Clown therapy for procedural pain in children: a systematic review and meta-analysis.

Among the distraction techniques used for the non-pharmacological management of acute pediatric pain, one of the most performed is clown therapy. Despite the presence in the literature of some systematic reviews that evaluate its effectiveness, none of them examines its outcomes on procedural pain which has therefore been investigated in this study. The literature search for randomized controlled trials (RCTs) was performed on the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus over a time frame ranging from each database setup date to 31 July 2021. The primary outcome was the procedural pain of children. We used the Cochrane Risk of Bias tool to assess the risk of bias of the included studies. Six RCTs were selected for this review, which included a total of 517 pediatric subjects. Children undergoing clown therapy during the venipuncture or peripheral vein cannulation procedure reported less pain than those exposed to the standard of care (SMD = -0.55; 95% CI: -1.23, 0.13) but the result was not found to be statistically significant. School-aged children and adolescent reported significantly less pain (SMD = -0.51; 95% CI: -0.92, -0.09). Compared to the standard of care, children's anxiety was significantly lower with clown therapy (SMD = -0.97; 95% CI: -1.38, -0.56). CONCLUSION: Clown therapy seems effective in reducing procedural pain in children, particularly for older age groups, but due to poor methodological quality and the high risk of bias of the studies included, the results obtained should be considered with caution. WHAT IS KNOWN: • Clown therapy is one of the most used techniques in the non-pharmacological management of acute pediatric pain. • Laughter physiologically stimulates the production of beta-endorphins, substances with an effect similar to opiates. WHAT IS NEW: • Clown therapy seems effective in reducing procedural pain and anxiety in children. • The intervention in school-age children or adolescents produces a statistically significant decrease in the symptom.

Development of the palliative care referral system: proposal of a tool for the referral of cancer patients to specialized palliative care.

BACKGROUND: Early palliative care (PC) has shown beneficial effects for advanced cancer patients. However, it is still debated what criteria to use to identify patients for PC referral. AIM: To document the initial steps of the development of the Palliative Care Referral System (PCRS), a tool to be used by oncologists in clinical practice. METHODS: A multiprofessional working group developed the PCRS based on the results of a scoping literature review on PC referral criteria. PCRS criteria were evaluated by experts via a nominal group technique (NGT). Descriptive statistics were used to summarize expert scores on relevance, appropriateness and perceived feasibility of the criteria proposed. Quotations of participants during the discussion were also reported. RESULTS: Sixteen studies, including PC referral criteria/tools, emerged from the scoping review. Severe symptoms, poor performance status, comorbidities and prognosis were the most commonly used criteria. The PCRS included nine major criteria and nine assessment methods; a scoring procedure was also proposed. Answers to the questionnaire during the NGT showed that five criteria reached full agreement on all items, while four did not, and were then discussed within the group. Participants agreed on the relevance of all criteria and on the appropriateness of methods proposed to assess most of them, while issues were raised about potential feasibility of the overall assessment of the PCRS in clinical practice. CONCLUSION: The PCRS has been developed as an help for oncologists to timely identify patients for specialized PC referral. Since feasibility emerged as the main concern, implementation strategies have to be tested in subsequent studies.

[Synopses of systematic reviews on effectiveness of heparin to prevent occlusion in central venous access devices]. / Sinossi di revisioni sistematiche sull'efficacia dell'eparina per prevenire le occlusioni nei dispositivi di accesso venoso centrale.

INTRODUCTION: Prevention of central venous access devices (CVAD) occlusion is crucial to the continuity and quality of care. There is wide consensus on the need to carry out a periodic flushing of the lumen of device in order to ensure its patency. The most commonly used solutions are the heparin solution (HS) and the physiological solution (NaCl 0.9% - PS). There are still controversial opinions on HS's effectiveness over PS. OBJECTIVE: To evaluate the effectiveness of HS compared to PS to prevent occlusion in CVAD. METHODS: A search strategy on four electronic databases (The Cochrane Library, Medline, Embase, CINAHL) was implemented on April 4, 2017. Records returned were independently analyzed; those complying with inclusion criteria were found in full text. They've been included systematic reviews of RCT or quasi-experimental studies that have compared the use of HS with PS. The quality assessment of reviews was done with AMSTAR checklist. RESULTS: Seven moderate-high quality systematic reviews met inclusion criteria. HS is was not superior to PS in preventing CVAD occlusions. DISCUSSION: Reviews included were of high quality methodological. The statistical heterogeneity between RCT was low while the clinical and methodological heterogeneity was high. CONCLUSIONS: HS was no longer effective than PS to prevent CVAD occlusions. Waiting for better quality studies to evaluate the overall DAVC management process, it seems reasonable to recommend using PS.

[Effectiveness of blood pressure home monitoring. Synopsis of systematic reviews.] / Efficacia del monitoraggio domiciliare della pressione arteriosa. Sinossi di revisioni sistematiche.

