-
Academic Pediatrics 2020School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood,... (Review)
Review
BACKGROUND
School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism.
OBJECTIVE
Conduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes.
DATA SOURCES
PubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar.
STUDY ELIGIBILITY CRITERIA
Original research, including quasi-experimental studies, without restriction on the type of telemedicine.
PARTICIPANTS
School-aged pediatric patients with asthma and their families.
INTERVENTIONS
School-based telemedicine.
STUDY APPRAISAL AND SYNTHESIS METHODS
Two authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements.
RESULTS
Of 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality of life, health care utilization, school absences, and spirometry. Four of 7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. Five of 6 reported increases in at least one quality-of-life metric, 2 of 7 reported a decrease in at least 1 health care utilization metric, 1 of 3 showed reductions in school absences, and 1 of 2 reported improvements in spirometry measures.
LIMITATIONS
Variability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2 of 7 studies were randomized controlled trials.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
High-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only 2 comparative trials were identified, and the contribution of telemedicine to these studies' results is unclear.
Topics: Absenteeism; Asthma; Child; Humans; Quality of Life; Schools; Telemedicine
PubMed: 32446856
DOI: 10.1016/j.acap.2020.05.008 -
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 -
PloS One 2016Globally, oral diseases contribute to major disease problems and oral health disparities persistently exist amongst vulnerable population groups. Two contributory... (Review)
Review
BACKGROUND
Globally, oral diseases contribute to major disease problems and oral health disparities persistently exist amongst vulnerable population groups. Two contributory factors to these challenges are the shortage of dental practitioners and the characteristic separation between the medical and dental professions. Nurses and midwives, in particular, are in a potentially excellent position to assist in basic oral health services such as dental health education and intraoral screening. We aimed to assess the effectiveness of integrating promotion of oral health of young children and their mothers into nursing and midwifery practice.
METHODS AND FINDINGS
Seven electronic databases including CENTRAL, EMBASE, MEDLINE, GLOBAL HEALTH, CINHAL, Scopus, and Web of Science were systematically searched whereas conference proceedings and theses were retrieved via PROQUEST. Only randomized, non-randomized trials and observational studies on preventive oral health programs delivered by nurses or midwives in healthcare settings or through home visits were included. Two investigators reviewed full-text articles independently to decide on eligibility for inclusion. Quality assessment was done using Cochrane tool for risk of bias for randomized trials and Downs and Black assessment tool for all other studies. Out of 3162 retrieved records, twenty one trials on oral health interventions incorporated into standard nursing practice were reviewed. Eighteen programs reported significant positive outcomes including reduction in caries experience, better oral hygiene and dietary habits and increased rates of dental visits amongst young children as reported by their caregivers.
CONCLUSIONS
Incorporating oral health promotion into nursing practice is a promising initiative for reducing oral health disparities by contributing to a downward trend in caries experience and increased access to dental care especially amongst the poor disadvantaged communities.
Topics: Databases, Factual; Dental Caries; Feeding Behavior; Female; Health Promotion; Humans; Nursing, Practical; Oral Health; Oral Hygiene; Pregnancy
PubMed: 27880790
DOI: 10.1371/journal.pone.0166760 -
The World Allergy Organization Journal Apr 2023With an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a...
BACKGROUND AND AIMS
With an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings.
METHODS
We systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022.
RESULTS
Our search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the "Scope and Purpose" and "Rigour of Development" domains of the AGREE II instrument. Among the shortlisted CPGs, scores on the "Applicability" domain were generally low, and only 3 CPGs rated highly in the "Implementability" domain of AGREE-REX, suggesting that the majority of CPGs fared poorly on global applicability. Recommendations on maternal diet and complementary feeding in infants were mostly consistent, but recommendations on use of hydrolysed formula and supplements varied considerably.
CONCLUSION
The overall quality of a CPG for Food Allergy and Atopic Dermatitis prevention did not correlate well with its global applicability. It is imperative that CPG developers consider stakeholders' preferences, local applicability, and adapt existing recommendations to each individual population and healthcare system to ensure successful implementation. There is a need for development of high-quality CPGs for allergy prevention outside of North America and Europe.
PROSPERO REGISTRATION NUMBER
CRD42021265689.
