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European Journal of Pediatrics Oct 2016Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I(2) statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95 % CI] for child anxiety score was -0.83 [-1.16, -0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95 % CI] -0.46 [-0.7, -0.21]} in the state anxiety was observed amongst parents.
CONCLUSION
We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents.
WHAT IS KNOWN
• Trials with clown doctors in pediatric population have shown conflicting results in allaying anxiety amongst children undergoing either hospitalization or invasive procedures What is new: • This is the first systematic review and meta-analysis on hospital clowns • We found out that hospital clowns reduce anxiety amongst children before undergoing either hospitalization or invasive procedures.
Topics: Adult; Anxiety; Child; Child, Hospitalized; Female; Hospitalization; Humans; Laughter Therapy; Pain Management; Pain Measurement; Parents; Pediatrics; Randomized Controlled Trials as Topic; Stress, Psychological
PubMed: 27605131
DOI: 10.1007/s00431-016-2764-0 -
The Canadian Journal of Neurological... Nov 2015Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in pediatrics for status epilepticus (SE) and refractory status... (Review)
Review
BACKGROUND
Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in pediatrics for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control.
METHODS
All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendations Assessment, Development, and Evaluation methodologies by two independent reviewers.
RESULTS
Overall, 20 original studies were identified, with 19 manuscripts and one meeting abstract. Two hundred and thirty-five pediatric patients were treated for 252 episodes of SE/RSE. Patients had varying numbers of antiepileptic drugs (two to eight) on board before lidocaine therapy. During 20 of the 252 (7.9%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied, with some using bolus dosing alone; others used a combination of bolus and infusion therapy. Overall, 60.0% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 57.6% and 12.3%, respectively. Patient outcomes were sparingly reported.
CONCLUSIONS
There currently exists Oxford level 2b, Grading of Recommendations Assessment Development, and Evaluation C evidence to support the consideration of lidocaine for SE and RSE in the pediatric population. Further prospective studies of lidocaine administration in this setting are warranted.
Topics: Anticonvulsants; Humans; Lidocaine; Pediatrics; Phenytoin; Prospective Studies; Seizures; Status Epilepticus
PubMed: 26303341
DOI: 10.1017/cjn.2015.278 -
Paediatric Anaesthesia Feb 2015The controversy over the benefits between normothermic and hypothermic cardiopulmonary bypass (CPB) for children is still uncertain. The purpose of this systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The controversy over the benefits between normothermic and hypothermic cardiopulmonary bypass (CPB) for children is still uncertain. The purpose of this systematic review and meta-analysis is to investigate the benefits and risks of normothermia comparing with hypothermia in pediatric cardiac surgery by randomized controlled trials.
METHODS
Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies reported in English up to September 28, 2013. Eligible studies were those in which investigators enrolled pediatric patients, who had cardiac surgery, randomized them to normothermic or hypothermic CPB. We prespecified the use of random-effects models to calculate risk ratios and 95% CIs for binary variables, weighted mean difference (WMD) or standard mean difference and 95% CIs for continuous variables. We assessed heterogeneity using I(2). When heterogeneity was absent (I(2) = 0%), we used fixed-effects models. The endpoints were serum lactate, serum creatinine, duration of clamp, and duration of CPB in pediatrics who had cardiac surgery in normothermic CPB compared with those in hypothermic CPB.
RESULTS
The initial search strategy identified 3910 citations, of which 10 trials compared pediatrics and seven trails were eligible. These seven trials included 419 participants from seven countries. The serum lactate and the serum creatinine had three time points. The outcomes had no different between normothermic group and hypothermic group. Duration of clamp (WMD = -10.793, 95% CI -28.89, 7.304; P = 0.242; I(2) = 86.6%; 204 patients, three trials) and duration of CPB (WMD = -41.780, 95% CI -89.523, 5.963; P = 0.086; I(2) = 95.6%; 199 patients, three trials) also had no significant differences between two groups.
