Search Results (181)

Background: Acute pain in children is frequently under-recognized and undertreated despite validated assessment tools and effective therapies. This systematic review aimed to synthesize recent evidence on assessment and management of acute pediatric pain. Methods: The review followed PRISMA 2020 guidelines. Clinical questions were developed using the PICO framework, and evidence certainty was assessed with GRADE. PubMed and Embase were searched for studies published from 2016 to 2025. Italian pediatric scientific societies and specialists involved in acute pediatric care contributed to the process. Results: A total of 13 studies were included. Validated pain scales showed high reliability and were associated with reduced pain scores after analgesic administration. Paracetamol and ibuprofen showed comparable efficacy for mild-to-moderate pain; evidence suggesting a modest late advantage of ibuprofen was inconsistent. Combination therapy reduced rescue analgesia in individual studies. Non-pharmacological interventions, including virtual reality, distraction, and hospital play, reduced anxiety and procedural distress, although certainty of evidence was low. Evidence on opioids was limited and did not show clear superiority over non-opioid strategies. Intranasal fentanyl appeared comparable to intravenous morphine and more feasible in emergency settings. Overall, evidence for several clinical questions remains limited, and GRADE recommendations were only possible for selected PICOs. Conclusions: Acute pediatric pain management should rely on structured assessment and multimodal strategies. Validated pain scales should be used routinely. Paracetamol and ibuprofen remain first-line treatments for mild-to-moderate pain, with possible context-specific benefits of ibuprofen or combination therapy. Non-pharmacological interventions may be useful adjuncts, especially for anxiety and procedural distress. Further high-quality studies are needed on opioids, intranasal administration, alternating regimens, and inhaled versus topical analgesia. Full article

Background/Objectives: Children with autism spectrum disorder (ASD) present unique challenges in pain assessment and management because of differences in communication, sensory processing, and pain expression, increasing the risk of pain underrecognition and inadequate treatment. This scoping review aimed to map and synthesize current evidence on pain processing, expression, assessment, and management in children with ASD, identify available pain assessment tools and interventions, and examine the contribution of individualized therapeutic environments to pain management. Methods: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science were systematically searched for studies published between January 2020 and December 2025. Search strategies combined Medical Subject Headings (MeSH) and free-text terms. Two reviewers independently screened studies extracted data using a standardized form, and synthesized findings narratively. No formal methodological quality appraisal was undertaken, consistent with PRISMA-ScR recommendations. Results: Included studies demonstrated substantial heterogeneity in pain perception and expression, with atypical behavioral responses, sensory differences, and communication difficulties frequently hindering pain recognition. Individualized, multidimensional pain assessment integrating behavioral observation, caregiver reports, and validated assessment tools was consistently supported. Sensory adaptations, tailored communication strategies, caregiver involvement, distraction techniques, and virtual reality showed potential to improve pain-related experiences and reduce procedural distress. However, evidence remained predominantly observational, methodologically heterogeneous, and limited by few psychometrically validated ASD-specific assessment instruments and the absence of standardized clinical protocols. Conclusions: Current evidence supports individualized, multidisciplinary pain assessment and management for children with ASD. Nevertheless, substantial evidence gaps remain, highlighting the need for validated ASD-specific assessment tools, standardized clinical protocols, and high-quality studies evaluating pharmacological, non-pharmacological, and technology-assisted interventions. Full article

Apert syndrome is a rare genetic disorder characterized by premature fusion of the cranial sutures, syndactyly of the extremities, and distinct craniofacial deformities. The condition results from mutations in the FGFR2 gene, which disrupt normal craniofacial growth and lead to complex functional and morphological abnormalities. Patients with Apert syndrome commonly present with stomatognathic abnormalities, which significantly affect oral function and facial development. The management of Apert syndrome requires a multidisciplinary therapeutic approach. Surgical treatment strategies are typically staged according to the patient’s age and clinical severity. Early interventions focus on cranial vault expansion procedures, such as fronto-orbital advancement and posterior vault distraction osteogenesis, aiming to relieve intracranial pressure and improve cranial morphology. During childhood and adolescence, midface advancement techniques are commonly performed to address midfacial hypoplasia and associated functional impairments. Early diagnosis and appropriate surgical planning play a crucial role in preventing complications and improving the functional, aesthetic, and psychosocial outcomes of patients with Apert syndrome. This narrative review summarizes current evidence while highlighting areas of ongoing controversy, particularly regarding surgical sequencing, orthodontic management and the integration of digital technologies into multidisciplinary care. Full article

