current standard of care). Anxiety, pain, and behaviour were evaluated by validated instruments at six time-points: T0: baseline, T1: 1 week preoperatively, T2: at hospital admission, T3: before discharge, T4: 1 week postoperatively, T5: 1 month postoperatively. RESULTS After playing the game (T1), the estimated mean anxiety score (VASa) was lower in Group A (1.9 units) versus Group B (2.7 units). The estimated mean VASa at T1 for Group A was 2.6 units lower compared to Group C (p = 0.003). For Group B, VASa levels were 1.8 units lower than in Group C (p = 0.045). After correction for "surgery type", Group A continued to show a significantly lower VASa compared to Group C (p = 0.044). On the other time points, no difference in anxiety and pain were observed, nor in post-hospitalization behaviour. CONCLUSION Children that played the CliniPup® game one week before surgery had a significant reduction in preoperative anxiety after playing the game, but not on the other time points. No differences on peri-operative pain were observed during the different time points. TYPE OF STUDY Randomized Trial. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Lucas E Matthyssens
- Department of Gastrointestinal and Paediatric Surgery, Princess Elisabeth Children's Hospital, Ghent University Hospital, Ghent University, C. Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Amber Vanhulle
- Faculty of Medicine and Health Sciences, Ghent University, Campus UZ Ghent, C. Heymanslaan 10, B-9000 Ghent, Belgium
| | - Lara Seldenslach
- Faculty of Medicine and Health Sciences, Ghent University, Campus UZ Ghent, C. Heymanslaan 10, B-9000 Ghent, Belgium
| | | | - Marc Coppens
- Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, C. Heymanslaan 10, B-9000 Ghent, Belgium
| | - Eline Van Hoecke
- Department of Paediatrics, Paediatric Psychology, Princess Elisabeth Children's Hospital, Ghent University Hospital, Ghent University, C. Heymanslaan 10, B-9000 Ghent, Belgium
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Sekhavatpour Z, Khanjani N, Reyhani T, Ghaffari S, Dastoorpoor M. The effect of storytelling on anxiety and behavioral disorders in children undergoing surgery: a randomized controlled trial. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2019; 10:61-68. [PMID: 31372090 PMCID: PMC6628943 DOI: 10.2147/phmt.s201653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Abstract
Background One of the most frightening procedures for children is surgery. This study aimed to assess the effect of animated illustrated stories on anxiety and behavioral disorders in children after surgery. Methods In this randomized controlled clinical trial (RCT), 60 children between 4 and 8 years who went through adenotonsillectomy were divided into two groups based on random numbers. In the intervention group, animated illustrated books were read for the children by the researcher, for 30 mins, on the night before surgery. Child’s anxiety was measured using the Revised Children’s Manifest Anxiety Scale (RCMAS) and Behavioral Disorder questionnaire (a researcher-made tool) before and 10 days after the book reading. Data were analyzed using descriptive statistics and the non-parametric Mann–Whitney U test and Wilcoxon signed-rank test. Results The results showed that mean scores of physiological anxiety (P-value<0.001), social concerns/concentration (P-value=0.012), and total anxiety (P-value<0.001), except worry/oversensitivity (P-value=0.140), statistically significantly decreased in the intervention group after book reading, but mean total anxiety and its three dimensions did not show statistically significant differences before and after treatment in the control group (P-value>0.05). Mean scores of the Behavioral Disorder questionnaire significantly decreased in the intervention group after book reading (P-value=0.001), but significantly increased in the control group (P-value<0.001). Conclusion The results showed that reading animated illustrated books could be effective in reducing anxiety and behavioral disorders in children after surgery. It seems that these books could be a new and creative way to distract children and can be used as supportive care.
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Affiliation(s)
- Zohreh Sekhavatpour
- Department of Pediatric Nursing, Anesthesiology, School of Paramedicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Narges Khanjani
- Department of Epidemiology, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Tayebeh Reyhani
- Department of Nursing, Faculty of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sogol Ghaffari
- Department of Psychologist, Dezful University of Medical Sciences, Dezful, Iran
| | - Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Chow CHT, Rizwan A, Xu R, Poulin L, Bhardwaj V, Van Lieshout RJ, Buckley N, Schmidt LA. Association of Temperament With Preoperative Anxiety in Pediatric Patients Undergoing Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e195614. [PMID: 31173131 PMCID: PMC6563582 DOI: 10.1001/jamanetworkopen.2019.5614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Preoperative anxiety is associated with poor behavioral adherence during anesthetic induction and adverse postoperative outcomes. Research suggests that temperament can affect preoperative anxiety and influence its short- and long-term effects, but these associations have not been systematically examined. OBJECTIVE To examine the associations of temperament with preoperative anxiety in young patients undergoing surgery. DATA SOURCES Studies from MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched from database inception to June 2018. STUDY SELECTION All prospective studies reporting associations of temperament with preoperative anxiety were included. Overall, 43 of 5451 identified studies met selection criteria. DATA EXTRACTION AND SYNTHESIS Using the PRISMA guidelines, reviewers independently read 43 full-text articles, extracted data on eligible studies, and assessed the quality of each study. Data were pooled using the Lipsey and Wilson random-effects model. MAIN OUTCOMES AND MEASURES Primary outcome was the association of temperament with preoperative anxiety in patients undergoing surgery. RESULTS A total of 23 studies, with 4527 participants aged 1 to 18 years, were included in this review. Meta-analysis of 12 studies including 1064 participants revealed that emotionality (r = 0.11; 95% CI, 0.04 to 0.19), intensity of reaction (r = 0.29; 95% CI, 0.11 to 0.46), and withdrawal (r = 0.40; 95% CI, 0.23 to 0.55) were positively associated with preoperative anxiety, whereas activity level (r = -0.23; 95% CI, -0.31 to -0.16) was negatively correlated with preoperative anxiety. Impulsivity was not significantly associated with preoperative anxiety. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies. Future studies should continue to explore temperament and other factors influencing preoperative anxiety and their transactional effects to guide the development of precision treatment approaches and to optimize perioperative care.
