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Journal of Pediatric Intensive Care Dec 2020There is a growing population of children with prolonged intensive care unit (ICU) hospitalization. These children with chronic critical illness (CCI) have a high health... (Review)
Review
There is a growing population of children with prolonged intensive care unit (ICU) hospitalization. These children with chronic critical illness (CCI) have a high health care utilization. Emerging data suggest a mismatch between the ICU acute care models and the daily care needs of these patients. Clinicians and parents report that the frequent treatment alterations typical for ICU care may be interrupting and jeopardizing the slow recoveries typical for children with CCI. These frequent treatment titrations could therefore be prolonging ICU stays even further. The aim of this study is to evaluate and summarize existing literature regarding pace and consistency of ICU care for patients with CCI. We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (of September 2018). PubMed (biomedical and life sciences literature), Excerpta Medica database (EMBASE), and The Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for English-language studies with data about CCI, care models, and pacing of clinical management. Four unique papers were identified. Our most important finding was that quality data on chronic ICU management, particularly for children, is sparse. All papers in this review confirmed the unique needs of chronic patients, particularly related to respiratory management, which is a common driver of ICU length of stay. Taken together, the papers support the hypothesis that protocols to reduce interdisciplinary management variability and to allow for slower management pacing should be studied for their impact on patient and health system outcomes. Optimizing value in ICU care requires mapping of resources to patient needs, particularly for patients with the most intense resource utilization. For children with CCI, parents and clinicians report that rapid treatment changes undermine recovery and prolong ICU stays. This review highlights the lack of quality pediatric research in this area and supports further investigation of a "slow and steady" approach to ICU management for children with CCI.
PubMed: 33133737
DOI: 10.1055/s-0040-1713160 -
Patient Education and Counseling Apr 2020To synthesize current evidence about experiences and information needs of parents/caregivers managing pediatric fever. (Review)
Review
OBJECTIVE
To synthesize current evidence about experiences and information needs of parents/caregivers managing pediatric fever.
METHODS
We used systematic review methodology with an a priori protocol. We searched Medline, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global, from 2000 to May 2018.
RESULTS
We included thirty-six studies (n = 29 quantitative, n = 7 qualitative; 15,727 participants). Quantitative data contained four themes; 1) caregivers seek information about pediatric fever, 2) low knowledge is coupled with misconceptions and anxiety, 3) fever assessment and management practices vary, 4) demographic factors (e.g., ethnicity, age, socioeconomic status, education) influence information needs and health practices. Qualitative data contained three themes; 1) tension between logic and emotion, 2) responsibility contrasted with sense of vulnerability, 3) seeking support and information to build confidence.
CONCLUSION
Parents often overestimate the risks associated with pediatric fever and struggle to make decisions during a child's febrile illness - leading to caregiving actions that may not reflect current clinical recommendations. Parents seek knowledge about how to care for a febrile child at home and what indicators should prompt them to seek medical attention.
PRACTICE IMPLICATIONS
In addition to providing clear, reliable information, interventions that address educational, pragmatic, and emotional domains may be effective in supporting parents.
Topics: Child; Family; Humans; Parents; Qualitative Research; Surveys and Questionnaires
PubMed: 31668490
DOI: 10.1016/j.pec.2019.10.004 -
Seminars in Oncology Nursing Oct 2023This systematic review aims to describe an overview of the overall care, patient and parent education, staff training, and management of complications from a nursing... (Review)
Review
OBJECTIVES
This systematic review aims to describe an overview of the overall care, patient and parent education, staff training, and management of complications from a nursing perspective of pediatric patients undergoing chimeric antigen receptor T (CAR-T) cell infusion in order to provide an updated summary of the approach to the management of these patients. CAR-T cellular therapy represents an innovation within pediatric hematology and oncology used to treat relapse and refractory leukemias, solid tumors, and lymphomas when standard therapy has not worked. However, this type of therapy could lead to the onset of some clinical complications that must be managed appropriately and promptly. Although their use is constantly increasing, the knowledge and resources in the literature are still limited.
DATA SOURCES
The review was conducted from January 2022 to July 2022 in PubMed, CINAHL, Scopus, and Cochrane and produced 502 articles. Based on the selection criteria and after removing duplicate articles, 26 articles were included in the study.
CONCLUSION
From these analyzed articles, it was possible to have an overview regarding the management, patient and parent education, staff training, and management of complications from a nursing perspective of pediatric patients undergoing CAR-T cell infusion.
