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Journal of Pediatric Surgery Apr 2022Medical errors were largely concealed prior to the landmark report "To Err Is Human". The purpose of this systematic scoping review was to determine the extent pediatric... (Review)
Review
BACKGROUND
Medical errors were largely concealed prior to the landmark report "To Err Is Human". The purpose of this systematic scoping review was to determine the extent pediatric surgery defines and studies errors, and to explore themes among papers focused on errors in pediatric surgery.
METHODS
The methodological framework used to conduct this scoping study has been outlined by Arksey and O'Malley. In January 2020, PubMed, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Oxford Level of Evidence was assigned to each study; only studies rated Level 3 or higher were included.
RESULTS
Of 3,064 initial studies, 12 were included in the final analysis: 4 cohort studies, and 8 outcome/audit studies. This data represented 5,442,000 aggregate patients and 8,893 errors. There were 6 different error definitions and 5 study methods. Common themes amongst the studies included a systems-focused approach, an increase in errors seen with increased complexity, and studies exploring the relationship between error and adverse events.
CONCLUSIONS
This study revealed multiple error definitions, multiple error study methods, and common themes described in the pediatric surgical literature. Opportunities exist to improve the safety of surgical care of children by reducing errors. Original Scientific Research Type of Study: Systematic Scoping Review Level of Evidence Rating: 1.
Topics: Child; Humans; Medical Errors; Systematic Reviews as Topic
PubMed: 34366133
DOI: 10.1016/j.jpedsurg.2021.07.019 -
Clinical Rehabilitation Jan 2022This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation.
DATA SOURCES
Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021.
REVIEW METHODS
Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration's tool for assessing the risk of bias and PROSPERO's registration number ID: CRD42020193535.
RESULTS
Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity.
CONCLUSION
A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.
Topics: Adolescent; Cerebral Palsy; Child; Humans; Muscle Strength; Muscles; Resistance Training; Walking Speed
PubMed: 34407619
DOI: 10.1177/02692155211040199 -
Obesity Reviews : An Official Journal... Feb 2023To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood... (Meta-Analysis)
Meta-Analysis Review
To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.
Topics: Male; Female; Humans; Child; Pediatric Obesity; Overweight; Financial Stress; Health Care Costs; Health Expenditures; Cost of Illness
PubMed: 36437105
DOI: 10.1111/obr.13535 -
Healthcare (Basel, Switzerland) Jul 2020Hospitalization disrupts children's lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children's lives. Thus, it is... (Review)
Review
BACKGROUND
Hospitalization disrupts children's lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children's lives. Thus, it is necessary to ensure holistic care during the process, including play therapy. The aim of this study was to analyze the effect of therapeutic play in hospitalized children.
METHODS
A systematic review was performed. The search was conducted in CINAHL (Cumulative Index of Nursing and Allied Health Literature), CUIDEN, and PubMed (Medline). The search equation was "pediatric nurs* AND play therapy". The search was performed in March 2020.
RESULTS
= 14 studies were included in the review. The studies reveal that the application of therapeutic play in hospitalized children decreases postoperative pain, improves behavior and attitude, and reduces anxiety during the hospital stay.
CONCLUSIONS
play therapy has a beneficial impact on the care of hospitalized children and should be implemented in pediatric units after assessing the resources and training needed for pediatric nurses.
PubMed: 32751225
DOI: 10.3390/healthcare8030239 -
Journal of Dentistry Dec 2022The aim of the study was to analyze data collected from studies worldwide on the prevalence of edentulism and dental caries, in community-dwellers aged ≥ 45 years. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of the study was to analyze data collected from studies worldwide on the prevalence of edentulism and dental caries, in community-dwellers aged ≥ 45 years.
DATA
Inclusion criteria; participants aged ≥ 45 years, community-dwellers. Exclusion criteria; participants aged < 45 years, in nursing homes, data obtained from dental clinics or pre-2005. The quality assessment tool by The National Heart, Lung and Blood Institute for Observational Cohort and Cross-sectional studies was used. Meta-analysis using the random-effects model (95% confidence interval) was done with data on participants who were edentulous and/or had active dental caries and stratified by regions of the world, age and Gross National Income per capita. Limitations in the data arose from several factors such as design of the studies included differences in socioeconomic status and access to health care among different countries.
SOURCES
Embase, MEDLINE via Pubmed and Scopus, manual searches, from January 2016, restricted to English. Experts from different countries were contacted to identify National oral health surveys (NOHS) conducted from 2010 onwards.
STUDY SELECTION
Eighty-six papers and seventeen NOHS were selected for data extraction. Majority of the studies (n = 69) were cross-sectional and of fair quality. 1.1%-70%, 4.9% - 98% prevalence of edentulism and dental caries, respectively. 22%, 45% estimated random-effects pooled prevalence of edentulism and dental caries, respectively.