PubMed: 37168277
DOI: 10.1016/j.waojou.2023.100770 -
Cureus Apr 2023A surgical patient post-fasciotomy presents a challenge to restore the cover of the muscle groups, and the use of the suturing dermatotraction techniques presents a... (Review)
Review
A surgical patient post-fasciotomy presents a challenge to restore the cover of the muscle groups, and the use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case-control study explored the trend of this technique, including duration of delayed primary wound closure, complications, and failure rates. A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), yielding a combined total of 820 articles between 1946 and June 18, 2022. Human studies with suturing dermatotraction techniques were included. Sixteen (16) studies reviewed met the criteria. The basic anatomy of the dermatotraction technique involves an anchor point on the skin, a material for traction, and a suture pattern. The shoelace technique was the predominant suture pattern, with staples as skin anchor material/method and silastic vessel loops as traction sling used by 11 studies. Modifications of this method included the use of intradermal Prolene sutures and pediatric catheters. The shortest duration for skin apposition was two days, and the longest was 113 days. Complications were comparable to that of surgical wounds and thus may not be attributable to the technique itself. Studies reviewed showed that superficial and early complications were more likely than deep or delayed complications. Negative pressure wound therapy (NPWT) and skin graft salvaged a few failed closures in two studies. There are varying practices of tightening rates with reports ranging from daily to every 72 hours. The rate of tightening and disease burden may account for the wide range of reported delayed primary closure. Most of the studies reviewed closed fasciotomy wounds with this technique within an average of <10 days. It is relatively cheaper, carries a low morbidity burden, and has multiple reported success in the closure of fasciotomy wounds in this review and thus should have an increased adoption as a first approach in managing fasciotomy wounds, especially in low-income countries.
PubMed: 37197103
DOI: 10.7759/cureus.37550 -
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 -
Canadian Journal of Anaesthesia =... Nov 2021To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs). (Review)
Review
PURPOSE
To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs).
SOURCES
This scoping review was conducted using PRISMA methodology. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials. Search strategies were developed with a medical librarian and revised through a peer review of electronic search strategies. All databases were searched from inception to 14 April 2020. Only full-text articles available in English were included. All identified articles were reviewed independently and in duplicate using predetermined criteria. All study designs were eligible if they reported on comfort-holding in a PICU. Data were extracted independently and in duplicate.
PRINCIPAL FINDINGS
Of 13,326 studies identified, 13 were included. Comfort-holding was studied in the context of end-of-life care, developmental care, mobilization, and as a unique intervention. Comfort-holding is common during end-of-life care with 77.8% of children held, but rare during acute management (51% of children < three years, < 5% of children ≥ three years). Commonly reported outcomes included child outcomes (e.g., physiologic measurements), safety outcomes (e.g., accidental line removal), parent outcomes (e.g., psychological symptoms), and frequency of holding.
CONCLUSION
There is a paucity of literature on comfort-holding in PICUs. This scoping review identifies significant gaps in the literature, including assessment of child-based outcomes of comfort-holding or safety assessment of comfort-holding, and highlights core outcomes to consider in future evaluations of this intervention including child-based outcomes, parent-based outcomes, and safety of the intervention.
Topics: Child; Critical Illness; Humans; Intensive Care Units, Pediatric
PubMed: 34405358
DOI: 10.1007/s12630-021-02090-3 -
Frontiers in Pediatrics 2023This systematic review aimed to evaluate the quality of clinical practice guidelines (CPGs) and recommendations for managing pain, sedation, delirium, and iatrogenic... (Review)
Review
A systematic review of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal syndrome in pediatric intensive care.
INTRODUCTION
This systematic review aimed to evaluate the quality of clinical practice guidelines (CPGs) and recommendations for managing pain, sedation, delirium, and iatrogenic withdrawal syndrome in pediatric intensive care (PICU). The objectives included evaluating the quality of recommendations, synthesizing recommendations, harmonizing the strength of the recommendation (SoR) and the certainty of evidence (CoE), and assessing the relevance of supporting evidence.
METHODS
A comprehensive search in four electronic databases (Medline, Embase.com, CINAHL and JBI EBP Database), 9 guideline repositories, and 13 professional societies was conducted to identify CPGs published from January 2010 to the end of May 2023 in any language. The quality of CPGs and recommendations was assessed using the AGREE II and AGREE-REX instruments. Thematic analysis was used to synthesize recommendations, and the GRADE SoR and CoE harmonization method was used to interpret the credibility of summary recommendations.
RESULTS
A total of 18 CPGs and 170 recommendations were identified. Most CPGs were of medium-quality, and three were classified as high. A total of 30 summary recommendations were synthesized across each condition, focused on common management approaches. There was inconsistency in the SoRs and CoE for summary recommendations, those for assessment showed the highest consistency, the remaining were conditional, inconsistent, inconclusive, and lacked support from evidence.
