Effectiveness of hospital clowning on pediatric anxiety and pain: Network meta-analysis.

OBJECTIVE: Anxiety and pain during medical procedures may have adverse short and long-term consequences. We summarize the effectiveness of hospital clown interventions, as compared with medication, the presence of a parent, standard care, and other non-pharmacological distraction interventions on anxiety and pain in minors undergoing medical procedures. METHOD: Randomized trials were identified in PsycINFO, MEDLINE, Embase, Scopus and CINAHL, and previous reviews. Screening of titles and abstracts and full-texts, data extraction and risk of bias assessment was done by two independent reviewers. We conducted random-effects network and pairwise meta-analyses based on a frequentist framework. RESULTS: Our analyses with 28 studies showed significantly lower anxiety scores in clowning and other distraction interventions as compared with the presence of parents. No differences were observed between clowning, medication, and other distraction interventions. Clowning interventions were superior to standard care in our main analyses, but non-significant in some of the sensitivity analyses. Furthermore, clowning led to significantly lower pain as compared with presence of parents and standard care. No differences were observed between clowning interventions and the other comparators. For both outcomes, large between study heterogeneity was present but no significant inconsistency between designs. Risk of bias was mainly high and accordingly the certainty of evidence is considered moderate to low. CONCLUSIONS: We found no significant difference between medication, other non-medical distraction interventions and hospital clown interventions. Hospital clowns and other distraction interventions were more effective in reducing anxiety and pain in children undergoing medical procedures than the presence of parents alone. In order to allow for better insights regarding the comparative effectiveness of clowning interventions future trials should include detailed descriptions about the clowning intervention itself and the comparator. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Implementing organized colorectal cancer screening programs in Europe-protocol for a systematic review of determinants and strategies.

BACKGROUND: With a high mortality of 12.6% of all cancer cases, colorectal cancer (CRC) accounts for substantial burden of disease in Europe. In the past decade, more and more countries have introduced organized colorectal cancer screening programs, making systematic screening available to entire segments of a population, typically based on routine stool tests and/or colonoscopy. While the effectiveness of organized screening in reducing CRC incidence and mortality has been confirmed, studies continuously report persistent program implementation challenges. This systematic review will synthesize the literature on organized CRC screening programs. Its aim is to understand what is currently known about the barriers and facilitators that influence the implementation of these programs and about the implementation strategies used to navigate these determinants. METHODS: A systematic review of primary studies of any research design will be conducted. CENTRAL, CINAHL, EMBASE, International Clinical Trials Registry Platform, MEDLINE, PsycINFO, and Scopus will be searched. Websites of (non-)government health care organizations and websites of organizations affiliated with authors of included studies will be screened for unpublished evaluation reports. Existing organized CRC screening programs will be contacted with a request to share program-specific grey literature. Two researchers will independently screen each publication in two rounds for eligibility. Included studies will focus on adult populations involved in the implementation of organized CRC screening programs and contain information about implementation determinants/ strategies. Publications will be assessed for their risk of bias. Data extraction will include study aim, design, location, setting, sample, methods, and measures; program characteristics; implementation stage, framework, determinants, strategies, and outcomes; and service and other outcome information. Findings will be synthesized narratively using the three stages of thematic synthesis. DISCUSSION: With its sole focus on the implementation of organized CRC screening programs, this review will help to fill a central knowledge gap in the literature on colorectal cancer screening. Its findings can inform the decision-making in policy and practice needed to prioritize resources for establishing new and maintaining existing programs in the future. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42022306580).

Implementation of infection prevention and control for hospitalized neonates: A narrative review.

BACKGROUND: The most prevalent infections encountered in neonatal care are healthcare-associated infections. The majority of healthcare-associated infections are considered preventable with evidence-based infection prevention and control (IPC) practices. However, substantial knowledge gaps exist in IPC implementation in neonatal care. Furthermore, the knowledge of factors which facilitate or challenge the uptake and sustainment of IPC programmes in neonatal units is limited. The integration of implementation science approaches in IPC programmes in neonatal care aims to address these problems. OBJECTIVES: The aim of this narrative review was to identify determinants which have been reported to influence the implementation of IPC programmes and best practices in inpatient neonatal care settings. SOURCES: A literature search was conducted in PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) in May 2022. Primary study reports published in English, French, German, Spanish, Portuguese, Italian, Danish, Swedish or Norwegian since 2000 were eligible for inclusion. Included studies focused on IPC practices in inpatient neonatal care settings and reported determinants which influenced implementation processes. CONTENT: The Consolidated Framework for Implementation Research was used to identify and cluster reported determinants to the implementation of IPC practices and programmes in neonatal care. Most studies reported challenges and facilitators at the organizational level as particularly relevant to implementation processes. The commonly reported determinants included staffing levels, work- and caseloads, as well as aspects of organizational culture such as communication and leadership. IMPLICATIONS: The presented knowledge about factors influencing neonatal IPC can support the design, implementation, and evaluation of IPC practices.

A Modified Implementation Mapping Methodology for Evaluating and Learning From Existing Implementation.

When empirically supported interventions are implemented in real-world practice settings, the process of how these interventions are implemented is highly relevant for their potential success. Implementation Mapping is a method that provides step-by-step guidance for systematically designing implementation processes that fit the respective intervention and context. It includes needs assessments among relevant stakeholders, the identification of implementation outcomes and determinants, the selection and design of appropriate implementation strategies, the production of implementation protocols and an implementation outcome evaluation. Implementation Mapping is generally conceptualized as a tool to prospectively guide implementation. However, many implementation efforts build on previous or ongoing implementation efforts, i.e., "existing implementation." Learnings from existing implementation may offer insights critical to the success of further implementation activities. In this article, we present a modified Implementation Mapping methodology to be applied when evaluating existing implementation. We illustrate the methodology using the example of evaluating ongoing organized colorectal cancer screening programs in Switzerland. Through this example, we describe how we identify relevant stakeholders, implementation determinants and outcomes as well as currently employed implementation strategies. Moreover, we describe how we compare the types of strategies that are part of existing implementation efforts with those that implementation science would suggest as being suited to address identified implementation determinants. The results can be used for assessing the current state of implementation outcomes, refining ongoing implementation strategies, and informing future implementation efforts.