@Article{info:doi/10.2196/63098,
author="Liszio, Stefan
and B{\"a}uerlein, Franziska
and Hildebrand, Jens
and van Nahl, Carolin
and Masuch, Maic
and Basu, Oliver",
title="Cooperative Virtual Reality Gaming for Anxiety and Pain Reduction in Pediatric Patients and Their Caregivers During Painful Medical Procedures: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="31",
volume="14",
pages="e63098",
keywords="virtual reality",
keywords="extended reality",
keywords="mixed reality",
keywords="serious game",
keywords="video game",
keywords="pain",
keywords="anxiety",
keywords="stress",
keywords="child",
keywords="caregiver",
keywords="patient experience",
keywords="well-being",
keywords="medical procedures",
keywords="punctures",
keywords="distraction",
keywords="intervention",
abstract="Background: The hospital experience is often marked by fear and pain, particularly for children undergoing medical procedures. Sedation is commonly used to alleviate patient anxiety, but it poses additional health risks. Caregivers, usually the parents, also experience emotional distress during the child's hospital stay, which can further exacerbate the child's anxiety and pain. While various interventions exist to ease patient distress, few consider the emotional well-being of caregivers. Objective: This study aims to explore the effectiveness of a cooperative virtual reality (VR) game as a novel nonpharmacological solution to reduce anxiety and pain for both pediatric patients and their caregivers during medical procedures. Specifically, we aim to investigate whether the VR game ``Sweet Dive VR'' (SDVR), designed for children aged between 6 and 12 years to play with 1 caregiver, can alleviate anxiety and pain during different types of needle punctures and Kirschner-wire removal. Methods: A prospective multicenter randomized clinical trial will be conducted. Eligible participants will be identified by scanning the hospital information system, and group allocation will follow stratified randomization. During the medical procedure, patients in the VR condition will play SDVR with a caregiver present, while patients in the control group will listen to a recording of gently crashing waves. Data collection will be carried out through self-reports of patients and caregivers using visual analog scales and questionnaires at 2 measurement time points: before and after the intervention. In addition, observation by the interviewers will occur during the intervention to capture emotional and pain reactions as well as interaction quality between patients and caregivers and smoothness of the procedure flow using a structured observation protocol. The measured variables will encompass patient affect and pain, caregiver affect, player experience, patient experience, and the flow of the procedure. Results: As of November 2024, we enrolled 39 patients and caregivers, 28 of whom completed the study. Data collection is still ongoing. Conclusions: Cooperative VR gaming, as exemplified by SDVR, emerges as a promising intervention to address anxiety and pain in pediatric patients while involving caregivers to support the emotional well-being of both parties. Our approach strives to foster positive shared experiences and to maintain trust between children and caregivers during emotionally challenging medical situations. Trial Registration: German Clinical Trial Register (DRKS) DRKS00033544; https://drks.de/search/en/trial/DRKS00033544 International Registered Report Identifier (IRRID): DERR1-10.2196/63098 ",
doi="10.2196/63098",
url="https://www.researchprotocols.org/2025/1/e63098"
}


@Article{info:doi/10.2196/55720,
author="Heuvelink, Annerieke
and Saini, Privender
and Ta?ar, {\"O}zg{\"u}r
and Nauts, Sanne",
title="Improving Pediatric Patients' Magnetic Resonance Imaging Experience With an In-Bore Solution: Design and Usability Study",
journal="JMIR Serious Games",
year="2025",
month="Feb",
day="13",
volume="13",
pages="e55720",
keywords="MRI",
keywords="magnetic resonance imaging",
keywords="imaging",
keywords="radiology",
keywords="pediatrics",
keywords="children",
keywords="patient guidance",
keywords="patient experience",
keywords="design",
keywords="usability",
keywords="breath hold",
abstract="Background: Annually, millions of children undergo a magnetic resonance imaging (MRI) examination. Hospitals increasingly aim to scan young children awake, as doing so benefits both patients and health care systems. To help hospitals reduce the need for anesthesia, we have developed solutions to prepare pediatric patients at home and in the hospital. Objective: The goal of our project was to design, develop, and test a solution that extends our preparation solutions by guiding and engaging children during their MRI examination. Methods: Pediatric In-bore was designed to deliver a familiar experience by reusing design elements from our preparation solutions. It offers child-friendly movies and auditory and visual guidance about examination progress and breath holding. To evaluate children's liking and understanding of the solution, we