Wong-Baker Faces Pain Rating Scale Research Articles

Effectiveness of Procedural Sedation and Analgesia in Pediatric Emergencies. A Cross-Sectional Study

IntroductionPain is defined as an unpleasant emotional and sensory experience associated with bodily harm or with situations that cause fear and anxiety. However, it is often undertreated in pediatric emergency departments. This study aims to assess the effectiveness of sedation-analgesia techniques, level of satisfaction among health care professionals and relatives, and agreement between the satisfaction of health care professionals and relatives. MethodsA cross-sectional design was conducted. Sociodemographic and clinical variables were recorded, together with those for effectiveness using the Face, Legs, Activity, Cry, and Consolability scale and the Wong-Baker FACES scale, and the satisfaction using the 10-point Likert scale. Stata 16.1 was used for data analysis. ResultsA total of 94 procedures were registered. The results suggested that these techniques were effective or mildly effective in only half of the cases. Satisfaction was considered good across the board, and the agreement between health care professionals (ie, pediatric nurses and pediatricians) was considered substantial. However, the agreement between health care professionals and relatives was moderate. DiscussionOur results suggested that the adequate management of pain in pediatric emergency departments is still a challenge, despite the availability of international guidelines. Future research lines should be focused on analyzing possible causes of the inefficacy of some sedation-analgesia techniques and the causes of the differences between the perspectives of health care professionals and relatives. These research lines may be useful to improve quality of care and pediatric patient comfort.

Laser Er:YAG-Assisted Debonding May Be a Viable Alternative to the Conventional Method for Monocrystalline Ceramic Brackets.

In orthodontic practice, due to the increased interest among patients in smile aesthetics, different types of brackets are now being used, with those most frequently applied being ones made of polycrystalline and monocrystalline ceramic. The aim of this study was to evaluate the laser Er:YAG-assisted debonding technique compared to conventional methods for removing monocrystalline ceramic brackets from human teeth. The study sample included 60 vital teeth (frontals of the upper jaw) from 10 patients who had monocrystalline ceramic brackets and were in the final phase of orthodontic treatment. The debonding procedure was carried out following a split-mouth study design, using either the conventional technique or laser Er:YAG 2940 nm radiation. For each tooth, three variables were evaluated: the patient's sujective tooth sensitivity associated with the debonding, the time required for debonding, and pulp blood flow microdynamics after the debonding. Three evaluation instruments were used to assess and quantify the treatment effects: (i) the Wong-Baker FACES Pain Rating Scale for pain assessment; (ii) a digital stopwatch/timer to measure the time required to remove the bracket; and (iii) laser Doppler flowmetry (LDF) for recording the pulp blood flow evolution. The statistical analysis of the recorded data showed a statistically significant difference between the two debonding methods regarding the tooth sensitivity during the debonding and the time required for the procedure. The subjective tooth sensitivity was reduced from a mean ± standard deviation of 3.07 ± 1.46 to 0.47 ± 0.86 on the Wong-Baker FACES scale (Wilcoxon signed rank, p < 0.001). The necessary time for debonding was reduced by 0.697 ± 0.703 s per tooth (paired t-test, p < 0.001). There was no difference in the blood microdynamics between the two debonding techniques. According to the results of this study, the laser Er:YAG-assisted debonding technique may be a viable alternative to the conventional method for monocrystalline ceramic brackets.

Characterization of pain in the first two weeks after tonsillectomy in children 3 to 8 years old. A pilot study.

