RESUMEN
BACKGROUND: Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear. OBJECTIVE: The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques. METHODS: A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children. RESULTS: From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] -2.37, 95% CI -3.20 to -1.54; Z=5.58; P<.001) and fear (IV -1.26, 95% CI -1.89 to -0.63; Z=3.92; P<.001) in children in the experimental groups. CONCLUSIONS: The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles.
RESUMEN
Objetivos: Describir el apoyo emocional y la competencia profesional percibida por las mujeres que han sufrido una pérdida por muerte intrauterina, y analizar la asociación entre la relación paciente-profesional y la intensidad del duelo y otras variables relacionadas con la pérdida. Por otra parte, se pretende conocer la existencia de variables predictoras del duelo por muerte intrauterina. Metodología: Estudio observacional, descriptivo y retrospectivo, en el que han participado 95 mujeres que tuvieron una o más pérdidas espontáneas del embarazo en los últimos 5 años. Se analizó la intensidad del duelo (adaptación española validada de la escala de duelo Perinatal Grief Scale, con puntuaciones de 16 a 80: a mayor puntuación, mayor intensidad del duelo) y la interacción con los profesionales sanitarios durante la pérdida (encuesta validada de la calidad de la atención en muerte intrauterina, con puntuaciones de 13 a 65: a mayor puntuación, mayor calidad en la atención percibida). Resultados: Un 90,5% de las mujeres presenta un duelo activo, y la media de intensidad de duelo es de 38,8 ± 9,8. La media obtenida en la interacción con los profesionales sanitarios fue de 39,2 ± 10,2. El duelo fue predicho por la interacción con el personal sanitario (R2 ajustado= 0,281), por la semana de la pérdida (R2 ajustado= 0,38) y por el tiempo transcurrido desde la pérdida (R2 ajustado= 0,409). Conclusiones: Existe una relación inversa entre la calidad de la atención percibida por las participantes durante la pérdida y la intensidad del duelo, que es la principal variable predictora del duelo en las mujeres de esta muestra. (AU)
Objectives: To describe the emotional support and professional competence perceived by women who have suffered a loss due to intrauterine death, and to analyze the association between the patient-professional relationship and the intensity of grief and other variables related to the loss. On the other hand, it is intended to know the existence of predictors of intrauterine death grief. Methodology: Retrospective descriptive observational study involving 95 women who had one or more spontaneous pregnancy losses in the last 5 years. Grief intensity was analyzed (validated Spanish adaptation of the Perinatal Grief Scale, with scores from 16 to 80 points: the higher the score, the greater the intensity of grief); and the interaction with health professionals during loss (validated survey of the quality of care in intrauterine death, with scores from 13 to 65 points: the higher the score, the higher the quality of perceived care). Results: 90,5% of the women have active grief (average grief intensity of 38.8 ± 9.8). The mean obtained in the interaction with health professionals was 39.2 ± 10.2. Grief was predicted by interaction with healthcare professionals (adjusted R2 = 0.281), by the gestational week of the loss (adjusted R2 = 0.38) and by the time elapsed since the loss (adjusted R2 = 0.409). Conclusions: There is an inverse relationship between the quality of care perceived by the participants during the loss and the intensity of grief, being this relationship the main predictor of grief in the women in this sample. (AU)