conducted a usability study. Ten healthy children participated in a mock MRI examination featuring pediatric In-bore. We observed task compliance (ability to lie still and hold one's breath) and conducted guided interviews to assess their experience and understanding of the guidance offered. Results: Participants (aged 5 to 10 years) were generally positive about pediatric In-bore. They liked the main character (Ollie the elephant) and her movie. Auditory and visual guidance were generally liked and understood. All but one participant successfully managed to lie still during the mock examination, and 6 (60\%) out of 10 participants successfully held their breath. Conclusions: Pediatric In-bore appears promising for engaging and guiding young children during awake MRI. It completes the Pediatric Coaching solution that now offers guidance throughout the MRI journey. Future research can expand on this work by evaluating the clinical impact of the Pediatric Coaching solution in a larger and more diverse sample of pediatric patients. ",
doi="10.2196/55720",
url="https://games.jmir.org/2025/1/e55720"
}


@Article{info:doi/10.2196/64561,
author="Sablewski, Armin
and Eimer, Christine
and Nemeth, Marcus
and Miller, Clemens",
title="Preoperative Anxiety Management Practices in Pediatric Anesthesia: Comparative Analysis of an Online Survey Presented to Experts and Social Media Users",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="27",
volume="8",
pages="e64561",
keywords="pediatric anesthesia",
keywords="pharmacological interventions",
keywords="nonpharmacological interventions",
keywords="preoperative",
keywords="anxiety",
keywords="anxiety management",
keywords="practices",
keywords="anesthesia",
keywords="comparative analysis",
keywords="online survey",
keywords="preoperative anxiety",
keywords="challenges",
keywords="postoperative outcome",
keywords="pediatric",
keywords="infant",
keywords="baby",
keywords="neonatal",
keywords="toddler",
keywords="child",
keywords="social media",
keywords="survey",
keywords="anesthesia provider",
abstract="Background: Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological and nonpharmacological interventions are used to reduce children's anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. Health care professionals using social media as a source of medical expertise may offer insights into their management approaches. Objective: A public survey targeting health care professionals was disseminated via social media platforms to evaluate current practices in anxiety management in children. The same questions were posed during an annual meeting of pediatric anesthesiologists with their responses serving as reference. The primary objective was to compare pediatric anesthesia expertise between the groups, while secondary objectives focused on identifying similarities and differences in preoperative anxiety management strategies hypothesizing expertise differences between the groups. Methods: Two surveys were conducted. The first survey targeted 100 attendees of the German Scientific Working Group on Pediatric Anesthesia in June 2023 forming the ``Expert Group'' (EG). The second open survey was disseminated on social media using a snowball sampling approach, targeting followers of a pediatric anesthesia platform to form the ``Social Media Group'' (SG). The answers to the 24 questions were compared and statistically analyzed. Questions were grouped into 5 categories (pediatric anesthesia expertise, representativity, structural conditions, practices of pharmacological management, and practices in nonpharmacological management). Results: A total of 194 responses were analyzed (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs 10 y, P<.001), higher specialist status (97.6\% vs 64.6\%, P<.001), and a greater pediatric anesthesia volume (43.9\% vs 12\% with more than 500 cases per year, P<.001). Regarding the representativity, 2 items out of 4 were statistically significant (level of care of institution, annual caseload of institution). Regarding the overall anxiety management practices used, there is a heterogeneous response pattern within both groups. Conclusions: Despite heterogeneous approaches, health care professionals using social media demonstrated less expertise in pediatric anesthesia but showed minimal differences in the daily management of preoperative anxiety compared with pediatric anesthesia experts. Our study highlights the potential for meaningful use of social media but future studies should explore the impact of social media health care professionals' knowledge in other specific topics. Additionally, regarding preoperative anxiety, further recommendations are needed that could help to standardize and improve anxiety levels in children. ",
doi="10.2196/64561",
url="https://pediatrics.jmir.org/2025/1/e64561"
}


@Article{info:doi/10.2196/39617,
author="Wozney, Lori
and Vakili, Negar
and Chorney, Jill
and Clark, Alexander
and Hong, Paul",
title="The Impact of a Text Messaging Service (Tonsil-Text-To-Me) on Pediatric Perioperative Tonsillectomy Outcomes: Cohort Study With a Historical Control Group",