Introduction and objective: To study the pain in children is a challenge. Tonsillectomy is a very common and painful surgical procedure in which there are still barriers to warrant an adequate pain management. The purpose of this study is to characterize the pain after surgery in children between 3 and 8 years-old who underwent tonsillectomy.
 Method: We performed a descriptive, observational and prospective study in children aged 3 to 8 who underwent tonsillectomy. The data collection was made through a pain questionnaire based in the intensity of pain from 0-10 in the Wong Baker scale (based on drawn faces). Parents also fulfilled other questions about the days that the children could not attend the school and the working days that the parents themselves lost. The analgesic treatment that each child received was also recorded.
 Results: Twenty-nine patient were included, 14 girls and 15 boys with a median age of 4. The highest level of pain was found the second day with a median value of 3,0. This second day was so chosen to compare the level of pain between indications. The median pain was 3,0 when it was for obstructive disease, but 4,0 when obstruction was associated with facial growth disorders. Children lost a median of 8 days at school and their parents 2 days at work each one.
 Discussion: Our limited data suggest that the long-term side effects of the upper airway obstruction due to tonsillar hypertrophy like disorders of facial growth made the surgery more painful and that the pain had in our environment a greater impact in patients and their parents lifes. It appears to be important to stablish a scheduled analgesic treatment for the first 10 days after surgery.

Analgesia Nociception Index Monitoring in the Evaluation of Postoperative Pain in Children: A Prospective Observational Pilot Study

PurposeIn this study, we aimed to evaluate the relationship between the analgesia nociception index (ANI) device and pain scales used in the postoperative pain assessment of pediatric patients who underwent laparoscopic appendectomy. DesignThe study was designed as a correlation observational pilot study. MethodsPostoperative pain was evaluated using pediatric pain scales (face, legs, arms, cry, consolability scale; numerical rating scale; Wong–Baker scale) and ANI device in school-aged children and adolescents. ResultsThe mean age of the children was 14.00 ± 1.63 years, and the mean BMI was 22.52. We found a statistically significant positive correlation between the pain scale scores and a statistically significant negative relationship between the pain scale score and the ANI. ConclusionsThe ANI device can be used safely and constantly for the objective assessment of postoperative pain in pediatric patients.

Virtual Reality during Intrathecal Pump Refills in Children: A Case Series.

Virtual reality has proven to be an effective approach to decrease pain in acute settings, both in adults and children. The aim of this study is to evaluate whether virtual reality (VR) could reduce pain during an intrathecal pump refill procedure in children receiving intrathecal drug delivery, compared to a standard refill procedure. This is a three-arm crossover randomized controlled trial, evaluating the effect of VR on pain in children with cerebral palsy undergoing an intrathecal pump refill compared to a standard refill and a refill with distraction (watching a video). Pain was evaluated using the Wong–Baker Faces Scale. Secondary outcomes were procedural pain, fear, state anxiety, the incidence of adverse events and satisfaction. Six children participated in this study, whereby all children underwent the three conditions. Five children indicated an equal of lower pain score during VR, compared to a standard refill. This finding of an equal or lower pain intensity score for the VR condition compared to the control condition was also revealed by the ratings of the parents, physician and the researcher. The influence of VR on anxiety and fear seem to be in line with the influence of watching a video. In terms of satisfaction, all children and parents agreed with the statement that they would like to use VR again for a next refill. Due to the lack of adverse events, the high degree of satisfaction of children with VR and the decreased pain levels after a refill with VR, physicians may aim to explore the implementation of VR during intrathecal pump refill procedures in children in a daily clinical routine care setting.

Evaluation of Effectiveness of Graphics Interchange Format and Wong–Baker FACES Pain Rating Scale as Pain Assessment Tool in Children