IMPLICATIONS FOR NURSING PRACTICE
The management of hematology-oncology patients undergoing CAR-T cell therapy from a nursing perspective is not simple. We hope this review can be used as a tool to guide nursing staff. In this regard, we have developed a summary table with the actions to be taken in the case of assisting a pediatric patient being treated with CAR-T.
Topics: Humans; Child; Receptors, Chimeric Antigen; Immunotherapy, Adoptive; Neoplasms; Leukemia; Cell- and Tissue-Based Therapy
PubMed: 37544775
DOI: 10.1016/j.soncn.2023.151478 -
Pediatric Emergency Care Jan 2024This systematic review aims to investigate the prevalence, preventability, and severity of medication errors in pediatric emergency departments (P-EDs). It also aims to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review aims to investigate the prevalence, preventability, and severity of medication errors in pediatric emergency departments (P-EDs). It also aims to identify common types of medication errors, implicated medications, risk factors, and evaluate the effectiveness of interventions in preventing these errors.
METHODS
A systematic review analyzed 6 primary studies with sample sizes ranging from 96 to 5000 pediatric patients in P-EDs. The review followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and included observational studies and randomized controlled trials involving patients aged 18 years and younger. Comprehensive searches in biomedical databases were conducted, and conflicts in record screening were resolved by a third reviewer using systematic review software.
RESULTS
Medication errors in P-EDs are prevalent, ranging from 10% to 15%, with dosing errors being the most common, accounting for 39% to 49% of reported errors. These errors primarily stem from inaccurate weight estimations or dosage miscalculations. Inadequate dosing frequency and documentation also contribute significantly to medication errors. Commonly implicated medications include acetaminophen, analgesics, corticosteroids, antibiotics, bronchodilators, and intravenous fluids. Most errors are categorized as insignificant/mild (51.7% to 94.5%) or moderate (47.5%). Risk factors associated with medication errors in P-EDs include less experienced physicians, severely ill patients, and weekend/specific-hour ordering. Human factors such as noncompliance with procedures and communication failures further contribute to medication errors. Interventions such as health information technology solutions like ParentLink and electronic medical alert systems, as well as structured ordering systems, have shown promise in reducing these errors, although their effectiveness varies.
CONCLUSIONS
Overall, this systematic review provides valuable insights into the complexity of medication errors in the P-ED, emphasizes the need for targeted interventions, and offers recommendations to enhance medication safety and reduce preventable errors in this critical health care setting.
Topics: Child; Humans; Drug Dosage Calculations; Emergency Service, Hospital; Medication Errors; Risk Factors; Randomized Controlled Trials as Topic; Observational Studies as Topic
PubMed: 38157396
DOI: 10.1097/PEC.0000000000003108 -
Pediatric Critical Care Medicine : a... May 2023Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and environmental triggers. PD is associated with substantial morbidity and mortality. The objective of this study is to systematically review and evaluate factors associated with PD in hospitalized pediatric patients.
DATA SOURCES
A systematic search of PubMed, Embase, Ovid Medline, Web- of-Science, Cochrane, CIHNAL, and Google Scholar databases was conducted for relevant studies (1990-2022).
STUDY SELECTION
We included studies that compared pediatric patients with and without delirium. Reviews, editorials, congress abstracts, or studies that did not report factors for PD were excluded. No restrictions were imposed on language.
DATA EXTRACTION
Title and abstract were independently screened by two reviewers. Individual characteristics, study design, and outcomes were independently extracted.
DATA SYNTHESIS
Categorical dichotomous data were summarized across groups using Mantel-Haenszel odds ratios (ORs) with 95% 95% CIs. Either fixed-effect or random effects models were used as indicated by the results of a heterogeneity test. Of 1,846 abstracts, 24 studies were included. We identified 54 factors studied in univariate analyses, and 27 of these were associated with PD in multivariable analyses. In pooled analyses, greater odds of PD were associated with developmental delay (OR 3.98; 95% CI 1.54-10.26), need for mechanical ventilation (OR 6.02; 95% CI 4.43-8.19), use of physical restraints (OR 4.67; 95% CI 1.82-11.96), and receipt of either benzodiazepines (OR 4.10; 95% CI 2.48-6.80), opiates (OR 2.88; 95% CI 1.89-4.37), steroids (OR 2.02; 95% CI 1.47-2.77), or vasoactive medication (OR 3.68; 95% CI 1.17-11.60).
CONCLUSIONS
In this meta-analysis, we identified seven factors associated with greater odds of developing delirium during pediatric critical illness.