CONCLUSIONS
Within the limitations of this study, the findings indicate that untreated dental caries and tooth loss are prevalent on a global level with wide variations among different countries, age groups and socioeconomic status.
CLINICAL SIGNIFICANCE
The findings demonstrate the reality of the new cohort of older adults, with higher tooth retention implying more dental caries incidence and the need for different care strategies to ensure better oral health. Large variations and difficulty in making comparisons among different countries highlight the need for more standardized, regular research.
Topics: Aged; Humans; Middle Aged; Dental Caries; Dental Health Surveys; Oral Health; Prevalence; Tooth Loss; Mouth, Edentulous
PubMed: 36265526
DOI: 10.1016/j.jdent.2022.104335 -
Journal of Neurotrauma Nov 2023Traumatic brain injury (TBI) is the leading cause of death and disability in children. Many clinical practice guidelines (CPGs) have addressed pediatric TBI in the last... (Review)
Review
Traumatic brain injury (TBI) is the leading cause of death and disability in children. Many clinical practice guidelines (CPGs) have addressed pediatric TBI in the last decade but significant variability in the use of these guidelines persists. Here, we systematically review CPGs recommendations for pediatric moderate-to-severe TBI, evaluate the quality of CPGs, synthesize the quality of evidence and strength of included recommendations, and identify knowledge gaps. A systematic search was conducted in MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Web sites of organizations publishing recommendations on pediatric injury care. We included CPGs developed in high-income countries from January 2012 to May 2023, with at least one recommendation targeting pediatric (≤ 19 years old) moderate-to-severe TBI populations. The quality of included clinical practice guidelines was assessed using the AGREE II tool. We synthesized evidence on recommendations using a matrix based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We identified 15 CPGs of which 9 were rated moderate to high quality using AGREE II. We identified 90 recommendations, of which 40 (45%) were evidence based. Eleven of these were based on moderate to high quality evidence and were graded as moderate or strong by at least one guideline. These included transfer, imaging, intracranial pressure control, and discharge advice. We identified gaps in evidence-based recommendations for red blood cell transfusion, plasma and platelet transfusion, thromboprophylaxis, surgical antimicrobial prophylaxis, early diagnosis of hypopituitarism, and mental health mangement. Many up-to-date CPGs are available, but there is a paucity of evidence to support recommendations, highlighting the urgent need for robust clinical research in this vulnerable population. Our results may be used by clinicians to identify recommendations based on the highest level of evidence, by healthcare administrators to inform guideline implementation in clinical settings, by researchers to identify areas where robust evidence is needed, and by guideline writing groups to inform the updating of existing guidelines or the development of new ones.
Topics: Adult; Child; Humans; Young Adult; Anticoagulants; Brain Injuries, Traumatic; Erythrocyte Transfusion; Hypopituitarism; Venous Thromboembolism; Practice Guidelines as Topic
PubMed: 37341019
DOI: 10.1089/neu.2023.0149 -
American Journal of Respiratory and... Jan 2023Pediatric-specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical...
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document.
Pediatric-specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients' readiness for extubation. Twenty-six international experts comprised a multiprofessional panel to establish pediatrics-specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. A systematic review was conducted for questions that did not meet an threshold of ⩾80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence and drafted and voted on the recommendations. Three questions related to systematic screening using an extubation readiness testing bundle and a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ⩾80% agreement. For the remaining eight questions, five systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials, measures of respiratory muscle strength, assessment of risk of postextubation upper airway obstruction and its prevention, use of postextubation noninvasive respiratory support, and sedation. Most recommendations were conditional and based on low to very low certainty of evidence. This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.
Topics: Humans; Child; Respiration, Artificial; Ventilator Weaning; Ventilators, Mechanical; Airway Extubation; Sepsis
PubMed: 36583619
DOI: 10.1164/rccm.202204-0795SO -
Journal of Pediatric Nursing 2021The role of play in the reduction of anxiety and pain and in the improvement of behaviours and overall wellbeing in children in the field of nursing care in hospital... (Review)
Review
PROBLEM
The role of play in the reduction of anxiety and pain and in the improvement of behaviours and overall wellbeing in children in the field of nursing care in hospital settings.
ELIGIBILITY CRITERIA
Studies published during the period 2014-2019 including original articles in English, Spanish and Portuguese. Databases consulted: SCOPUS, MEDLINE/PubMed, WoS, and CUIDEN (Nursing database in Spanish).