The objective of this preliminary study was to evaluate the validity and reliability of the graphics interchange format (GIF) as a self-reporting pain assessment tool in children. In this in vivo observational study, pain assessment of 42 children aged 7-13 years with a chief complaint of dental pain reporting the first time to the Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, Maharashtra, India, were included. Informed consent was obtained from the parents or guardians. All the responses were obtained by a single practitioner, after showing the respective self-reporting pain scale, that is, Wong-Baker FACES Pain Rating Scale (WBFPRS) and GIF pain scale. A questionnaire study was performed at the end of the study. The data were recorded, and then statistical analyses were performed. Both scales showed significant differences (p = 0.001*) when scales were individually compared to the actual pain intensity experienced by the patient. Both WBFPRS and GIF pain scales have shown non-significant differences (p = 0.155). The GIF pain scale has shown very strong relationship (r = 0.936, p = 0.001*), while WBFPRS showed strong relationship (r = 0.725, p = 0.001*). The GIF pain scale has shown almost perfect agreement (k = 0.911) whereas WBFPRS has shown substantial agreement (k = 0.710) with actual pain intensity. In the questionnaire study, most children strongly agreed that the GIF pain scale is easier to understand than WBFPRS. The GIF pain scale is a very promising self-report pain assessment tool for children. Further research on improving the GIF pain scale is very important. The newly devised GIF pain scale seems to be a very promising self-report pain scale for effective determination of pain experienced by the patient.

Gait parameters, functional performance and physical activity in active and inactive Juvenile Idiopathic Arthritis

BackgroundChildren with Juvenile Idiopathic Arthritis (JIA) may adopt different movement patterns and participate in physical activity during different states of disease. Research questionWhich specific features of gait and physical function performance differ among children with active or inactive JIA compared to healthy children? MethodsForty-three children participated (14.5 ± 4.2 yrs; 60 % female). 3D-motion analysis methods were coupled with force measures from an instrumented treadmill captured gait mechanical measures. The 30-second Chair Rise Test (repetitions) and stair ascent-descent tests were performed, and the 11-point Wong-Baker face scale assessed pain after each test. ResultsCompared to healthy controls children with active and inactive JIA had worse outcomes (12–21 % slower self-selected and fast walking speeds, 28–34 % slower stair navigation times, 28 % fewer chair rise repetitions in 30 s; all p < .05). Children with active JIA had 8–13 % slower gait speeds, 4 % fewer chair rise repetitions and 14–16 % slower stair navigation times. At faster walking speed, children with active JIA had less hip joint flexion/extension excursion in the sagittal plane during the gait cycle, produced higher leg stiffness, and demonstrated greater interlimb asymmetry in GRF vertical impulse during loading than healthy children (all p < .05). The Pedi-FABS subscore of “Duration: performing athletic activity for as long as you would like without stopping” was rated lower in children with active JIA compared to controls (p < .05). ConclusionGait speed, specific load-bearing functional tasks and leg stiffness features of gait may be informative ‘functional biomarkers’ for assessing JIA burden and tracking treatment efficacy. Additional prospective studies are needed to determine how these features change over time with pain change, and understand impact on quality of life and physical activity participation.

The Effect of External Cold and Vibration on Infiltration-Induced Pain in Children: A Randomized Clinical Trial.

Introduction Children's fear of and anxiety about dental treatments are important problems in maintaining health. The anesthetic injection is the main cause of dental fear. One of the methods to reduce the infiltration-induced pain is to use external cold or vibration using the gate control system. Various devices have been used to apply cold and vibration, including the BUZZY device (BUZZY Company, Arizona). Studies have shown contradictory results for the effectiveness of cold and vibration. This study aimed to investigate the effect of cold and vibration versus cold alone on maxillary infiltration-induced pain and stress. Methods Thirty children aged 6–12 years who required profound restoration of deciduous or permanent first molars were recruited in this randomized double-blind clinical trial. The anesthetic gel and BUZZY device were used in half of the children's jaws, and the anesthetic gel and the cold alone were used in the other half of the jaws. To measure stress from the heart rate, the Wong–Baker scale was used as the subjective scale, and the face, legs, activity, cry, consolability (FLACC) scale was used as the objective scale. Results The FLACC score was significantly lower in the BUZZY group than in the cold-alone group, but the Wong–Baker scale and heart rate did not show a significant difference between the two groups. Conclusions The BUZZY device can be effective in reducing infiltration-induced dental pain.