CONCLUSION
Normothermic CPB is as safe as hypothermic CPB in children requiring correction of simple congenital cardiac defects.
Topics: Body Temperature; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Heart Defects, Congenital; Humans; Hypothermia, Induced; Pediatrics; Risk; Treatment Outcome
PubMed: 25331483
DOI: 10.1111/pan.12560 -
Pediatric Emergency Care Sep 2014Pediatric strokes lead to significant morbidity and mortality. To date, no systematic review has been available to guide the initial diagnostic approach to pediatric... (Review)
Review
CONTEXT
Pediatric strokes lead to significant morbidity and mortality. To date, no systematic review has been available to guide the initial diagnostic approach to pediatric stroke.
OBJECTIVE
The objective of this review was to elucidate the current data regarding etiologies of stroke in children and then develop an initial diagnostic evaluation for the pediatric patient presenting to the emergency department with a stroke.
DATA SOURCE
Using the PubMed engine, the MEDLINE database was searched using the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guidelines.
STUDY SELECTION
The inclusion and exclusion criteria were established a priori. Studies must have extractable data regarding first strokes in pediatric patients with clear diagnostic categories.
DATA EXTRACTION
A standardized tool was developed to extract demographic data and stroke etiologies.
RESULTS
Twelve studies were found that met the inclusion criteria. From these studies, a total of 1455 children aged between 21 days and 20 years were available to assess the etiologies of stroke.
CONCLUSIONS
In pediatric patients, the etiologies of stroke are varied and differ for children with ischemic stroke versus hemorrhagic stroke. With the present systematic review, a guide to the initial evaluation of stroke is presented.
Topics: Adolescent; Brain Ischemia; Cerebral Hemorrhage; Child; Humans; Infant; Pediatrics; Stroke
PubMed: 25186513
DOI: 10.1097/PEC.0000000000000218 -
Journal of Pediatric Nursing 2021Health diaries with both clinical and narrative elements have been widely used in pediatrics to study children's and families' experiences of illness and coping... (Review)
Review
PROBLEM
Health diaries with both clinical and narrative elements have been widely used in pediatrics to study children's and families' experiences of illness and coping strategies. The objective of this study is to obtain a synthesis of the literature about narrative health diaries using the PRISMA extension for scoping reviews.
ELIGIBILITY CRITERIA
Sources were limited to: English language; narrative diaries; children/adolescents and/or parents/caregivers.
SAMPLE
The following databases were searched: PubMed, Embase and CINAHL with no time limits.
RESULTS
Among 36 articles included the most common context where a diary was implemented was the home (61%), the hospital (17%) and the school (14%). The most common diarist is the child or adolescent (50%). Paper diary was the most common type (53%), followed by the video diary (19%), the e-diary (8%) or the audio diary (8%). None of the studies explored the impact of the use of diaries on patient outcomes.
CONCLUSIONS
The narrative health diary is used to report patient experiences of illness or common life from the point of view of the child, adolescent or other family members. The diversity of the diaries found shows how the narrative diary may be 'adapted' to different settings and pediatric populations.
IMPLICATIONS
The narrative diary is a relevant tool for the exploration of children's and adolescents' experiences of illness and common life. Studies are still needed to describe the impact of narrative diaries keeping on children's health outcomes.