journal="JMIR Perioper Med",
year="2022",
month="Sep",
day="20",
volume="5",
number="1",
pages="e39617",
keywords="tonsillectomy",
keywords="otorhinolaryngology",
keywords="text messaging",
keywords="caregivers",
keywords="surgery",
keywords="perioperative",
keywords="patient discharge",
keywords="aftercare",
keywords="short messaging service",
keywords="pain management",
keywords="mobile phone",
abstract="Background: Tonsillectomy is a common pediatric surgical procedure performed in North America. Caregivers experience complex challenges in preparing for their child's surgery and coordinating care at home and, consequently, could benefit from access to educational resources. A previous feasibility study of Tonsil-Text-To-Me, an automated SMS text messaging service that sends 15 time-sensitive activity reminders, links to nutrition and hydration tips, pain management strategies, and guidance on monitoring for complications, showed promising results, with high levels of caregiver satisfaction and engagement. Objective: This study aimed to pilot-test Tonsil-Text-To-Me in a real-world context to determine whether and how it might improve perioperative experiences and outcomes for caregivers and patients. Methods: Caregivers of children aged 3 to 14 years undergoing tonsillectomy were included. Data from a historical control group and an intervention group with the same study parameters (eg, eligibility criteria and surgery team) were compared. Measures included the Parenting Self-Agency Measure, General Health Questionnaire-12, Parents' Postoperative Pain Measure, Client Satisfaction Questionnaire-8, and engagement analytics, as well as analgesic consumption, pain, child activity level, and health service use. Data were collected on the day before surgery, 3 days after surgery, and 14 days after surgery. Participants in the intervention group received texts starting 2 weeks before surgery up to the eighth day after surgery. Descriptive and inferential statistics were used. Results: In total, 51 caregivers (n=32, 63\% control; n=19, 37\% intervention) who were predominately women (49/51, 96\%), White (48/51, 94\%), and employed (42/51, 82\%) participated. Intervention group caregivers had a statistically significant positive difference in Parenting Self-Agency Measure scores (P=.001). The mean postoperative pain scores were higher for the control group (mean 10.0, SD 3.1) than for the intervention group (mean 8.5, SD 3.7), both of which were still above the 6/15 threshold for clinically significant pain; however, the difference was not statistically significant (t39=1.446; P=.16). Other positive but nonsignificant trends for the intervention group compared with the control group were observed for the highest level of pain (t39=0.882; P=.38), emergency department visits ($\chi$22=1.3; P=.52; Cramer V=0.19), and other measures. Engagement with resources linked in the texts was moderate, with all but 1 being clicked on for viewing at least once by 79\% (15/19) of the participants. Participants rated the intervention as highly satisfactory across all 8 dimensions of the Client Satisfaction Questionnaire (mean 29.4, SD 3.2; out of a possible value of 32.0). Conclusions: This cohort study with a historical control group found that Tonsil-Text-To-Me had a positive impact on caregivers' perioperative care experience. The small sample size and unclear impacts of COVID-19 on the study design should be considered when interpreting the results. Controlled trials with larger sample sizes for evaluating SMS text messaging interventions aimed to support caregivers of children undergoing tonsillectomy surgery are warranted. ",
doi="10.2196/39617",
url="https://periop.jmir.org/2022/1/e39617",
url="http://www.ncbi.nlm.nih.gov/pubmed/36125849"
}


@Article{info:doi/10.2196/25540,
author="Rochat, Jessica
and Ehrler, Fr{\'e}d{\'e}ric
and Siebert, N. Johan
and Ricci, Arnaud
and Garretas Ruiz, Victor
and Lovis, Christian",
title="Usability Testing of a Patient-Centered Mobile Health App for Supporting and Guiding the Pediatric Emergency Department Patient Journey: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Mar",
day="15",
volume="5",
number="1",
pages="e25540",
keywords="usability",
keywords="user-centered design",
keywords="information systems",
keywords="mobile apps",
keywords="emergency service",
keywords="hospital",
keywords="pediatrics",
keywords="mobile phone",