INTRODUCTION: Home blood pressure monitoring (HmBPM) is as a valuable and useful tool for hypertension management; some uncertainties remain about benefits of intervention in clinical practice. OBJECTIVE: To assess the effects of home blood pressure monitoring on blood pressure values. METHODS: A search on the following databases The Cochrane Library, Medline, CINAHL, Embase, Web of Science was carried out on January the 12 2016 . The records retrieved were analysed independently and those which met the inclusion criteria were gathered as full text. In the synopsis were included only systematic reviews with meta-analysis of Randomised Controlled Trials comparing home blood pressure monitoring with ambulatory (ABPM) or hospital (HsBPM) blood pressure monitoring. AMSTAR checklist was used to evaluate reviews quality while for comparing meta-analysis it was proceeded to index of Higgins I2 analysis. RESULTS: Five systematic reviews met inclusion criteria. The overall methodological quality of included studies was high. Range of I2 was equal to 37%-72% (moderate to high heterogeneity). Compared to ABPM, HsBPM or standard of care, HmBPM was associated with moderate but statistically significant reduction in systolic blood pressure (weighted mean difference from -2.50 mmHg to -4.25 mmHg) and diastolic blood pressure (weighted mean difference from -1.45 mmHg to -2.37 mmHg). DISCUSSION: The reduced size of HmBPM effect results in a moderate benefit in clinical practice. Potential advantages on blood pressure control are dependent on patient ability to perform and interpret HmBPM results as well as health professionals to use recorded data to introduce or modify drug therapy and improve the overall compliance to antihypertensive treatment. CONCLUSIONS: HmBPM is more effective in reducing systolic and diastolic blood pressure compared to other interventions but the clinical significance of its effect is moderate.

[Is repositioning regimen effective to prevent pressure injuries? Synopsis of systematic reviews.] / Il regime di riposizionamento è efficace per la prevenzione di lesioni da pressione? Sinossi di revisioni sistematiche.

INTRODUCTION: Repositioning regimen is an intervention recommended by guidelines and traditionally used in daily care practice but its benefit for preventing pressure injuries (PI) is not clinically proved. OBJECTIVE: To determine the effect of repositioning regimen to prevent PI. METHODS: A research on five electronic databases (The Cochrane Library, Medline, Embase, CINAHL, Web of Science) was conducted on March 23, 2017. Records returned by the search strategy were independently analyzed and those that respected inclusion criteria have been found in full text. In synopsis have been included systematic reviews of controlled clinical trials or quasi-experimental studies that compare repositioning regimen with usual care. The AMSTAR checklist has been used for quality evaluation. RESULTS: Five systematic reviews met inclusion criteria. The methodological quality of included studies have been very heterogeneous. Compared to usual cares, intervention is not associated with a statistically significant reduction of PI. DISCUSSION: A few and small available studies do not allow to ascertain a benefit from the intervention, if any. At the moment, the application of an individualized repositioning regimen seems a reasonable solution. Further researches are needed to confirm that a more frequent repositioning and a 30° lateral decubitus intake help to prevent PI. It is also necessary to evaluate the economic impact, the acceptability and risks associated with the intervention. CONCLUSION: It is still unclear the role of repositioning regimen to prevent PI.

Characterizing Different Multidisciplinary Team Models Implemented Within One Comprehensive Cancer Center.

Background: The multidisciplinary approach is considered "best practice" in oncology. Multidisciplinary Teamwork (MDTW) can be broadly classified into Multidisciplinary Team Meetings (MDTM) and Multidisciplinary Cancer Clinics (MDCC; involving also patients), yet both models are heterogeneously implemented. Purpose: This study aims at describing the different MDTW implemented models in a Comprehensive Cancer Center. Methods: All clinical unit directors of the hospital were contacted to identify any MDTW activities the personnel of the unit were involved in. Structured interviews were carried out to collect MDTWs information, ie, type (MDTM vs MDCC), team composition, aims, disease phase, use of Patient Reported Outcome Measures (PROMs). Descriptive analyses and Social Network Analysis (SNA) were performed. Results: Among 38 structured interviews, 25 concerned MDTMs and 13 in MDCCs. Responders were mainly surgeons (35%) and oncologists (29%), 35% of them were team leaders. Teams were mostly composed of physicians only (64% in MDTMs, 69% in MDCCs). Case managers (8% and 31%), palliative care specialists (12% and 23%) and psychologists (20% and 31%) were involved to a lesser extent, mainly when dealing with advanced disease. MDTWs were mainly aimed at integrating the skills of the different specialists (respectively 72% for MDTMs and 64% for MDCCs) and offering the best overall patient care pathway (64%, 61.5%). MDTWs were directed at patients in both diagnostic (72%, 61.5%) and locally advanced/metastatic (32%, 38.4%) disease. PROMs were seldom used (24%, 23%). SNA shows a similar density in the two MDTWs, but in the MDCCs two nodes remain isolated (pathologists and radiologists). Conclusion: Despite a high number of MDTWs for advanced/metastatic disease, there is limited involvement of palliative care specialists, psychologists, and nurses.

Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol.

INTRODUCTION: Early palliative care (PC) in the clinical pathway of advanced cancer patients improves symptom control, quality of life and has a positive impact on overall quality of care. At present, standardised criteria for appropriate referral for early PC in oncology care are lacking. The aim of this project is to develop a set of standardised referral criteria and procedures to implement appropriate early PC for advanced cancer patients (the palliative care referral system, PCRS) and test its impact on user perception of quality of care received, on patient quality of life and on the use of healthcare resources. SETTING: Selected oncology clinics and PC outpatient clinic. METHODS AND ANALYSIS: A scoping literature review and an expert consultation through a nominal group technique will be used to revise existing referral tools and to develop a new one, the PCRS. 25 patients will be enrolled in a pilot study to assess feasibility of the implementation of PCRS; 10 interviews with patients and healthcare professionals will be carried out to evaluate applicability.A pretest-post-test quasiexperimental study involving 150 patients before implementation of the PCRS and 150 patients after implementation will be carried out.Patient satisfaction with care received, quality of life and use of resources, and caregiver satisfaction with care will also be assessed to explore the impact of the intervention. ETHICS AND DISSEMINATION: Ethical approval for the study has been granted by the Institutional Review board of the Fondazione IRCCS Istituto Nazionale Tumori; approval reference INT201/19.Results will be disseminated through open access publications and through scientific communication presented at national and international conferences. TRIAL REGISTRATION NUMBER: NCT04936568.