This qualitative study, grounded in a phenomenological-interpretive design, aimed to explore university students’ experiences regarding digital hyperconnectivity, emotional well-being, and the balance between academic and personal life at a private university in Viña del Mar, Chile. The sample consisted of 18 Occupational Therapy students (mean age: 22.4 years; 61.1% female, 27.8% male, 5.6% non-binary; representing a diverse range of undergraduate academic years from second to fifth). Data were collected through individual semi-structured interviews and analyzed using open, axial, and selective coding following grounded theory guidelines, with the assistance of Atlas.ti v25 software, to identify emerging categories and establish conceptual relationships. Findings were organized into two analytical categories. The first, Experiences and perceptions of digital hyperconnectivity, portrays hyperconnectivity as a taken-for-granted everyday condition shaped by intensive device use and the predominance of social media, streaming platforms, and artificial intelligence tools; within this category, a tension emerges between recognized practical/pedagogical usefulness and distracting or compulsive patterns of use. The second, Emotional well-being and balance in academic life, highlights the impact on emotions, time management, sleep, and relationships, as well as disconnection strategies to restore balance (time limits, mental breaks, and offline activities). In conclusion, digital hyperconnectivity is significantly associated with emotional well-being and the academic-personal life balance. Students’ narratives suggest that technology can enrich learning when accompanied by regulation, media literacy, and deliberate disconnection practices. Therefore, context-sensitive institutional interventions are needed to promote conscious disconnection, digital identity education, and a pedagogical design that integrates digital tools through a critical and ethical approach. Full article

Background/Objectives: Needle-related procedures such as venipuncture are common in pediatric hospitals and are a major cause of pain, fear and distress for those affected. Despite the availability of a wide range of evidence-based support options, it is often the professionals who decide which interventions are offered. In this study, we adapted the CARD^TM (Comfort, Ask, Relax, Distract) system for needle-related procedures in hospitals. CARD^TM was originally developed to encourage children to actively participate in their vaccination process at school. It allows them to choose from numerous evidence-based interventions in the four different letter categories (C-A-R-D) to reduce pain, fear and related vaccination symptoms. Our aim was to examine perceptions of CARD^TM for needle-related procedures in a children’s hospital, including aspects of acceptability, feasibility, self-efficacy in managing fear and pain, and overall experiences. Methods: A qualitative descriptive design was used. The sample included nine children aged 10 to 15 undergoing needle-related procedures and seven nurses who performed these procedures. We conducted individual interviews and asked them about their experiences with CARD^TM. Data were evaluated using qualitative content analysis. Results: Four themes were identified: awareness of options and needs; relationship building; empowerment; and acceptability. CARD^TM helped children identify available options, prepare themselves, recognize their own needs and select strategies. CARD^TM offered a concrete framework for action that promoted participation and self-efficacy and strengthened the relationship between nurses and children. In practice, CARD^TM was perceived to be easy to implement and acceptable. Conclusions: The present findings suggest the applicability of CARD^TM for hospital needle-related procedures. Full article