abstract="Background: Patient experience in emergency departments (EDs) remains often suboptimal and can be a source of stress, particularly in pediatric settings. In an attempt to support patients and their families before, during, and after their visit to a pediatric ED, a mobile health (mHealth) app was developed by a multidisciplinary team based on patient-centered care principles. Objective: This study aims to evaluate the usability (effectiveness, efficiency, and satisfaction) of a new mHealth app, InfoKids, by potential end users through usability testing. Methods: The app was assessed through an in-laboratory, video-recorded evaluation in which participants had to execute 9 goal-oriented tasks, ranging from account creation to the reception of a diagnostic sheet at the end of the emergency care episode. Effectiveness was measured based on the task completion rate, efficiency on time on task, and user satisfaction according to answers to the System Usability Scale questionnaire. Think-aloud usability sessions were also transcribed and analyzed. Usability problems were rated for their severity and categorized according to ergonomic criteria. Results: A total of 17 parents participated in the study. The overall completion rate was 97.4\% (149/153). Overall, they reported good effectiveness, with the task successfully completed in 88.2\% (135/153) of cases (95\% CI 83\%-93\%). Each task, with the exception of the first, created difficulties for some participants but did not prevent their completion by most participants. Users reported an overall good to excellent perceived usability of the app. However, ergonomic evaluation identified 14 usability problems occurring 81 time. Among these, 50\% (7/14) were serious as their severity was rated as either major or catastrophic and indicated areas of improvements for the app. Following the suggested usability improvements by participants, mitigation measures were listed to further improve the app and avoid barriers to its adoption. Conclusions: Usability of the InfoKids app was evaluated as good to excellent by users. Areas of improvement were identified, and mitigation measures were proposed to inform its development toward a universal app for all ED patients visiting a digitalized institution. Its contribution could also be useful in paving the way for further research on mobile apps aimed at supporting and accompanying patients in their care episodes, as research in this area is scarce. ",
doi="10.2196/25540",
url="https://pediatrics.jmir.org/2022/1/e25540",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289754"
}


@Article{info:doi/10.2196/29656,
author="Rossi, Silvia
and Santini, Junior Silvano
and Di Genova, Daniela
and Maggi, Gianpaolo
and Verrotti, Alberto
and Farello, Giovanni
and Romualdi, Roberta
and Alisi, Anna
and Tozzi, Eugenio Alberto
and Balsano, Clara",
title="Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="13",
volume="24",
number="1",
pages="e29656",
keywords="children",
keywords="emotional health",
keywords="emergency department",
keywords="social robots",
keywords="anxiety",
keywords="stress",
abstract="Background: Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations. Objective: This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels. Methods: This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r). Results: A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2\%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57). Conclusions: SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting. Trial Registration: ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909 ",
doi="10.2196/29656",
url="https://www.jmir.org/2022/1/e29656",
url="http://www.ncbi.nlm.nih.gov/pubmed/34854814"
}


@Article{info:doi/10.2196/26040,
author="Canares, Therese
and Parrish, Carisa
and Santos, Christine
and Badawi, Alia
and Stewart, Alyssa
and Kleinman, Keith
and Psoter, Kevin
and McGuire, Joseph",
title="Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2021",
month="Jul",
day="28",
volume="4",
number="3",
pages="e26040",
keywords="pediatrics",
keywords="psychological distress",
keywords="virtual reality",
keywords="procedural pain",
keywords="anxiety",
keywords="phlebotomy",
abstract="Background: Virtual reality (VR) has shown promise in reducing children's pain and anxiety during venipuncture, but studies on VR lack objective observations of pediatric coping. Notably, the process of capturing objective behavioral coping data can be labor- and personnel-intensive. Objective: The primary aims of this pilot trial were to assess the feasibility of conducting a trial of VR in a pediatric emergency department and the feasibility of documenting observed coping behaviors during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the pediatric emergency department. Methods: This stratified, randomized, controlled pilot trial compared coping and distress between child life--supported VR engagement and child life specialist support without VR during painful procedures in children aged 7-22 years in the pediatric emergency department. An external control (reference group) received no standardized support. Primary feasibility outcomes included rates of recruitment, rates of withdrawal from VR, and rates of completed Child Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) observations. Secondary clinical outcomes were applied to venipuncture procedures and included CAMPIS-SF coping and distress (range 0-1.0), pain and anxiety on a visual analog scale (range 0-10), and cybersickness symptoms. Results: Overall recruitment was 93\% (66/71), VR withdrawal rate was 27\% (4/15), and of the completed