Sleep Patterns, Pain, and Emotional Functioning in Youth with Inflammatory Bowel Disease.

Objective: Youth with inflammatory bowel disease (IBD) may be at increased risk for sleep difficulties due to the painful and inflammatory nature of their disease. Moreover, children and adolescents with IBD experience impairment across a variety of psychosocial domains. However, researchers have yet to investigate the complex interplay between sleep, disease-related symptoms, and psychosocial factors in this population. The purpose of this study was to examine sleep patterns, pain, and mood in pediatric IBD. Methods: A sample of 25 children and adolescents with IBD (Mage = 14.24, Range = 10-18 years; 56% male) were recruited from a pediatric gastroenterology clinic. Youth wore an actigraphy watch and completed daily measures of affect and pain over the course of 14 days. Statistical analyses involved repeated measures general estimating equations. Results: No significant association for sleep with negative affect was demonstrated. Despite majority of this sample being in disease remission, results revealed that increased sleep onset latency was associated with presence of next day pain and pain was associated with better next night sleep efficiency. Conclusions: Findings of the current study suggest youth with IBD experience poor sleep quality, which is significantly related to the pain they experience. Consequently, healthcare providers should screen for and address sleep quality to optimize outcomes in their pediatric patients. Objectively assessing sleep patterns (e.g., actigraphy) may prove useful for pediatric IBD samples; however, additional research is needed to determine actigraphy's feasibility and efficacy in assessing sleep patterns in real world settings (e.g., pediatric medical clinics).

Implementation of a Psychosocial Screener for Adults in an Outpatient Burn Clinic.

Burn injuries are significant medical traumas often resulting in substantial psychosocial distress. Early identification of psychosocial concerns is crucial to developing individualized treatments to improve psychosocial functioning. Few studies have examined the prevalence of a broad range of psychosocial concerns in an adult outpatient burn setting. In this study, they developed and implemented a screening instrument to identify patients experiencing acute psychosocial distress/risk and patients with mental health difficulties necessitating a psychology consult. The instrument assessed depression, anxiety, substance abuse, posttraumatic stress, perceived safety at home, and suicidal ideation. Adult patients (N = 178) completed the screener during an initial outpatient clinic visit. Responses on the screener were used to identify patients as "high risk" (ie, endorsing suicidal ideation and/or feeling unsafe at home), "moderate risk" (ie, endorsing no-acute mental health symptoms), or "low risk" (ie, few to no symptoms endorsed). Patients in the "high risk" category were immediately evaluated by the attending physician, who then determined whether emergency treatment was needed. Patients in the "moderate risk" category were referred to the on-site psychology team for in-person or phone consultation within 3 days of screener completion. Of the 178 individuals screened, a majority endorsed low to no psychosocial distress (N = 124; 69.7%). About one-third (N = 52) indicated moderate levels of psychosocial distress, and two patients (1.1%) endorsed acute psychosocial distress. This novel screening tool was effectively implemented in an outpatient burn clinic and demonstrates considerable promise for identifying psychosocially vulnerable patients in an adult burn survivor population.

Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care.

Burn care often involves procedures that result in significant pain experiences for patients which, in turn, can lead to poorer physical and psychological health outcomes. Distraction and virtual reality (VR) are an effective adjunct to pharmacological interventions in reducing pain. Much of the research that has demonstrated efficacy for VR in burn care has involved expensive and extensive technology. Thus, identifying cost-effective, feasible, acceptable, and effective approaches to apply distraction within routine burn care is important. The objective of this mixed-methods study was to evaluate key stakeholder (i.e., patients, providers) perceptions of feasibility, acceptability, and effectiveness for the use of low-cost VR technology during routine burn care with adult patients. Ten adult patients used VR during burn care dressing changes in an outpatient clinic setting, after which they completed a satisfaction survey and individual qualitative interview. Providers also completed a satisfaction/perception survey after each participant's care. Quantitative and qualitative results from both patient and provider perspectives consistently supported the feasibility and utility of applying low-cost VR technology in this outpatient burn clinic setting. Special considerations (e.g., aspects to consider when choosing an apparatus or application) stemming from stakeholder feedback are discussed.