A study to assess the effectiveness of conventional methods along with balloon inflation vs conventional methods only in reduction of pain and fear during venipuncture in children age group of 5-12 years admitted in paediatric wards of GGSMC &amp;amp; H, Faridkot, Punjab

Introduction: Children are vulnerable to all kinds of illness. Illness and hospitalization are the first crisis that children face. Venipuncture is one of the most painful invasive procedures. Distraction has shown to be an effective non-pharmacological pain management technique. Aim: The study was intended to assess the effectiveness of conventional methods along with balloon inflation vs conventional methods only in reduction of pain and fear during venipuncture in children age group of 5-12 years admitted in pediatric wards of GGSMC&H, Faridkot, Punjab.Methods: A quantitative research approach and experimental research design was used to conduct the study. Total 80 patients (5-12 years) were selected who were admitted in the pediatric wards on the basis of inclusion and exclusion criteria and randomly allocated into experimental and conventional group through computerized block design method. Socio demographic data sheet was used to collect baseline information, Wong-Baker Faces Pain Rating Scale and Children’s Fear Scale were used to assess the pain and fear level.Results: Study found that the median of pain score in experimental group was 8 in conventional group was 10. Median of fear score in experimental group was 3 and in conventional group was 4. Mann-Whitney U test was applied for statistical analysis and p value was <0.001 which was statistically highly significant.Conclusions: This study concluded that conventional methods along with balloon inflation was effective as a non-pharmacological method of reduction/management of pain and fear during venipuncture.

Consistency of pediatric pain ratings between dyads: an updated meta-analysis and metaregression.

Accurate assessment of pediatric pain remains a challenge, especially for children who are preverbal or unable to communicate because of their health condition or a language barrier. A 2008 meta-analysis of 12 studies found a moderate correlation between 3 dyads (child-caregiver, child-nurse, and caregiver-nurse). We updated this meta-analysis, adding papers published up to August 8, 2021, and that included intraclass correlation/weighted kappa statistics (ICC/WK) in addition to standard correlation. Forty studies (4,628 children) were included. Meta-analysis showed moderate pain rating consistency between child and caregiver (ICC/WK = 0.51 [0.39-0.63], correlation = 0.59 [0.52-0.65], combined = 0.55 [0.48-0.62]), and weaker consistency between child and health care provider (HCP) (ICC/WK = 0.38 [0.19-0.58], correlation = 0.49 [0.34-0.55], combined = 0.45; 95% confidence interval 0.34-0.55), and between caregiver and HCP (ICC/WK = 0.27 [-0.06 to 0.61], correlation = 0.49 [0.32 to 0.59], combined = 0.41; 95% confidence interval 0.22-0.59). There was significant heterogeneity across studies for all analyses. Metaregression revealed that recent years of publication, the pain assessment tool used by caregivers (eg, Numerical Rating Scale, Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale), and surgically related pain were each associated with greater consistency in pain ratings between child and caregiver. Pain caused by surgery was also associated with improved rating consistency between the child and HCP. This updated meta-analysis warrants pediatric pain assessment researchers to apply a comprehensive pain assessment scale Patient-Reported Outcomes Measurement Information System to acknowledge psychological and psychosocial influence on pain ratings.

A Case-Control Study of the Effects of Implementing the Registered Nurses' Association of Ontario Guidelines for the Assessment and Management of Postoperative Pain and the Use of Relaxation Therapy in 312 Patients with Bone and Soft-Tissue Malignancy.