Topics: Adaptation, Psychological; Adolescent; Caregivers; Child; Family; Humans; Narration; Pediatrics
PubMed: 33622642
DOI: 10.1016/j.pedn.2021.02.006 -
Experimental Dermatology May 2023Atopic dermatitis (AD) is the most common skin inflammatory disease. Dysregulation of innate and adaptive immune systems plays a major role in the pathophysiology of AD.... (Review)
Review
Atopic dermatitis (AD) is the most common skin inflammatory disease. Dysregulation of innate and adaptive immune systems plays a major role in the pathophysiology of AD. JAKi (Janus Kinase Inhibitors) reduce the production of pro-inflammatory cytokines and represent a promising novel treatment for AD. To assess and summarize the overall efficacy and safety of topial JAKi in the treatment of AD in adults and pediatrics, a broad search was performed on Ovid Medline, Ovid Embase, Cochrane Library, Web of Sciences, Scopus, CINAHL and Google Scholar until 14 June 2022. After screening, 19 studies remained for the final review. The current systematic review was conducted according to PRISMA, and the protocol was registered in PROSPERO (ID #CRD42022303321). Topical delgocitinib, tofacitinib, ruxolitinib, cerdulatinib and ifidancitinib are effective in treating AD and significantly improve EASI, IGA, pruritus-NRS score and some other indexes in adults. Moreover, topical delgocitinib was observed to have a great efficacy in the treatment of AD in paediatrics. All topical JAKi showed minimal risk of mild-to-moderate adverse effects. Available topical JAKi are effective and safe modalities in treating AD. Nevertheless, further studies with longer duration and head-to-head comparative trials are necessary to find the best option with the least adverse effects.
Topics: Humans; Adult; Child; Dermatitis, Atopic; Janus Kinase Inhibitors; Pruritus; Time Factors; Pediatrics; Treatment Outcome
PubMed: 36691705
DOI: 10.1111/exd.14753 -
Pediatrics Jun 2020To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs).
OBJECTIVE
To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs).
DATA SOURCES
Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases.
STUDY SELECTION
Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included.
DATA EXTRACTION
Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications.
RESULTS
VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope.
LIMITATIONS
Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations.
CONCLUSIONS
This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
Topics: Child; Child, Preschool; Humans; Infant; Infant, Newborn; Pediatrics; Randomized Controlled Trials as Topic; Vascular Access Devices
PubMed: 32482738
DOI: 10.1542/peds.2019-3474H -
Spine May 2017A systematic review. (Review)
Review
STUDY DESIGN
A systematic review.
OBJECTIVE
The aim of this study was to provide an evidence-based recommendation for when and how to employ imaging studies when diagnosing back pain thought to be caused by spondylolysis in pediatric patients.
SUMMARY OF BACKGROUND DATA
Spondylolysis is a common structural cause of back pain in pediatric patients. The radiologic methods and algorithms used to diagnose spondylolysis are inconsistent among practitioners.
METHODS
A literature review was performed in PubMed and Cochrane databases using the search terms "spondylolysis," "pediatric," "adolescent," "juvenile," "young," "lumbar," "MRI," "bone scan," "CT," and "SPECT." After inclusion criteria were applied, 13 articles pertaining to diagnostic imaging of pediatric spondylolysis were analyzed.
RESULTS
Ten papers included sensitivity calculations for comparing imaging performance. The average sensitivity of magnetic resonance imaging (MRI) with computed tomography (CT) as the standard of reference was 81.4%. When compared with single-photon emission CT (SPECT), the average sensitivity of CT was 85% and the sensitivity of MRI was 80%. Thirteen studies made a recommendation as to how best to perform diagnostic imaging of patients with clinically suspected spondylolysis. When compared with two-view plain films, bone scans had seven to nine times the effective radiation dose, while four-view plain films and CT were approximately double. Of the diagnostic methods examined, MRI was the most expensive followed by CT, bone scan, four-view plain films, and two-view plain films.
CONCLUSION
Due to their efficacy, low cost, and low radiation exposure, we find two-view plain films to be the best initial study. With unusual presentations or refractory courses, practitioners should pursue advanced imaging. MRI should be used in early diagnosis and CT in more persistent courses. However, the lack of rigorous studies makes it difficult to formulate concrete recommendations.
LEVEL OF EVIDENCE
3.
Topics: Back Pain; Early Diagnosis; Humans; Magnetic Resonance Imaging; Pediatrics; Radiography; Spondylolysis
PubMed: 27669047
DOI: 10.1097/BRS.0000000000001912 -
Hospital Pediatrics Jun 2021Pediatric family-centered rounds (FCRs) have been shown to have benefits in staff satisfaction, teaching, and rounding efficiency, but no systematic review has been... (Meta-Analysis)
Meta-Analysis
CONTEXT
Pediatric family-centered rounds (FCRs) have been shown to have benefits in staff satisfaction, teaching, and rounding efficiency, but no systematic review has been conducted to explicitly examine the humanistic impact of FCRs.