Children undergoing cancer treatment face repeated, prolonged hospitalisations carrying substantial risks of psychological distress, social isolation, and impaired development. Volunteers offering structured non-medical activities are widely employed to complement professional psychosocial care in paediatric oncology settings, yet empirical evidence examining their role specifically—as distinct from professionally delivered psychosocial interventions—remains sparse. This narrative review, conducted in accordance with SANRA criteria and drawing on a structured search of PubMed, PsycINFO, and Google Scholar (2000–2025), supplemented by a targeted verification search in July 2026, synthesises the theoretical and preliminary empirical basis for volunteer involvement, critically evaluates associated clinical risks, and proposes evidence-informed recommendations for paediatric oncology clinical practice. Three theoretical frameworks provide the conceptual grounding for volunteer activities: developmental psychological models (Piaget; Erikson), stress and coping theory (Lazarus and Folkman), and the biopsychosocial model (Engel). Indirect empirical evidence—derived predominantly from professionally delivered interventions—supports short-term benefits of structured distraction, play, and social activities on procedural anxiety, pain experience, and sense of social inclusion; the sole study examining volunteer-facilitated activities specifically in paediatric oncology reported meaningful reductions in distress and high family satisfaction. Eight categories of clinical risk are identified, including physical and psychological overload, erosion of child autonomy, suppression of authentic emotional expression, and inadequate coordination with healthcare staff. Six practice recommendations are proposed, centred on a working definition of the volunteer role, mandatory pre-access training, genuine individualisation including cultural adaptation, multidisciplinary-team-led coordination, and structured programme evaluation. Volunteer involvement can meaningfully complement professional psychosocial care when delivered within a structured, supervised, and multidisciplinary-team-coordinated framework. The paediatric oncology team occupies a pivotal role in realising the potential benefits while safeguarding children from associated risks. Prospective research employing standardised volunteer programme definitions and validated child-reported outcome measures is urgently needed to build an evidence base commensurate with the clinical importance of this practice. Full article

Background and Aims: Rapid digital transformation has generated pervasive attentional disruption in research and professional settings, raising the question of how the temporal conditions that support deep scientific thinking can be preserved. Our narrative review aimed to (i) synthesize neurobiological evidence on the mechanisms through which task-irrelevant digital interruption impairs deep thinking; (ii) discuss the conditions required for deep thinking and the potential threats posed by contemporary developments, including generative artificial intelligence-related cognitive offloading; and (iii) elaborate evidence-based, multi-level recommendations for research institutions. Methods: Targeted searches of PubMed, Google Scholar, and Web of Science (January 2010–September 2025) were conducted using terms spanning attentional neuroscience, digital distraction, neuroplasticity, and cognitive performance, supplemented by forward and backward citation tracking. Peer-reviewed empirical studies, meta-analyses, and theoretical frameworks addressing neurobiological mechanisms of sustained attention and the cognitive effects of digital interruption in professional and/or research settings were included. Results and Interpretation: Deep thinking and protected thinking time are treated as distinct constructs: the former as a sustained, integrative cognitive process supported by coordinated executive control and default mode network activity, the latter as uninterrupted temporal intervals within which that process can occur. Repeated engagement with task-irrelevant digital stimuli is associated with cortico-striatal strengthening and prefrontal-parietal under-consolidation, producing a plasticity paradox in which attentional fragmentation becomes self-reinforcing. The emergence of generative artificial intelligence introduces a qualitatively distinct threat through voluntary cognitive offloading, which reduces deep engagement independently of attentional distraction. Conclusions: Evidence-based strategies spanning individual, team, organizational, technological, and assessment levels are available to preserve protected thinking time. Direct evidence linking these intervals to specific research-impact outcomes remains limited, and institutional interventions should be prospectively evaluated. Full article