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Affiliation(s)
- Cheryl H. T. Chow
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Ayesha Rizwan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard Xu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lauren Poulin
- Clinical Psychology Graduate Program, York University, Toronto, Ontario, Canada
| | - Varun Bhardwaj
- Bachelor of Health Sciences Program, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J. Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Louis A. Schmidt
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
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Dehghan F, Jalali R, Bashiri H. The effect of virtual reality technology on preoperative anxiety in children: a Solomon four-group randomized clinical trial. Perioper Med (Lond) 2019; 8:5. [PMID: 31171963 PMCID: PMC6549331 DOI: 10.1186/s13741-019-0116-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preoperative anxiety correlates positively with the amount of postoperative pain, analgesic use, and length of hospital stay. The purpose of this study was to investigate the effect of virtual reality technology on pre-operative anxiety in children. METHODS The study utilized Solomon four-group design intervention and a randomized clinical trial. A total of 40 candidates undergoing abdominal surgery were randomly divided into two groups. The pre-operative anxiety scale was assessed by a checklist containing a standardized Yale Preoperative Anxiety Scale questionnaire. The interventional group had a 5-min exposure to the operating room using virtual reality technology, but the control group did not receive virtual reality exposure. The data were analyzed using SPSS-23 software. RESULTS Non-parametric test for two independent groups showed no significant difference in baseline scores between interventional 1 and control 1 groups except for vocalization (p = 0.019), but there was a significant change in all subscales among intervention group 1 from baseline to post-test (p < 0.05) except for state of apparent arousal. CONCLUSIONS The medical treatment using virtual reality technology, as well as distraction and drowning in the virtual reality, reduced pre-operative anxiety in children.
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Affiliation(s)
- Fateme Dehghan
- Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Psychology, Faculty of Social Sciences, Razi University, Kermanshah, Iran
| | - Rostam Jalali
- Nursing Department, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Isar Square, Kermanshah, Iran
| | - Hasan Bashiri
- Kermanshah University of Medical Sciences, Kermanshah, Iran
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Verschueren S, van Aalst J, Bangels AM, Toelen J, Allegaert K, Buffel C, Vander Stichele G. Development of CliniPup, a Serious Game Aimed at Reducing Perioperative Anxiety and Pain in Children: Mixed Methods Study. JMIR Serious Games 2019; 7:e12429. [PMID: 31199333 PMCID: PMC6592492 DOI: 10.2196/12429] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/20/2019] [Accepted: 04/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background An increasing number of children undergo ambulatory surgery each year, and a significant proportion experience substantial preoperative anxiety and postoperative pain. The management of perioperative anxiety and pain remains challenging in children and is inadequate, which negatively impacts the physical, psychosocial, and economic outcomes. Existing nonpharmacological interventions are costly, time consuming, vary in availability, and lack benefits. Therefore, there is a need for an evidence-based, accessible, nonpharmacological intervention as an adjunct to existing pharmacological alternatives to reduce perioperative anxiety and pain in children undergoing ambulatory surgery. Technology-enabled interventions have been proposed as a method to address the unmet need in this setting. In particular, serious games hold a unique potential to change health beliefs and behaviors in children. Objective The objective of this research was to describe the rationale, scientific evidence, design aspects, and features of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods The SERES Framework for serious game development was used to create the serious game, CliniPup. In particular, we used a mixed methods approach that consisted of a structured literature review supplemented with ethnographic research, such as expert interviews and a time-motion exercise. The resulting scientific evidence base was leveraged to ensure that the resulting serious game was relevant, realistic, and theory driven. A participatory design approach was applied, wherein clinical experts qualitatively reviewed several versions of the serious game, and an iterative creative process was used to integrate the applicable feedback. Results CliniPup, a serious game, was developed to incorporate a scientific evidence base from a structured literature review, realistic content collected during ethnographic research such as expert interviews, explicit pedagogical objectives from scientific literature, and game mechanics and user interface design that address key aspects of the evidence. Conclusions This report details the systematic development of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Clinical experts validated CliniPup’s underlying scientific evidence base and design foundations, suggesting that it was well designed for preliminary evaluation in the target population. An evaluation plan is proposed and briefly described.
