Pediatric Headache Management and Use of the PedMIDAS.

BACKGROUND: Headache is a worldwide problem affecting people of all ages, races, and incomes. Childhood headache is a common condition affecting quality of life and prompting frequent medical visits. The Pediatric Migraine Disability Assessment tool (PedMIDAS) is a validated questionnaire recognized in the assessment of pediatric headache. Use of the PedMIDAS is supported in the 2014 American Academy of Neurology headache quality measurement set, which provides practice parameters for headache management. OBJECTIVE: The purpose of this quality improvement project is to introduce the PedMIDAS into the assessment of pediatric headache patients in a pediatric neurology practice in an attempt to standardize care and discern provider satisfaction. METHODS: Chart review (11-21-16 to 11-30-17) following provider/staff education regarding the PedMIDAS. RESULTS: The PedMIDAS was completed 23% of the time (404/1741). CONCLUSIONS: Although the PedMIDAS was only completed 23% of the time, providers surveyed regarding usefulness indicated the PedMIDAS is helpful with quantifying the disability experienced by pediatric headache patients. IMPLICATIONS FOR NURSING: Assessing disability through the use of the PedMIDAS is a beneficial practice change helping with evaluating headache interventions, differentiating headache frequency from disability, and clarifying the severity of pain related to headache that affects daily life.

Preprocedural distress in children with cancer: an intervention using biofeedback and relaxation.

Children diagnosed with cancer experience many invasive procedures throughout diagnosis and treatment of their disease. These procedures, oftentimes a source of distress in children, can elicit a variety of anticipatory symptoms prior to the actual procedure. Although there have been efforts to develop approaches to alleviate this distress through use of distraction, relaxation, sedation, guided imagery, and hypnosis, there has not been a combination treatment that merged relaxation techniques and biofeedback within a pediatric framework. A group of 12 children diagnosed with cancer participated in a 4-session intervention combining relaxation and biofeedback. This feasibility study suggests that the combination intervention offered in a clinical setting may be beneficial to children experiencing procedural distress as a novel coping strategy.

A pilot exploration of symptom trajectories in adolescents with cancer during chemotherapy.

BACKGROUND: Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer have multiple symptoms related to chemotherapy, but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms. OBJECTIVES: The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables. METHODS: Nine adolescents with cancer within 6 months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, 1 week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random-effects repeated-measures analysis was computed. RESULTS: The significant trajectories were fatigue (P = .003), difficulty sleeping (P = .032), and nausea (P = .04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (r = .86, P = .003), trait anxiety and fatigue (r = -0.82, P < .001), and stress and pain (r = 0.78, P = .039). CONCLUSIONS: Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated. IMPLICATIONS FOR PRACTICE: Pilot findings suggest that monitoring symptoms, stress, and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.