BACKGROUND The present study aimed to investigate the effects of implementing the Registered Nurses' Association of Ontario (RNAO) guidelines for the management of postoperative pain and the use of Jacobson's relaxation technique (JRT) in patients with bone and soft-tissue malignancy at a single center in China. MATERIAL AND METHODS A total of 312 patients were recruited and randomly divided into 2 groups. In the intervention group, the RNAO pain-management technique of JRT was adopted, while the control group received the standard institutional nursing management. Pain scores after the operation, according to the Numerical Rating Scale (NRS) combined with the Wong-Baker Faces Pain Rating Scale and Short-Form McGill Pain Questionnaire, were compared between the 2 groups. Nursing satisfaction was compared as well. RESULTS At 6, 24, and 72 h after the operation, the NRS scores combined with the Wong-Baker Faces Pain Rating Scale in the intervention group were significantly lower than those in the control group (P<0.001); 72 h after the operation, the Pain Rating Index, Visual Analogue Scale, present pain intensity, and total scores for the intervention group were significantly lower than those for the control group (P<0.001 for all 4 scores). The scores reported from the patients for nursing response and consequent care (P<0.001), nursing competence (P=0.029), and surgical pain-control satisfaction (P<0.001) in the intervention group were also significantly higher than those in the control group. CONCLUSIONS JRT can improve postoperative pain-control and nursing satisfaction in patients with malignant bone and soft-tissue tumors. These data suggest a benefit for application of JRT in clinical care.

Effectiveness of Cold Pack Application on Reduction of Pain Perception during Active Phase of Labour among Parturient Mothers

Pregnancy is the period of gestation from the fertilization of an egg, through development of a fetus, and ending at birth of the baby. A woman’s desire for, and cold pack of, pain relief during labour are influenced by many factors, including her expectations, the complexity of her labour and the severity of her pain. Objectives: To assess the pre-test and post-test level of pain perception during active phase of labour among parturient mothers both in experimental and control group, effectiveness of cold pack on reduction of pain perception during active phase of labour among parturient mothers in the experimental group, association between the level of pain perception during active phase of labour among parturient mothers with their selected demographic variables. Methods: An experimental research design was adopted for the study with 60 samples who met the inclusion criteria were selected by purposive sampling technique. Semi structured interview method was used to collect the demographical and obstetrical data, Wong Baker Scale tool was used to measure the level of pain. Result: The study shows that there is a significant difference between the posttest levels of pain perception during active phase of labour among parturient mothers in the experimental group than in the control group. Conclusion: There was a significant association in the post test level of pain perception among parturient mother in the experimental group than in the control group at p&lt;0.01 and p&lt;0.001 level. Thus the cold pack application is an effective non-pharmacological method which can be used to manage the level of pain perception during labour.

Acceptability of Prednisolone in an Open-Label Randomised Cross-Over Study-Focus on Formulation in Children.

Developing acceptable medicines for children is a complicated task. Several factors must be considered, including age, physiology, texture preference, formulation, and legal framework among others. In the development of new paediatric medicines, these factors are assessed. However, for older medicines, e.g., prednisolone, acceptability is still a challenge. This study was an open-label randomised three-arm cross-over study investigating different formulations of prednisolone (crushed tablets, whole tablets, and oral solution) in paediatric patients with asthma and asthma-like symptoms. Participants were randomised into two different formulations on two consecutive days. For each formulation, the child or caregiver was asked to evaluate acceptability using a modified five-point Wong Baker Face scale. An analysis of variance (ANOVA) model was used to test for significance. For the 41 children, included mean age was 4.7 years (SD ± 3.6), and mean weight was 21 kg (SD ± 10.8). Sixty-one percent were boys. The participants were divided accordingly into three age groups: 6 to 23 months (N = 11), 2 to 5 years (N = 14), and 6–11 years (N = 16). The overall acceptability was low, with only 23 out of 71 scores rating the treatment either 1 or 2 (32%). The ANOVA test showed a significant difference in acceptability score between crushed tablets and whole tablets (p < 0.003). The mean acceptability score for the crushed tablet was the least favourable at 3.9 compared to oral solution (3.1), oro-dispersible tablet (2.8), and whole tablets (2.4). This is problematic in long-term treatment and for the youngest children who cannot swallow tablets. The improvement of age-appropriate and acceptable formulations is necessary.