Topics: Humans; Child; Benzodiazepines; Cognitive Dysfunction; Critical Illness; Delirium
PubMed: 36790201
DOI: 10.1097/PCC.0000000000003196 -
Journal of Pediatric Nursing 2019Non-invasive thermometry methods have been used as substitutes for intra-corporeal ones in order to decrease patient discomfort and risk for complications, yet the... (Meta-Analysis)
Meta-Analysis
PROBLEM
Non-invasive thermometry methods have been used as substitutes for intra-corporeal ones in order to decrease patient discomfort and risk for complications, yet the evaluation of their performance is necessary. Our aim was to synthesize the evidence on the accuracy and precision of temporal artery (TA) thermometry, as well as on its sensitivity and specificity for fever detection.
ELIGIBILITY CRITERIA
This systematic review and meta-analysis included method-comparison studies, which compared TA temperature measurements with invasive thermometry ones, were published between 2000 and 2018, and were conducted on patients aged <18 years.
SAMPLE
Thirty articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, Web of Science, Cochrane Library, EMBASE and Scopus.
RESULTS
Quantitative synthesis indicated that pooled mean TA temperature was lower than core temperature by 0.01 °C (95% limits of agreement, -0.06 °C to 0.03 °C). Average summary sensitivity and specificity for fever detection were 0.72 (95% confidence interval, 0.66-0.79) and 0.91 (95% confidence interval, 0.86-0.93) respectively. Subgroup analysis indicated a trend toward larger temperature underestimation in febrile patients and in ages ≤4 years.
CONCLUSIONS
Despite its satisfactory accuracy, precision and specificity, TA thermometry has low sensitivity when used in pediatric patients, which does not allow satisfactory fever detection.
IMPLICATIONS
TA thermometry cannot be recommended for replacing rectal temperature measurement methods in children, due to its high proportion of false negative readings during screening for fever.
Topics: Child; Fever; Humans; Sensitivity and Specificity; Temporal Arteries; Thermometry
PubMed: 30865876
DOI: 10.1016/j.pedn.2019.03.004 -
International Journal of Environmental... May 2021Falls account for a high proportion of the safety accidents experienced by hospitalized children. This study aims to analyze the contents and effects of fall prevention... (Meta-Analysis)
Meta-Analysis Review
Falls account for a high proportion of the safety accidents experienced by hospitalized children. This study aims to analyze the contents and effects of fall prevention programs for pediatric inpatients to develop more adaptable fall prevention programs. A literature search was performed using PubMed (including Medline), Science Direct, CINAHL, Embase, and Cochrane. We included articles published from the inception of each of the databases up to 31 March 2019. A total of 1725 results were reviewed according to the inclusion and exclusion criteria, and nine studies were selected. Data were analyzed using descriptive statistics and the Comprehensive Meta-Analysis program. Four of the nine studies divided their participants into a high-risk fall group and a low-or medium-risk fall group, and all studies used a high-risk sign/sticker as a common protocol guideline for its high-risk fall group. The odds ratio of 0.95 (95% Cl 0.550-1.640) for the fall prevention program in seven studies was not statistically significant. To develop a standardized fall prevention program in the future, randomized control trial studies that can objectively measure the fall rate reduction effect of the integrated fall prevention program need to be expanded.
Topics: Accidental Falls; Child; Humans; Inpatients; Randomized Controlled Trials as Topic
PubMed: 34072495
DOI: 10.3390/ijerph18115853 -
The Journal of Surgical Research Jun 2017The purpose of the article was to analyze current literature on surgeon and parents' understanding and role in the informed consent process for children undergoing... (Review)
Review
BACKGROUND
The purpose of the article was to analyze current literature on surgeon and parents' understanding and role in the informed consent process for children undergoing surgery.
METHODS
A systematic database search (MEDLINE, EMBASE, PsycINFO, and EBM Reviews) was performed to identify articles concerning any aspect of the surgical informed consent for children undergoing an invasive procedure. Articles analyzing informed consent in research studies, non-English-language articles, review articles, case reports and/or series, letters-commentaries, and dentistry and/or nursing-related articles were excluded. Articles meeting inclusion criteria were analyzed to identify common themes related to the process of informed consent.
RESULTS
One hundred seventy-eight articles were identified on primary search, after removing duplicates and screening titles for relevance, 83 abstracts were reviewed. Thirty-two additional abstracts were identified by secondary search. Twelve of 115 articles met inclusion criteria. Analysis identified five different study themes. Information delivered during consent (Content) was studied in five articles (42%), three (25%) studied the mechanics or delivery of the information (Delivery), three (25%) studied parent participation and discussion (Interchange), six articles (50%) discussed surgeons' perceptions or the parents' ability to understand or recall the information (Comprehension), and five articles (42%) evaluated surgeon or parent satisfaction or anxiety (Satisfaction). None of the articles studied all five categories.