Background: Virtual reality (VR) is a promising technology for the relief of physical and psychosocial burdens. We found that individualised VR videos were well tolerated and accepted and seemed to have a stronger effect on well-being and emotional connection than standardised VR in cancer inpatients under palliative care. For implementation, it is important to actively involve patients, as their input helps to ensure that the VR intervention meets their needs, thus making it more likely to be accepted and effective in practice, while balancing the needs of healthcare professionals. Aim: Exploration of patients’ and healthcare professionals’ perspectives on best practice VR intervention implementation. Design: Workshop-based 360° focus group using a strengths–weaknesses–opportunities–threats (SWOT) model and deductive/inductive qualitative analysis with a ‘framework’ approach. Setting/participants: The focus group took place at the National Centre for Tumour Therapy of a German university hospital. Participants were a local doctor (1) and nurses (3) with VR experience, the cooperating patient advisory board of the study (2), and members of a regional self-help group (3). Results: Eighteen subthemes were identified in the SWOT model. While there was agreement on the ‘strength of distraction’ and ‘opportunities of individualised VR’, concerns remained regarding data protection when using private VR content. There was an argument about gatekeeping by relatives worried about mental distress in patients immersing in home or family VR scenes. In contrast, many ideas were discussed regarding how to overcome rejectionist staff attitudes. However, the high organisational time and staff deployment were addressed as major weaknesses. Conclusions: Involving patient stakeholders and healthcare professionals in the planning of the implementation strategy revealed several issues that require attention. In particular, information needs to be provided not only to patients but also to relatives and hospital staff, alongside ensuring data protection and adequate staffing. Trial registration: Registered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11 July 2023. Full article

Pediatric phlebotomy is a common invasive procedure frequently associated with pain, anxiety, and fear, which may negatively affect children’s cooperation and overall healthcare experiences. Virtual reality (VR) has emerged as a promising non-pharmacological intervention capable of providing immersive distraction and emotional engagement during painful medical procedures. The aim of this systematic review was to evaluate the effectiveness of immersive VR in reducing pain perception and anxiety-related outcomes among pediatric patients undergoing phlebotomy procedures. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question was developed using the PICO framework. Randomized controlled trials and comparative controlled studies published between January 2020 and September 2025 were identified through systematic searches of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies involving children and adolescents aged 4–17 years undergoing phlebotomy or venipuncture procedures were eligible for inclusion. A total of six studies comprising 557 pediatric participants were included in the review. The VR interventions involved immersive and interactive environments, including educational simulations, animated scenarios, and game-based experiences delivered through head-mounted displays. Four studies reported statistically significant reductions in pain and/or anxiety among participants exposed to VR compared with control groups, whereas two studies found no significant differences. Across the included studies, VR interventions were generally well accepted by children, parents, and healthcare professionals, with only mild and transient adverse effects reported. However, substantial heterogeneity was observed regarding clinical settings, VR technologies, intervention protocols, and outcome assessment methods. The current evidence suggests that immersive VR is a promising adjunctive strategy for reducing pain and anxiety during pediatric phlebotomy procedures. Nevertheless, the available evidence remains limited by methodological heterogeneity and relatively small sample sizes. Future research should focus on larger, well-designed randomized controlled trials using standardized intervention protocols and outcome measures to support evidence-based implementation of VR in pediatric clinical practice. Full article

The transition to university is a critical period of academic, social, and emotional adjustment. Social media plays a central yet complex role, offering opportunities for connection while also posing risks to wellbeing, productivity, and social integration. This study explores how first-year undergraduates experience and interprets their social media use during this transition. Using a constructivist grounded theory approach, nine focus groups were conducted with 40 first-year students at a UK university. Analysis generated a model conceptualising social media as a ‘double-edged sword’ within the broader social transition. Five interrelated themes were identified: social transition, polarised attitudes, quality of social connection, wellbeing support, and quantity and form of use. Social media supported early connection-building, maintaining peer ties, and accessing support, yet excessive or passive use intensified social comparison, fear of missing out, and academic distraction. Students recognised problematic use themselves, often prompting peer intervention to restore balance. Form, purpose, and perceived impact shaped experiences more than time spent. Findings highlight the importance of student agency, peer networks, and institutional support, offering implications for promoting healthy social media practices, wellbeing, and smoother transitions to university life. Full article