A randomized controlled trial on virtual reality distraction during venous cannulation in young children.

Background and ObjectivesPain management in children is often inadequate, and the single most common painful procedure in children who are hospitalized is needle procedures. Virtual reality (VR) has been shown to decrease anxiety and pain in children undergoing painful procedures primarily in children from the age of 7 years. Our aim for this study is to investigate patient satisfaction and pain reduction by using a three‐dimensional VR interactive game as a distraction in 4–7 years old children during venous cannulation.MethodsIn this randomized clinical trial, we enrolled 106 children aged 4–7 years who were scheduled for venous cannulation. Patients assigned to the control group were adherent to standard of care, including topical numbing cream, positioning, and distraction in this group by games of choice on a tablet/smartphone. In the study group, children were adherent to standard of care and were distracted by an interactive VR game. Primary outcomes were patient satisfaction and the procedural pain assessed by using Wong–Baker Faces Pain Rating Scale; secondary outcomes were the procedural time and any adverse events.ResultsWe found an overall high level of patient satisfaction with our regime of topical numbing cream, positioning, and distraction. The primary outcome of pain during the procedure was median 20 mm (IQR 0–40) and 20 mm (IQR 0–55) (Wong–Baker 0–100 mm) in the VR group and the control group, respectively (difference: 0 mm, 95%CI: 0–20, p = .19). No significant difference was found in procedural times. The number of adverse effects was low, with no significant difference between the two groups.ConclusionsVR distraction is an acceptable form of distraction for children 4–7 years old when combined with topical numbing cream and positioning during preoperative venous cannulation. No difference was found between VR‐ and smartphone/tablet distraction.

Evaluation of Caries Removal Efficacy Using BRIX 3000 and Atraumatic Restorative Treatment in Primary Molars: A Clinical Comparative Study

The aim of the present study was to compare and evaluate the efficacy of two minimally invasive methods in the removal of infected carious dentin in primary molars. Eighty primary molars with class I occlusal caries involving dentin were selected and allocated to either of the two groups using convenient sampling. Group A (n = 40) caries were excavated using BRIX 3000 and in Group B (n = 40) atraumatic restorative treatment (ART) caries were excavated using hand instruments only. In both groups, caries removal efficacy was evaluated clinically using caries detection dye (Sable and Sleek), and the patient's discomfort level was noted using the Wong-Baker faces pain rating scale (WBFPS). The results indicated that BRIX 3000 was effective in the removal of caries from primary molars with a significant difference. While there was no statistically significant difference seen in pain perception on caries excavation using both the methods. Although, a mild discomfort was noted in Group B. Comparing the two minimally invasive techniques, the new chemomechanical solution (BRIX 3000) was an effective method for the removal of caries from primary molars. So, it can be considered an alternative to the conventional caries removal method in treating pediatric dental patients. BRIX 3000 gel is effective in the removal of caries in children who are anxious and apprehensive as it is a noninvasive method of treatment in the pediatric age group.

Effects of Whistling Compared with Buzzy Device During Blood Sampling on Pain and Fear in Children’s Emergency Department

ABSTRACT Blood sampling from a peripheral vein in children can be significant. Pediatric nurses should be able to use the techniques which decrease the pain and fear duration of the blood sampling. This research studied the effect of vibration bee and whistling (concentrate on breathing) blood sampling on pain and fear in the children’s emergency. In this randomized clinical trial study, 120 children ages 3–6 years referred to a pediatric ward in Najaf, Iraq, using Random Blocking Method, were divided into three groups; vibration bee, whistling, and control group. A musical vibration bee, with the cold bag attached to it, was closed for 5 minutes at approximately 5-10 cm above the blood sampling site. A final minute, the vibration was applied; then, the procedure was done. The pain severity was measured by Wong Baker Faces scale. Data were analyzed by SPSS19 software at the significant level of 95%. There was a significant difference in pain intensity between the control groups and the intervention groups (p = .000). Moreover, there was a significant difference in children’s medical fear scale between the control groups and the intervention groups (p = .000). Whistling (concentrate on breathing) may be an easily accessed, inexpensive, and effective technique to control or reduce pain and fear in young children. But, vibration bee with cold has a greater effect for reducing pain and fear. It is suggested to use vibration bee (with cold) in painful aggressive procedures in children.