CONCLUSION
This systematic review provides an overview of the quality of CPGs for these four conditions in the PICU. While three CPGs achieved high-quality ratings, the overall findings reveal gaps in the evidence base of recommendations, patient and family involvement, and resources for implementation. The findings highlight the need for more rigorous and evidence-based approaches in the development and reporting of CPGs to enhance their trustworthiness. Further research is necessary to enhance the quality of recommendations for this setting. The results of this review can provide a valuable foundation for future CPG development.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274364, PROSPERO (CRD42021274364).
PubMed: 37868267
DOI: 10.3389/fped.2023.1264717 -
The Cochrane Database of Systematic... Oct 2019Persistent pulmonary hypertension of the newborn (PPHN) is a disease entity that describes a physiology in which there is persistence of increased pulmonary arterial... (Review)
Review
BACKGROUND
Persistent pulmonary hypertension of the newborn (PPHN) is a disease entity that describes a physiology in which there is persistence of increased pulmonary arterial pressure. PPHN is characterised by failure to adapt to a functional postnatal circulation with a fall in pulmonary vascular resistance. PPHN is responsible for impairment in oxygenation and significant neonatal mortality and morbidity. Prostanoids and their analogues may be useful therapeutic interventions due to their pulmonary vasodilatory and immunomodulatory effects.
OBJECTIVES
Primary objective• To determine the efficacy and safety of prostanoids and their analogues (iloprost, treprostinil, and beraprost) in decreasing mortality and the need for extracorporeal membrane oxygenation (ECMO) among neonates with PHSecondary objective• To determine the efficacy and safety of prostanoids and their analogues (iloprost, treprostinil, and beraprost) in decreasing neonatal morbidity (necrotizing enterocolitis (NEC), chronic lung disease (CLD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), length of hospital stay, and duration of mechanical ventilation) and improving neurodevelopmental outcomes among neonates with PHComparisons• Prostanoids and their analogues at any dosage or duration used to treat PPHN versus 'standard treatment without these agents', placebo, or inhaled nitric oxide (iNO) therapy• Prostanoids and their analogues at any dosage or duration used to treat refractory PPHN as an 'add-on' therapy to iNO versus iNO alone SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9), MEDLINE via PubMed (1966 to 16 September 2018), Embase (1980 to 16 September 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 16 September 2018). We also searched clinical trials databases, conference proceedings of the Pediatric Academic Societies (1990 to 16 September 2018), and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. We contacted authors who have published in this field as discerned from the reference lists of identified clinical trials and review authors' personal files.
SELECTION CRITERIA
Randomized and quasi-randomized controlled trials evaluating prostanoids or their analogues (at any dose, route of administration, or duration) used in neonates at any gestational age less than 28 days' postnatal age for confirmed or suspected PPHN.
DATA COLLECTION AND ANALYSIS
We used the standard methods of Cochrane Neonatal to conduct a systematic review and to assess the methodological quality of included studies (neonatal.cochrane.org/en/index.html). Three review authors independently assessed the titles and abstracts of studies identified by the search strategy and obtained full-text versions for assessment if necessary. We designed forms for trial inclusion or exclusion and for data extraction. We planned to use the GRADE approach to assess the quality of evidence.
MAIN RESULTS
We did not identify any eligible neonatal trials evaluating prostanoids or their analogues as sole agents in the treatment of PPHN.
AUTHORS' CONCLUSIONS
Implications for practiceCurrently, no evidence shows the use of prostanoids or their analogues as pulmonary vasodilators and sole therapeutic agents for the treatment of PPHN in neonates (age 28 days or less).Implications for researchThe safety and efficacy of different preparations and doses and routes of administration of prostacyclins and their analogues in neonates must be established. Well-designed, adequately powered, randomized, multi-center trials are needed to address the efficacy and safety of prostanoids and their analogues in the treatment of PPHN. These trials should evaluate long-term neurodevelopmental and pulmonary outcomes, in addition to short-term outcomes.
PubMed: 31573068
DOI: 10.1002/14651858.CD012963.pub2 -
JDR Clinical and Translational Research Apr 2020Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of... (Review)
Review
BACKGROUND
Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence.
OBJECTIVES
To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review.
DATA SOURCES
Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source).
STUDY ELIGIBILITY
The measure's focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author.
APPRAISAL
The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal.
SYNTHESIS
Descriptive analysis.
RESULTS
We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns.
LIMITATIONS
Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched.
CONCLUSIONS
The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted.
KNOWLEDGE TRANSFER STATEMENT
Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health-related quality of life measure they wish to use in children.
Topics: Adolescent; Child; Child, Preschool; Dental Caries; Family; Humans; Oral Health; Quality of Life
PubMed: 31238010
DOI: 10.1177/2380084419855636