procedures, 100\% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the pediatric emergency department were included in the analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to child life specialist support, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in the VR group and child life specialist group than in the reference group (P=.046). There were no significant differences in the distress and pain ratings for patients and caregivers between the groups. Caregivers rated the lowest perceived anxiety in the child life specialist group (P=.03). There was no apparent change in cybersickness symptoms before and after VR use (P=.37). Conclusions: Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR was utilized, particularly with the availability of research staff. VR and child life specialists improved coping in children during venipuncture procedures. Given the high participation rate, future studies to evaluate the efficacy of VR are recommended to determine whether an off-the-shelf VR headset can be a low-cost and low-risk tool to improve children's coping during venipuncture or other related procedures. Trial Registration: ClinicalTrials.gov NCT03686176; https://clinicaltrials.gov/ct2/show/NCT03686176 ",
doi="10.2196/26040",
url="https://pediatrics.jmir.org/2021/3/e26040",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319249"
}


@Article{info:doi/10.2196/24967,
author="Ridout, Brad
and Kelson, Joshua
and Campbell, Andrew
and Steinbeck, Kate",
title="Effectiveness of Virtual Reality Interventions for Adolescent Patients in Hospital Settings: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="28",
volume="23",
number="6",
pages="e24967",
keywords="virtual reality",
keywords="hospital",
keywords="pain",
keywords="anxiety",
keywords="adolescents",
abstract="Background: Given the high level of interest and increasing familiarity with virtual reality among adolescents, there is great potential to use virtual reality to address adolescents' unique health care delivery needs while in hospital. While there have been reviews on the use of virtual reality for specific health conditions and procedures, none to date have reviewed the full scope of virtual reality hospital interventions for adolescents who are often combined with children as a homogenous group, despite the fact that adolescents experience virtual environments different from children. Objective: The aim of this review was to systematically identify available evidence regarding the use of virtual reality interventions for adolescent patients in hospital settings to evaluate effectiveness, suitability, and safety and identify opportunities for future research. Methods: PubMed, PsycINFO, Medline, and Scopus databases were searched using keywords and phrases. Retrieved abstracts (n=1525) were double screened, yielding 276 articles for full-text screening. Of these, 8 articles met inclusion criteria. Data were extracted to a standardized coding sheet, and a narrative synthesis was performed due to the heterogeneity of the studies. Results: Four RCTs and 4 single-case reports were identified for inclusion, all of which aimed to reduce pain or anxiety. The scenarios targeted were burn pain, venipuncture, chemotherapy, preoperative anxiety, and palliative care. Three out of 4 RCTs found significant reductions in pain or anxiety outcomes measures when using virtual reality compared to standard care or other distraction techniques; however, only 1 study combined self-reported experiences of pain or anxiety with any physiological measures. Single-case reports relied primarily upon qualitative feedback, with patients reporting reduced pain or anxiety and a preference for virtual reality to no virtual reality. Conclusions: Virtual reality can provide a safe and engaging way to reduce pain and anxiety in adolescents while in hospital, particularly when virtual reality software is highly immersive and specifically designed for therapeutic purposes. As VR becomes more accessible and affordable for use in hospitals, larger and more diverse studies that capitalize on adolescents' interest in and aptitude for virtual reality, and on the full range of capabilities of this emerging technology, are needed to build on these promising results. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020198760; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020198760 ",
doi="10.2196/24967",
url="https://www.jmir.org/2021/6/e24967",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185015"
}


@Article{info:doi/10.2196/25504,
author="Gold, I. Jeffrey
and Annick, T. Erin
and Lane, S. Arianna
and Ho, Katherine
and Marty, T. Ryan
and Espinoza, C. Juan",
title="``Doc McStuffins: Doctor for a Day'' Virtual Reality (DocVR) for Pediatric Preoperative Anxiety and Satisfaction: Pediatric Medical Technology Feasibility Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="19",
volume="23",
number="4",
pages="e25504",
keywords="virtual reality (VR)",
keywords="pediatric",
keywords="anxiety",
keywords="preoperative",
keywords="satisfaction",