Efficacy and safety of low dose oral ketamine for controlling pain and distress during intravenous cannulation in children: a double-blind, randomized, placebo-controlled trial.

BackgroundKetamine is widely used in infants and young children for procedural sedation and anesthesia. The aim of this study was to evaluate the efficacy and safety of low dose oral ketamine to control pain and distress in children during intravenous (IV) cannulation.MethodsThis is a prospective, randomized, double-blind study, including children aged between 3 and 6 years requiring a non-emergent IV-line placement. Children were randomly assigned to two groups, treated either with oral ketamine or a placebo. All patients were monitored for vital signs. Pain was assessed using the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wong-Baker Faces Pain Rating Scale (WBFS) scales and sedation using a 5-point sedation score. The facility of IV-line placement was measured by a 3-point scale. Adverse effects were recorded after 1 and 24 hours.ResultsA total of 79 and 81 children were entered in the ketamine and placebo groups, respectively. The heart and respiratory rates increased significantly in the placebo group. The median CHEOPS 4 (95% confidence interval [CI] 3, 4, P < 0.001) and WBFS 6 (95% CI 4, 6, P < 0.001) scores decreased statistically in the ketamine group. IV-line placement was 50% easier in the ketamine group (95% CI 37%, 63%, P < 0.001). No serious adverse effects were observed in all cases.ConclusionsLow dose oral ketamine effectively decreased the pain and distress during IV cannulation in children without any significant adverse reactions.

Offer of a bandage versus rigid immobilisation in 4- to 15-year-olds with distal radius torus fractures: the FORCE equivalence RCT.

Torus (buckle) fractures of the wrist are the most common fractures in children involving the distal radius and/or ulna. It is unclear if children require rigid immobilisation and follow-up or would recover equally as well by being discharged without any immobilisation or a bandage. Given the large number of these injuries, identifying the optimal treatment strategy could have important effects on the child, the number of days of school absence and NHS costs. To establish whether or not treating children with a distal radius torus fracture with the offer of a soft bandage and immediate discharge (i.e. offer of a bandage) provides the same recovery, in terms of pain, function, complications, acceptability, school absence and resource use, as treatment with rigid immobilisation and follow-up as per usual practice (i.e. rigid immobilisation). A pragmatic, multicentre, randomised controlled equivalence trial. Twenty-three UK emergency departments. A total of 965 children (aged 4-15 years) with a distal radius torus fracture were randomised from January 2019 to July 2020 using a secure, centralised, online-encrypted randomisation service. Exclusion criteria included presentation > 36 hours after injury, multiple injuries and an inability to complete follow-up. A bandage was offered to 489 participants and applied to 458, and rigid immobilisation was carried out in 476 participants. Participants and clinicians were not blinded to the treatment allocation. The pain at 3 days post randomisation was measured using the Wong-Baker FACES Pain Rating Scale. Secondary outcomes were the patient-reported outcomes measurement system upper extremity limb score for children, health-related quality of life, complications, school absence, analgesia use and resource use collected up to 6 weeks post randomisation. A total of 94% of participants provided primary outcome data. At 3 days, the primary outcome of pain was equivalent in both groups. With reference to the prespecified equivalence margin of 1.0, the adjusted difference in the intention-to-treat population was -0.10 (95% confidence interval -0.37 to 0.17) and the per-protocol population was -0.06 (95% confidence interval -0.34 to 0.21). There was equivalence of pain in both age subgroups (i.e. 4-7 years and 8-15 years). There was no difference in the rate of complications, with five complications (1.0%) in the offer of a bandage group and three complications (0.6%) in the rigid immobilisation group. There were no differences between treatment groups in functional recovery, quality of life or school absence at any point during the follow-up. Analgesia use was marginally higher at day 1 in the offer of a bandage group than it was in the rigid immobilisation group (83% vs. 78% of participants), but there was no difference at other time points. The offer of a bandage significantly reduced the cost of treatment and had a high probability of cost-effectiveness at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year. Families had a strong pre-existing preference for the rigid immobilisation treatment. Given this, and the inability to blind families to the treatment allocation, observer bias was a concern. However, there was clear evidence of equivalence. The study findings support the offer of a bandage in children with a distal radius torus fracture. A clinical decision tool to determine which children require radiography is an important next step to prevent overtreatment of minor wrist fractures. There is also a need to rationalise interventions for other common childhood injuries (e.g. 'toddler's fractures' of the tibia). This trial is registered as ISRCTN13955395 and UKCRN Portfolio 39678. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 33. See the NIHR Journals Library website for further project information.