Background: Vertebral column resection (VCR) has historically been recognized as the most efficacious corrective intervention for severe rigid spinal deformities. Nevertheless, advancements in preoperative optimization, staged corrective methodologies, osteotomies, and contemporary instrumentation have broadened the spectrum of therapeutic options available. The definitive role of VCR in the modern management of rigid congenital spinal deformities remains a topic of ongoing scholarly discourse. Methods: This study presents two illustrative cases of severe congenital spinal deformities that were addressed employing various surgical methodologies, alongside a comprehensive review of the current literature pertaining to VCR and less invasive alternatives, including halo-gravity traction (HGT), temporary internal distraction techniques, pedicle subtraction osteotomy (PSO), asymmetric pedicle subtraction osteotomy (APSO), and multi-rod constructs. Results: The cases elucidated herein underscore the necessity for treatment strategies to be tailored specifically to the characteristics of the deformity, its flexibility, the neurological risks involved, and the individual patient’s specific attributes. In one case, significant deformity correction achieved via preoperative HGT facilitated successful management through multilevel Ponte osteotomies and posterior spinal fusion, thereby obviating the need for VCR. In other patient suffering from severe rigid congenital kyphotic deformity with pronounced anterior column deficiencies, VCR was deemed essential to realize adequate correction and neural decompression. All patients exhibited substantial radiographic correction, enhancements in health-related quality-of-life metrics, diminished disability and pain, while maintaining correction without neurological complications or implant failure at the final follow-up evaluation. Conclusions: VCR continues to be a vital element within the surgical repertoire for the treatment of severe rigid spinal deformities; however, it should not be deemed obligatory in every instance. Diligent preoperative evaluation, staged correction methodologies, and less invasive osteotomy techniques may permit satisfactory correction while mitigating surgical morbidity in suitably selected patients. Treatment approaches should be customized, favoring the least invasive procedure capable of achieving safe and lasting correction whenever practicable. Full article

Investigating the predictors of moral distress is particularly important for protecting nurses’ mental health and professional satisfaction, thereby preventing burnout and attrition from the profession. The primary aim of this study was to evaluate the predictors of moral distress among nurses. A cross-sectional study design was used. The sample consisted of 412 nurses from 11 hospitals across Slovakia. The mean age of the respondents was 40.48 years (SD = 10.92). Moral distress was assessed using the Modified Moral Distress Scale. Linear regression analysis was used to evaluate predictors of moral distress. Personal accomplishment, the maladaptive coping strategy of self-distraction, continuous shift operation, and emotional burnout emerged as significant predictors of the frequency of moral distress among nurses (AdjR² = 15.5%; R² = 0.155). Regarding the intensity of moral distress, significant predictors included personal accomplishment, the maladaptive strategy of self-distraction and the adaptive strategy of religiosity and spirituality (AdjR² = 14.0%; R² = 0.140), which appear to function as adaptive coping mechanisms for dealing with the intensity of moral distress. Systematic investigation of predictors of moral distress among nurses may contribute to the development of interventions and programs that support nurses, thereby improving not only their job satisfaction but also the quality of patient care. Full article

Surgical trauma triggers a complex metabolic and inflammatory response that can profoundly affect patient recovery and clinical outcomes. The magnitude of this stress response correlates with surgical complexity, patient comorbidities, and baseline nutritional status. Immunonutrition refers to the strategic use of specific nutrients, including arginine, glutamine, omega-3 polyunsaturated fatty acids, and nucleotides, to modulate immune and inflammatory responses beyond their basic nutritional value. These pharmaconutrients possess distinct immunomodulatory properties that may attenuate surgical stress responses, enhance immune function, and improve clinical outcomes. While numerous randomized controlled trials and meta-analyses have been conducted over the past several decades, significant methodological heterogeneity, variable product compositions, inconsistent administration protocols, and divergent patient populations complicate the interpretation of findings. Recent well-designed investigator-initiated trials without industry funding have failed to demonstrate benefits, raising questions about the validity of earlier positive findings and challenging current guideline recommendations. The evidence base reveals promising signals of benefit in selected populations combined with substantial limitations. Available evidence suggests that immunonutrition may be most beneficial in severely malnourished patients undergoing major gastrointestinal surgery, particularly when administered perioperatively or postoperatively, though the certainty of this evidence remains moderate at best, given the methodological limitations in the existing literature. From an economic perspective, immunonutrition may represent a dominant intervention in appropriate patient populations, though cost-effectiveness estimates derive primarily from older studies with methodological limitations. However, focus on specialized immunonutrition should not distract from fundamental perioperative nutritional care, including systematic risk screening, optimization when feasible, early postoperative feeding, and achievement of adequate protein and calorie targets. Only through methodologically rigorous research addressing fundamental questions can the promise of perioperative immunonutrition be fully realized. Full article