keywords="Doc McStuffins",
abstract="Background: Preoperative anxiety is a common occurrence among children and is associated with a host of maladaptive postoperative behaviors. Consequently, increased attention has been placed on interventions to reduce preoperative anxiety and its associated outcomes. Child Life preparation prior to surgery includes evidence-based practices such as age-appropriate distraction and therapeutic play. Virtual reality (VR) is a promising addition to the Child Life toolbox to address anxiety prior to surgery. The current study evaluates the implementation and feasibility of a VR experience, ``Doc McStuffins: Doctor for a Day Virtual Reality Experience'' (DocVR), developed by Disney Junior in collaboration with Children's Hospital Los Angeles, to target pediatric preoperative anxiety. Objective: The primary aim of this study was to examine the feasibility and efficacy of DocVR for preoperative anxiety. A secondary aim was to improve patient, caregiver, and health care provider satisfaction with the preoperative experience. Methods: In this study, 51 patients (age 6-14 years) scheduled for surgery in the ambulatory surgery center and the main operating room at Children's Hospital Los Angeles were approached to participate in Disney's DocVR experience. The patients played the DocVR experience for an average of 18 minutes (3-55 minutes). Irrespective of surgical procedure, patients and their families were eligible, as long as they had no known marked cognitive or visual impairments that would interfere with completing the survey and engaging in the DocVR experience. Results: Patients who tried the DocVR experience (n=51) responded overwhelmingly positively to both the VR technology and to the game itself. Patients experienced a statistically significant decrease in anxiety following DocVR game play (Z=--3.26, P=.001). On the Facial Affective Scale, the percentage of patients who chose the face with the most positive facial expression to represent their affect increased from 23\% (12/51) pre-VR to 49\% (25/47) post-VR. Furthermore, 97\% (38/39) of patients reported feeling more comfortable at the hospital, and 74\% (28/38) reported feeling less scared at the hospital after playing the game. The game was enjoyed by 94\% (46/49) of patients, and 88\% (30/34) of patients reported feeling both ``Interested'' and ``Involved'' in the game. Conclusions: DocVR is a feasible and beneficial VR experience to relieve pediatric preoperative anxiety and improve satisfaction in the preoperative area. The VR experience resulted in a decrease in overall anxiety and an increase in overall positive affect during the preoperative time. Patients also responded positively to the game, confirming their interest in the content and affirming the quality of the DocVR experience. The positive response to the game indicates that DocVR has the potential to make the overall preoperative experience less anxiety-producing and more comfortable, which leads to improved patient satisfaction. Naturally, improved patient outcomes lead to improved caregiver and health care provider satisfaction. ",
doi="10.2196/25504",
url="https://www.jmir.org/2021/4/e25504",
url="http://www.ncbi.nlm.nih.gov/pubmed/33730687"
}


@Article{info:doi/10.2196/23496,
author="Beran, Tanya
and Pearson, Reynolds Jacqueline
and Lashewicz, Bonnie
and Baggott, Sandy",
title="Perspectives of Child Life Specialists After Many Years of Working With a Humanoid Robot in a Pediatric Hospital: Narrative Design",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="19",
volume="22",
number="11",
pages="e23496",
keywords="child life",
keywords="support",
keywords="pediatric",
keywords="distraction",
keywords="robotics",
keywords="human-robot interaction",
abstract="Background: Child life specialists (CLSs) play an important role in supporting patients and their families during their visits to a children's hospital. Although CLSs are equipped with considerable expertise to support families during some of the most difficult moments of their lives, we introduced an additional resource to them in the form of a humanoid robot named MEDi. Objective: The aim of this study is to explore the experiences of CLSs using a robot to support children. Methods: We interviewed 7 CLSs who had worked with this robot for several years. The transcribed interviews were analyzed using open and axial coding. Results: The first main theme that emerged was the process of navigating from fear to friendship in learning to use a humanoid robot for therapeutic support. The second major theme was MEDi as a source of connection and support to children. CLSs' perceptions of MEDi as an adaptable resource and working with the limits of MEDi constituted the last 2 themes. Conclusions: These descriptions show how CLSs can incorporate a robot into their practice. ",
doi="10.2196/23496",
url="http://www.jmir.org/2020/11/e23496/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33211014"
}


@Article{info:doi/10.2196/23626,
author="Rantala, Arja
and Jansson, M. Miia
and Helve, Otto