SAMPLE
Seventeen relevant records were selected. After critical reading using the CASPe (Critical Appraisal Skills Programme in Spanish) instrument, 7 articles were rejected and 10 were finally selected.
RESULTS
Each of eight studies showed significant evidence for the role of therapeutic play in the reduction of anxiety and pain and in the overall wellbeing of paediatric patients.
IMPLICATIONS
This review aimed to critically assess and synthesize the existing empirical evidence on the contributions of therapeutic play interventions for reducing anxiety, pain and improving the overall wellbeing of paediatric patients.
CONCLUSIONS
Based on these findings, it may be safe to say that therapeutic play interventions are effective in reducing the negative emotional manifestations of children, decreasing preoperative anxiety and pain, improving compliance with the induction of anaesthesia and reducing anxiety and postoperative pain. There is also evidence that dramatic puppetry is an effective preoperative care and preparation strategy for reducing anxiety in children undergoing surgery.
Topics: Anxiety; Anxiety Disorders; Child; Emotions; Humans; Pain, Postoperative; Preoperative Care
PubMed: 33711642
DOI: 10.1016/j.pedn.2021.02.022 -
The Benefits and Burdens of Pediatric Palliative Care and End-of-Life Research: A Systematic Review.Journal of Palliative Medicine Aug 2019The aim of this study is to report the benefits and burdens of palliative research participation on children, siblings, parents, clinicians, and researchers. Pediatric...
The aim of this study is to report the benefits and burdens of palliative research participation on children, siblings, parents, clinicians, and researchers. Pediatric palliative care requires research to mature the science and improve interventions. A tension exists between the desire to enhance palliative and end-of-life care for children and their families and the need to protect these potentially vulnerable populations from untoward burdens. Systematic review followed PRISMA guidelines with prepared protocol registered as PROSPERO #CRD42018087304. MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and The Cochrane Library were searched (2000-2017). English-language studies depicting the benefits or burdens of palliative care or end-of-life research participation on either pediatric patients and/or their family members, clinicians, or study teams were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Twenty-four studies met final inclusion criteria. The benefit or burden of palliative care research participation was reported for the child in 6 papers; siblings in 2; parents in 19; clinicians in 3; and researchers in 5 papers. Benefits were more heavily emphasized by patients and family members, whereas burdens were more prominently emphasized by researchers and clinicians. No paper utilized a validated benefit/burden scale. The lack of published exploration into the benefits and burdens of those asked to take part in pediatric palliative care research and those conducting the research is striking. There is a need for implementation of a validated benefit/burden instrument or interview measure as part of pediatric palliative and end-of-life research design and reporting.
Topics: Adolescent; Adult; Attitude of Health Personnel; Biomedical Research; Child; Child, Preschool; Family; Female; Health Personnel; Humans; Infant; Infant, Newborn; Male; Palliative Care; Pediatrics; Professional-Family Relations; Qualitative Research; Terminal Care
PubMed: 30835596
DOI: 10.1089/jpm.2018.0483 -
Frontiers in Public Health 2022Pressure ulcers (PUs) are an indicator of the quality of nursing care and nurses can prevent PUs well if they have sufficient knowledge. Numerous studies in this field... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure ulcers (PUs) are an indicator of the quality of nursing care and nurses can prevent PUs well if they have sufficient knowledge. Numerous studies in this field have reported different results. The aim of this study was to estimate the pooled score of nurses' knowledge about PU prevention based on the Pressure Ulcer Knowledge Assessment Tool (PUKAT).
METHODS
In this systematic review and meta-analysis, databases including Web of Science, ScienceDirect, PubMed, and Scopus were searched. All studies published in English between 2011 and 2022 that reported the status of nurses' knowledge of PU prevention based on PUKAT were included in the analysis. Based on heterogeneity between the studies, the data were analyzed using a random effects model.
RESULTS
The pooled scores of PU prevention knowledge in nurses and nursing students were (51.5%; 95% CI: 45.8-57.2%) and (48.9%; 95% CI: 42.5-55.2%), respectively. As the age of the participants increased, the pooled score of pressure ulcer prevention knowledge increased significantly ( = 0.028). The publication bias was not significant. The highest and lowest knowledge scores in nurses and nursing students were related to the fourth dimension (nutrition) and the fifth dimension (preventive measures to reduce the amount of pressure/shear), respectively.
CONCLUSION
Knowledge of nurses and nursing students about PU prevention is insufficient. Providing regular training to nurses and including the principles of PU prevention in the curriculum of nursing students to improve their knowledge seems necessary.
Topics: Clinical Competence; Curriculum; Humans; Pressure Ulcer; Students, Nursing; Suppuration
PubMed: 36159260
DOI: 10.3389/fpubh.2022.964680