Parents' self-reported experiences and information needs related to acute pediatric asthma exacerbations: A mixed studies systematic review.

Objective: To systematically review the scientific literature examining parents' experiences and information needs for the management of their child's asthma exacerbations. Methods: We searched five databases for quantitative and qualitative studies in Canada and the United States from 2002 onwards. A convergent integrated approach and the Mixed Method Appraisal Tool were used to analyze and appraise the evidence, respectively. Results: We included 84 studies (27 quantitative, 54 qualitative, 3 mixed methods). Some parents lacked confidence in recognizing or managing exacerbations. A few parents were uncertain when and where to seek medical help. The main barrier to accessing care was cost. Impacts on parents included poor sleep, distress, and lifestyle disruptions. Parents felt they lacked information and wanted education on treatments and how to recognize and manage exacerbations via education sessions, written materials, community outreach and online resources. Conclusion: Improved education for parents may help reduce parents' stress, asthma-related morbidities for children and use of urgent health services. Innovation: The development of tailored interventions and knowledge translation strategies with input from target audiences (e.g. parents, health care providers) is necessary to meet their information needs and support adherence to clinical recommendations.

Effectiveness and safety of interventions to manage childhood overweight and obesity: An Overview of Cochrane systematic reviews.

BACKGROUND: Childhood overweight and obesity are associated with adverse physical, social, and psychological outcomes. OBJECTIVES: We conducted an overview of Cochrane systematic reviews on the effectiveness and risks of interventions to treat overweight and obesity in children and adolescents. METHODS: In June 2019, we searched the Cochrane Database of Systematic Reviews for eligible reviews. The primary outcomes were change in adiposity (body mass and body mass index [BMI] z-score) and adverse events. Two reviewers screened studies and one reviewer extracted and another verified data. Two reviewers assessed methodological quality and reached consensus. Data were synthesized narratively. RESULTS: We included seven Cochrane reviews published between 2011 and 2017 containing evidence from 167 randomized controlled trials with 21,050 participants. Lifestyle and behavioural interventions more effectively reduced weight compared with no intervention, usual care, or another behavioural treatment (three reviews, low-to-moderate certainty). Parent-child lifestyle and behavioural interventions more effectively reduced BMI z-score compared with no intervention (one review, low certainty). Decision support tools for healthcare providers more effectively limited increases in BMI z-score compared with usual care (one review, moderate certainty). Pharmacologic treatments combined with behavioural modification more effectively reduced adiposity compared with placebo or usual care (one review, low certainty), but the risk of adverse events was greater than non-pharmacologic therapy. Surgical interventions (e.g., LAP-BAND) combined with behavioural modification more effectively reduced adiposity compared with behavioural modification alone (one review, low certainty). Those who underwent surgery reported a higher number of adverse events compared with those treated with lifestyle modification. CONCLUSIONS: There is low-certainty evidence that lifestyle and behavioural interventions, pharmacologic interventions, and surgical interventions are effective in weight management for children with overweight and obesity. Safety data remain lacking across all intervention modalities. Future research should focus on implementation strategies. Further, a focus on overall well-being may be more beneficial than weight management specifically.

Vitamin D supplementation to improve pregnancy and perinatal outcomes: an overview of 42 systematic reviews.

OBJECTIVE: To review the evidence to assess effectiveness of vitamin D supplementation during pregnancy and associations of serum vitamin D levels with perinatal outcomes. DESIGN: Overview of systematic reviews (SRs). DATA SOURCES: Searches conducted in January 2019: Ovid Medline (1946-), Cochrane Library databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Two reviewers independently screened titles and abstracts, and full texts using predefined inclusion criteria: SRs evaluating vitamin D supplementation in pregnant women and/or examining the association between serum vitamin D levels reporting at least one predefined perinatal outcome. Only SRs with high AMSTAR scores were analysed. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by one reviewer and checked by a second. Results were assessed for quality independently by two reviewers using GRADE criteria. RESULTS: Thirteen SRs were included, synthesising evidence from 204 unique primary studies. SRs of randomised controlled trials (RCTs) with the highest level of evidence showed no significant benefit from vitamin D in terms of preterm birth (RR 1.00 (95% CI 0.77, 1.30); high quality), pre-eclampsia (RR 0.91 (0.45, 1.86); low quality), gestational diabetes (RR 0.65 (0.39, 1.08); very low quality), stillbirth (RR 0.75 (0.50, 1.12); high quality), low birth weight (RR 0.74 (0.47, 1.16); low quality), caesarean section (RR 1.02 (0.93, 1.12); high quality). A significant difference was found for small for gestational age (RR 0.72 (0.52, 0.99); low quality). SRs of observational studies showed associations between vitamin D levels and preterm birth (RR 1.19 (1.08, 1.31); moderate quality), pre-eclampsia (RR 1.57 (1.21, 2.03) for 25-hydroxy vitamin D (25 (OH)D)<50 nmol/L subgroup; low quality), gestational diabetes (RR 1.12 (1.02, 1.22) for 25 (OH)D<50 nmol/L and RR 1.09 (1.03, 1.15)<75 nmol/L; moderate quality) and small for gestational age (RR 1.35 (1.18, 1.54)<50 nmol/L; low quality). SRs showed mixed results for associations between vitamin D and low birth weight (very low quality) and caesarean section (very low quality). CONCLUSION: There is some evidence from SRs of observational studies for associations between vitamin D serum levels and some outcomes; however SRs examining effectiveness from RCTs showed no effect of vitamin D supplementation in pregnancy with the exception of one predefined outcome, which had low quality evidence. Credibility of the evidence in this field is compromised by study limitations (in particular, the possibility of confounding among observational studies), inconsistency, imprecision and potential for reporting and publication biases.

Digital Technology Distraction for Acute Pain in Children: A Meta-analysis.

CONTEXT: Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE: To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES: Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION: Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION: Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS: There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS: Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS: Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.

Parent experiences and information needs related to bronchiolitis: A mixed studies systematic review.

OBJECTIVE: To inform evidence-based knowledge products (i.e., infographics, videos, eBooks) of relevance to parents, we systematically reviewed evidence on parent experiences and information needs related to bronchiolitis. METHODS: We searched Medline, CINAHL, PsycINFO, and ProQuest Dissertations & Theses Global, and scanned reference lists for studies published post-2000. We appraised quality in duplicate using the Mixed Methods Appraisal Tool (MMAT) and synthesized findings narratively. RESULTS: We retrieved 797 records and included 29; 14 (48%) met >50% of MMAT criteria. Studies predominantly enrolled mothers. Most reported quantitatively on hospitalization experiences (n = 9, 31%), treatments (n = 5, 17%), or respiratory syncytial virus (RSV) prophylaxis (n = 9, 31%). Ten (34%) studies reported on information needs; 3 contributed qualitative data. Parents could not always identify bronchiolitis symptoms. During hospitalization, parents endured guilt and anxiety. Mothers wanted to take an active role in their child's care but often felt uninvolved. Barriers to RSV prophylaxis included transportation, scheduling, and insurance issues. CONCLUSIONS: Evidence focused primarily on hospitalization, which parents found frightening. More information is needed on home care experiences and information preferences. PRACTICE IMPLICATIONS: Timely education and support from healthcare providers may help to alleviate parents' fears and enhance involvement in their child's care.