and Lahdenne, Pekka
and Pikkarainen, Minna
and P{\"o}lkki, Tarja",
title="Parental Experiences of the Pediatric Day Surgery Pathway and the Needs for a Digital Gaming Solution: Qualitative Study",
journal="JMIR Med Inform",
year="2020",
month="Nov",
day="13",
volume="8",
number="11",
pages="e23626",
keywords="anxiety",
keywords="children",
keywords="day surgery",
keywords="delivery of health care",
keywords="digital solution",
keywords="gamification",
keywords="nursing",
keywords="pain",
keywords="qualitative study",
keywords="technology",
abstract="Background: The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents' experiences help care providers to provide effective, family-centered care that responds to parents' needs throughout the day surgery pathway. Objective: The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. Methods: This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Parental experiences of the children's day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category---the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. Conclusions: Parents need guidance and support for their children's day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways. ",
doi="10.2196/23626",
url="http://medinform.jmir.org/2020/11/e23626/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33185556"
}


@Article{info:doi/10.2196/18174,
author="Brief, James
and Chawla, Anupama
and Lerner, Diana
and Vitola, Bernadette
and Woroniecki, Robert
and Morganstern, Jeffrey",
title="The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2020",
month="Nov",
day="10",
volume="3",
number="2",
pages="e18174",
keywords="colonoscopy",
keywords="app",
keywords="pediatrics",
keywords="prep",
keywords="smartphone",
keywords="mobile phone",
keywords="mHealth",
abstract="Background: Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation. Objective: The aim of this study is to determine if an app (SB Colonoscopy Prep) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information. Methods: In total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material. Results: App users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, P=.02), indicating better colonoscopy preps. In total, 75\% (15/20) of app users and 41\% (9/22) of written instruction users had preps categorized as ``excellent'' on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50\%], written instruction users 8/22 [36\%]; P=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; P=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; P=.56). Conclusions: Smartphone app use was associated with an increased number of colonoscopy preps classified as ``excellent'' on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure. Trial Registration: ClinicalTrials.gov NCT04590105; https://clinicaltrials.gov/ct2/show/NCT04590105 ",
doi="10.2196/18174",
url="https://pediatrics.jmir.org/2020/2/e18174",
url="http://www.ncbi.nlm.nih.gov/pubmed/33170131"
}


@Article{info:doi/10.2196/16639,
author="Petersen, L. Christian
and G{\"o}rges, Matthias
and Todorova, Evgenia
and West, C. Nicholas
and Newlove, Theresa
and Ansermino, Mark J.",
title="Feasibility of Using a Single Heart Rate--Based Measure for Real-time Feedback in a Voluntary Deep Breathing App for Children: Data Collection and Algorithm Development",
journal="JMIR Perioper Med",
year="2020",
month="Sep",
day="23",
volume="3",
number="2",
pages="e16639",
keywords="pediatric pain",
keywords="respiratory sinus arrhythmia",
keywords="biofeedback",
keywords="pulse oximetry",
keywords="mobile health",
keywords="anxiety",
keywords="diaphragmatic breathing",
keywords="self-regulation",
abstract="Background: Deep diaphragmatic breathing, also called belly breathing, is a popular behavioral intervention that helps children cope with anxiety, stress, and their experience of pain. Combining physiological monitoring with accessible mobile technology can motivate children to comply with this intervention through biofeedback and gaming. These innovative technologies have the potential to improve patient experience and compliance with strategies that reduce anxiety, change the experience of pain, and enhance self-regulation during distressing medical procedures. Objective: The aim of this paper was to describe a simple biofeedback method for quantifying breathing compliance in a mobile smartphone app. Methods: A smartphone app was developed that combined pulse oximetry with an animated protocol for paced deep breathing. We collected photoplethysmogram data during spontaneous and subsequently paced deep breathing in children. Two measures, synchronized respiratory sinus arrhythmia (RSAsync) and the corresponding relative synchronized inspiration/expiration heart rate ratio (HR-I:Esync), were extracted from the photoplethysmogram. Results: Data collected from 80 children aged 5-17 years showed a positive RSAsync effect in all participants during paced deep breathing, with a median (IQR; range) HR-I:Esync ratio of 1.26 (1.16-1.35; 1.01-1.60) during paced deep breathing compared to 0.98 (0.96-1.02; 0.82-1.18) during spontaneous breathing (median difference 0.25, 95\% CI 0.23-0.30; P<.001). The measured HR-I:Esync values appeared to be independent of age. Conclusions: An HR-I:Esync level of 1.1 was identified as an age-independent threshold for programming the breathing pattern for optimal compliance in biofeedback. ",