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Affiliation(s)
| | - June van Aalst
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Buffel C, van Aalst J, Bangels AM, Toelen J, Allegaert K, Verschueren S, Vander Stichele G. A Web-Based Serious Game for Health to Reduce Perioperative Anxiety and Pain in Children (CliniPup): Pilot Randomized Controlled Trial. JMIR Serious Games 2019; 7:e12431. [PMID: 31199324 PMCID: PMC6592396 DOI: 10.2196/12431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was developed to address this unmet need. CliniPup was generated using the SERES framework for serious game development. Objective The goal of the research was to clinically evaluate CliniPup as an adjunct therapy to existing pharmacological interventions aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods CliniPup was evaluated in a prospective randomized controlled pilot trial in 20 children aged 6 to 10 years who underwent elective surgery and their parents. Study participants were randomly assigned to the test (n=12) or control group (n=8). Children in the test group played CliniPup 2 days prior to surgery, and children in the control group received standard of care. On the day of surgery, pediatric anxiety was measured with the modified Yale Preoperative Anxiety Scale and parental anxiety was assessed with the State-Trait Anxiety Inventory. Pediatric postoperative pain was assessed by the Wong-Baker Faces Pain Rating Scale. Child and parent user experience and satisfaction were also evaluated in the test group using structured questionnaires. Results Despite the small sample, preoperative anxiety scores were significantly lower (P=.01) in children who played CliniPup prior to surgery compared to controls. Parental preoperative anxiety scores were also lower in the test group (P=.10) but did not reach significance. No significant differences were observed in postoperative pain scores between groups (P=.54). The evaluation of user experience and satisfaction revealed that both children and parents were satisfied with CliniPup and would recommend the game to peers. Conclusions Results of the pilot trial introduce CliniPup as a potentially effective and attractive adjunct therapy to reduce preoperative anxiety in children undergoing ambulatory surgery with a trend toward positive impact on parental preoperative anxiety. These results support the use of the SERES framework to generate an evidence-based SGH that results in positive health outcomes for patients. Based on these preliminary findings, we propose a research agenda to further develop and investigate this tool. Trial Registration ClinicalTrials.gov NCT03874442; https://clinicaltrials.gov/ct2/show/NCT03874442 (Archived by WebCite at http://www.webcitation.org/78KZab8qc)
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Affiliation(s)
| | - June van Aalst
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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Przybylska MA, Burke N, Harris C, Kazmierczyk M, Kenton E, Yu O, Coleman H, Joseph S. Delivery of the UN Convention on the Rights of the Child in an acute paediatric setting: an audit of information available and service gap analysis. BMJ Paediatr Open 2019; 3:e000445. [PMID: 31423467 PMCID: PMC6688700 DOI: 10.1136/bmjpo-2019-000445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The United Nations Convention on Children's Rights stresses the importance of providing children with information relating to their health and well-being, yet reports suggest children are offered insufficient support in healthcare environments. We audited the information provided to children and families requiring planned surgical admission in comparison to those admitted acutely to medical paediatrics. Additionally, we identified examples of child-specific information resources in national and international hospitals. METHODS Three approaches were taken to gain insight into practice locally, nationally and internationally.(1) Information resources provided to paediatric inpatients admitted to the acute receiving unit were audited in comparison to information given to children with planned admissions via process observations.(2) Qualitative feedback was gained from play specialists (n=2), families (n=30) and children (n=9; aged 3-15 years) via interviews.(3) A review, including UK, Australian and US hospitals, was conducted to assess child-specific information resources (n=36 hospitals) and to systematically compare the information available on websites (n=9 hospitals). RESULTS At the study site, no child-specific information resources were available for acute admissions, whereas planned admissions were offered significant information face-to-face with supplemental resources. Child, parent and play specialist interviews highlighted gaps in information provision regarding hospital practicalities and processes. Twelve external child-specific resources were identified, for 4-14 year olds, explaining key care information: medical procedures, equipment and staff. These resources could positively respond to the topics cited as lacking by the interviewed patients and families at the study site. International hospital websites provided considerably more in-depth information compared with UK hospitals. CONCLUSIONS The hospital experience of children and families can be improved by ensuring they are provided with adequate information relating to their hospital stay. It is essential that suitable high-quality resources are consistently available and that feedback from children informs the process of resource development.
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Affiliation(s)
| | - Niall Burke
- Department of General Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
| | - Clare Harris
- Department of General Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
| | - Marcel Kazmierczyk
- Department of General Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
| | - Ellie Kenton
- Department of General Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
| | - Olivia Yu
- Department of General Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
| | - Harriet Coleman
- Department of General Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
| | - Sonia Joseph
- Department of General Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
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