CONCLUSIONS
Studies of the surgical informed consent process in children are scarce. Prospective studies evaluating surgeon and parent perception regarding the Content, Delivery, and Interchange of information as well as Comprehension and Satisfaction are needed to understand barriers to the surgeon-patient relationship and to optimize the informed consent process in children undergoing surgery.
Topics: Attitude of Health Personnel; Child; Decision Making; Humans; Parental Consent; Parents; Professional-Family Relations; Surgeons; Surgical Procedures, Operative
PubMed: 28601314
DOI: 10.1016/j.jss.2017.02.047 -
Quality of Life Research : An... Feb 2018Previous work in pediatric oncology has found that clinicians and parents tend to under-report the frequency and severity of treatment-related symptoms compared to child... (Review)
Review
OBJECTIVE
Previous work in pediatric oncology has found that clinicians and parents tend to under-report the frequency and severity of treatment-related symptoms compared to child self-report. As such, there is a need to identify high-quality self-report instruments to be used in pediatric oncology research studies. This study's objective was to conduct a systematic literature review of existing English language instruments used to measure self-reported symptoms in children and adolescents undergoing cancer treatment.
METHODS
A comprehensive literature search was conducted in MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO to identify relevant articles published through November 10, 2016. Using pre-specified inclusion/exclusion criteria, six trained reviewers carefully screened abstracts and full-text articles for eligibility.
RESULTS
There were 7738 non-duplicate articles identified in the literature search. Forty articles met our eligibility criteria, and within these articles, there were 38 self-report English symptom instruments. Most studies evaluated only cross-sectional psychometric properties, such as reliability or validity. Ten studies assessed an instrument's responsiveness or ability to detect changes in symptoms over time. Eight instruments met our criteria for use in future longitudinal pediatric oncology studies.
CONCLUSIONS
This systematic review aids pediatric oncology researchers in identifying and selecting appropriate symptom measures with strong psychometric evidence for their studies. Enhancing the child's voice in pediatric oncology research studies allows us to better understand the impact of cancer and its treatment on the lives of children.
Topics: Adolescent; Adult; Biomedical Research; Child; Cross-Sectional Studies; Humans; Medical Oncology; Psychometrics; Quality of Life; Reproducibility of Results; Self Report; Young Adult
PubMed: 28879501
DOI: 10.1007/s11136-017-1692-4 -
Resuscitation May 2021Current American Heart Association Pediatric Life Support (PLS) guidelines do not recommend the routine use of sodium bicarbonate (SB) during cardiac arrest in pediatric... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Current American Heart Association Pediatric Life Support (PLS) guidelines do not recommend the routine use of sodium bicarbonate (SB) during cardiac arrest in pediatric patients. However, SB administration during pediatric resuscitation is still common in clinical practice. The objective of this study was to assess the impact of SB on mortality and neurological outcomes in pediatric patients with in-hospital cardiac arrest.
METHODS
We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to January 2021. We included studies of pediatric patients that had two treatment arms (treated with SB or not treated with SB) during in-hospital cardiac arrest (IHCA). Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was assessed using GRADE system.
RESULTS
We included 7 observational studies with a total of 4877 pediatric in-hospital cardiac arrest patients. Meta-analysis showed that SB administration during pediatric cardiac resuscitation was associated with a significantly decreased rate of survival to hospital discharge (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63, p value = 0.0003). There were insufficient studies for 24-h survival and neurologic outcomes analysis. The subgroup analysis showed a significantly decreased rate of survival to hospital discharge in both the "before 2010" subgroup (OR 0.47; 95% CI 0.30-0.73; p value = 0.006) and the "after 2010" subgroup (OR 0.46; 95% CI 0.25-0.87; p value = 0.02). The certainty of evidence ranged from very low to low.
CONCLUSIONS
This meta-analysis of non-randomized studies supported current PLS guideline that routine administration of SB is not recommended in pediatric cardiac arrest except in special resuscitation situations.
TRIAL REGISTRATION
The protocol was registered with PROSPERO on 8 August 2020 (registration number: CRD42020197837).
Topics: Cardiopulmonary Resuscitation; Child; Hospitals; Humans; Out-of-Hospital Cardiac Arrest; Patient Discharge; Sodium Bicarbonate
PubMed: 33662526
DOI: 10.1016/j.resuscitation.2021.02.035