OBJECTIVE
The objective with this review is to determine if FCRs promote the core values of humanism in medicine by answering the question, "Do FCRs promote humanistic pediatric care?"
DATA SOURCES
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and Dissertation Abstracts for peer-reviewed pediatric studies through January 1, 2020. We used search terms including FCRs, communication, humanism, and the specific descriptors in the Gold Foundation's definition of humanism.
STUDY SELECTION
Abstracts ( = 1003) were assessed for 5 primary outcomes: empathy, enhanced communication, partnership, respect, and satisfaction and service. We evaluated 158 full-text articles for inclusion, reconciling discrepancies through an iterative process.
DATA EXTRACTION
Data abstraction, thematic analysis, and conceptual synthesis were conducted on 29 studies.
RESULTS
Pediatric family-centered rounds (FCRs) improved humanistic outcomes within all 5 identified themes. Not all studies revealed improvement within every category. The humanistic benefits of FCRs are enhanced through interventions targeted toward provider-family barriers, such as health literacy. Patients with limited English proficiency or disabilities or who were receiving intensive care gained additional benefits.
CONCLUSIONS
Pediatric FCRs promote humanistic outcomes including increased empathy, partnership, respect, service, and communication. Limitations included difficulty in defining humanism, variable implementation, and inconsistent reporting of humanistic outcomes. Future efforts should include highlighting FCR's humanistic benefits, universal implementation, and adapting FCRs to pandemics such as coronavirus disease 2019.
Topics: Attitude of Health Personnel; Child; Child, Hospitalized; Communication; Empathy; Humanism; Humans; Pediatrics; Professional-Family Relations; Teaching Rounds
PubMed: 34021029
DOI: 10.1542/hpeds.2020-000240 -
Academic Pediatrics 2015Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients.
OBJECTIVES
To summarize the efficacy of SDM interventions in pediatrics on patient-centered outcomes.
DATA SOURCES
We searched Ovid Medline, Ovid Embase, Ovid Cochrane Library, Web of Science, Scopus, and Ovid PsycInfo from database inception to December 30, 2013, and performed an environmental scan.
STUDY ELIGIBILITY CRITERIA
We included interventions designed to engage pediatric patients, parents, or both in a medical decision, regardless of study design or reported outcomes.
STUDY APPRAISAL AND SYNTHESIS METHODS
We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias assessment. Meta-analysis was performed on 3 outcomes: knowledge, decisional conflict, and satisfaction.
RESULTS
Sixty-one citations describing 54 interventions met eligibility criteria. Fifteen studies reported outcomes such that they were eligible for inclusion in meta-analysis. Heterogeneity across studies was high. Meta-analysis revealed SDM interventions significantly improved knowledge (standardized mean difference [SMD] 1.21, 95% confidence interval [CI] 0.26 to 2.17, P = .01) and reduced decisional conflict (SMD -1.20, 95% CI -2.01 to -0.40, P = .003). Interventions showed a nonsignificant trend toward increased satisfaction (SMD 0.37, 95% CI -0.04 to 0.78, P = .08).
LIMITATIONS
Included studies were heterogeneous in nature, including their conceptions of SDM.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
A limited evidence base suggests that pediatric SDM interventions improve knowledge and decisional conflict, but their impact on other outcomes is unclear.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42013004761 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013004761).
Topics: Adolescent; Child; Child, Preschool; Decision Making; Decision Support Techniques; Humans; Infant; Infant, Newborn; Patient Participation; Pediatrics; Physician-Patient Relations; Professional-Family Relations
PubMed: 25983006
DOI: 10.1016/j.acap.2015.03.011