The effect of virtual reality glasses against the fear of circumcision: A randomized controlled trial

Background/Aim: Circumcision is an invasive operation that male children undergo in our country and some others. During this process, the child can experience fear, anxiety, and pain simultaneously. As a randomized controlled VR study, this research was conducted to determine the effect of virtual reality (VR) glasses on reducing fear/anxiety and pain during circumcision in children.&#x0D; Methods: The study was conducted on 125 children (6-11 years old). The same healthcare team performed the circumcision of the children in both groups. The children were randomly split into VR and control groups. The children in the VR group, just before the circumcision, watched their preferred cartoon film via VR glasses. No additional procedure was applied to the children in the control group except for ordinary procedures in the hospital. The fear and pain status measured by Wong-Baker Faces Pain Rating Scale and Children Fair Scale of all the children were evaluated before and after the operation by the child, parents, and the observer. Descriptive statistics, chi-square, and t-tests analyzed the data.&#x0D; Results: There was no significant difference between the groups regarding demographic characteristics such as age, BMI, previous hospitalization, and anesthetic drug used before the procedure of the children included in the study. Preoperative (VR = 1.03 (0.18), control = 1.05 (0.22)) and pre-procedural (VR = 2.61 (1.02), control = 2.33 (1.22)) fear levels were also similar (P &gt; 0.05). After the procedure, it was determined that the mean duration of the procedure (365.36 (64.73) sec), crying time (21.31 (41.74) sec), and fear scores (0.36 (0.68)) of the children in the VR group were lower (P &lt; 0.001). However, pain mean scores were similar (P &gt; 0.05).&#x0D; Conclusion: It is thought that watching a cartoon with VR glasses during the circumcision operation may be effective in reducing the child's fear level, crying, and operation time.

Quasi-experimental study to assess the effectiveness of squeezing ball on pain during insertion of intravenous cannula among children in selected hospitals of Pune City

Hospitalized Children suffer pain from various hospital procedures, trauma, and other illnesses. A wide variety of tools for treating pediatric pain appropriately is beneficial i.e., play therapy, distraction, relaxation, and coping skills. Aim of the study: Assess the effectiveness of squeezing ball on pain during insertion of intravenous cannula among children. Material and method: in the present study, the researcher adopted a Quantitative Approach and Quasi-experimental research design. It was carried out on 60 hospitalized children. The non-probability purposive sampling technique was used for the selection of samples, data were collected using demographic profiles and squeezing ball was given to 30 children of the experimental group. The assessment of pain was done using FLACC Pain Scale and Wong Bakers Pain Scale. The reliability of the tool was found “r=0.8 for FLACC scale and r=1 for Wong-Baker scale. The pilot study was done on 10 children, the study was found feasible.