Background: Working memory is essential for college students’ academic success, yet modern sedentary and digitally distracted lifestyles threaten cognitive health. This network meta-analysis compared the effectiveness of six exercise modalities on working memory in this population. Methods: Following PRISMA-NMA guidelines (PROSPERO: CRD420261331066), we systematically searched PubMed, Web of Science, Embase, Cochrane Library, SPORTDiscus, and CNKI for randomized controlled trials up to 13 February 2026. The primary outcome was reaction time on working memory tasks. We used frequentist random-effects network meta-analysis in Stata 18.0. Results: Thirty-five trials (2314 participants) were included. Compared to controls, significant benefits were found for aerobic exercise (SMD = −0.63, 95% CI: −0.94 to −0.32), mixed-modal training (SMD = −0.59, 95% CI: −0.92 to −0.26), HIIT (SMD = −0.56, 95% CI: −0.96 to −0.16), and resistance training (SMD = −0.48, 95% CI: −0.82 to −0.14). Ball sports and cognitive training showed no significant effects. HIIT and mixed-modal training ranked highest (SUCRA 80.3% and 76.0%). Chronic interventions (≥4 weeks) yielded larger effects than acute protocols. Direct comparisons among effective modalities revealed no significant differences. Conclusions: Aerobic-dominant exercise interventions were associated with moderate working memory improvements in college students, though the optimal type remains uncertain pending further comparative trials. Full article

Background: Peripheral venous cannulation is one of the most common clinical procedures, yet it often causes significant pain, anxiety, and discomfort for patients. While pharmacological methods exist, non-pharmacological interventions offer a low-cost, low-risk alternative that eliminates waiting times for anesthetic onset. The aim of this review is to synthesize the various nonpharmacological interventions for procedural pain reduction during PIVC in adults, covering interventions ranging from psychological distraction to advanced procedural support technologies. Methods: A systematic review was conducted following PRISMA 2020 guidelines and the Joanna Briggs Institute (JBI) framework. Databases including PubMed, CINAHL, Web of Science, and Scopus were searched for studies published between 2015 and 2025. Inclusion criteria focused on randomized controlled trials (RCTs) and quasi-experimental studies involving adult patients undergoing PIVC. Results: Thirty studies (29 randomized controlled trials and one experimental study) were included in the final analysis. The interventions were categorized into three primary groups: distraction techniques, physical methods, and behavioral techniques. The application of virtual reality (VR), optical illusion cards, and music therapy significantly reduced pain scores and enhanced patient satisfaction. Similarly, physical methods, such as thermomechanical stimulation (e.g., the Buzzy^® device), local heat application, and vibration, were found to be effective in lowering pain intensity compared to standard care. Behavioral techniques, including the “cough trick,” diaphragmatic breathing, and the Valsalva maneuver, consistently demonstrated efficacy in reducing both procedural pain and anxiety. Notably, while most interventions successfully reduced pain, certain methods—such as near-infrared (NIR) vein visualization—improved procedural success rates without significantly altering the subjective perception of pain. Conclusions: Findings from this review suggest that non-pharmacological interventions may serve as effective, safe, and feasible adjuncts for pain management during peripheral venous cannulation. Techniques such as the cough trick and vibration-based devices are particularly recommended due to their ease of integration into routine nursing practice, potentially improving patient comfort and clinical outcomes. Full article