doi="10.2196/16639",
url="http://periop.jmir.org/2020/2/e16639/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393917"
}


@Article{info:doi/10.2196/17367,
author="Bray, Lucy
and Sharpe, Ashley
and Gichuru, Phillip
and Fortune, Peter-Marc
and Blake, Lucy
and Appleton, Victoria",
title="The Acceptability and Impact of the Xploro Digital Therapeutic Platform to Inform and Prepare Children for Planned Procedures in a Hospital: Before and After Evaluation Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="11",
volume="22",
number="8",
pages="e17367",
keywords="health literacy",
keywords="augmented reality",
keywords="children",
keywords="procedure",
keywords="health",
keywords="artificial intelligence",
abstract="Background: There is increasing interest in finding novel approaches to improve the preparation of children for hospital procedures such as surgery, x-rays, and blood tests. Well-prepared and informed children have better outcomes (less procedural anxiety and higher satisfaction). A digital therapeutic (DTx) platform (Xploro) was developed with children to provide health information through gamification, serious games, a chatbot, and an augmented reality avatar. Objective: This before and after evaluation study aims to assess the acceptability of the Xploro DTx and examine its impact on children and their parent's procedural knowledge, procedural anxiety, and reported experiences when attending a hospital for a planned procedure. Methods: We used a mixed methods design with quantitative measures and qualitative data collected sequentially from a group of children who received standard hospital information (before group) and a group of children who received the DTx intervention (after group). Participants were children aged between 8 and 14 years and their parents who attended a hospital for a planned clinical procedure at a children's hospital in North West England. Children and their parents completed self-report measures (perceived knowledge, procedural anxiety, procedural satisfaction, and procedural involvement) at baseline, preprocedure, and postprocedure. Results: A total of 80 children (n=40 standard care group and n=40 intervention group) and their parents participated in the study; the children were aged between 8 and 14 years (average 10.4, SD 2.27 years) and were attending a hospital for a range of procedures. The children in the intervention group reported significantly lower levels of procedural anxiety before the procedure than those in the standard group (two-tailed t63.64=2.740; P=.008). The children in the intervention group also felt more involved in their procedure than those in the standard group (t75=?2.238; P=.03). The children in the intervention group also reported significantly higher levels of perceived procedural knowledge preprocedure (t59.98=?4.892; P=.001) than those in the standard group. As for parents, those with access to the Xploro intervention reported significantly lower levels of procedural anxiety preprocedure than those who did not (t68.51=1.985; P=.05). During the semistructured write and tell interviews, children stated that they enjoyed using the intervention, it was fun and easy to use, and they felt that it had positively influenced their experiences of coming to the hospital for a procedure. Conclusions: This study has shown that the DTx platform, Xploro, has a positive impact on children attending a hospital for a procedure by reducing levels of procedural anxiety. The children and parents in the intervention group described Xploro as improving their experiences and being easy and fun to use. ",
doi="10.2196/17367",
url="http://www.jmir.org/2020/8/e17367/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32780025"
}


@Article{info:doi/10.2196/19752,
author="Ahmadpour, Naseem
and Weatherall, David Andrew
and Menezes, Minal
and Yoo, Soojeong
and Hong, Hanyang
and Wong, Gail",
title="Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="17",
volume="22",
number="7",
pages="e19752",
keywords="virtual reality",
keywords="periprocedural anxiety",
keywords="children",
keywords="adolescents",
keywords="stakeholder perspective",
keywords="design",
keywords="VR",
keywords="pediatrics",
keywords="patient experience",
keywords="app",
keywords="eHealth",
abstract="Background: Virtual reality (VR) technology is a powerful tool for augmenting patient experience in pediatric settings. Incorporating the needs and values of stakeholders in the design of VR apps in health care can contribute to better outcomes and meaningful experiences for patients. Objective: We used a multiperspective approach to investigate how VR apps can be designed to improve the periprocedural experiences of children and adolescents, particularly those with severe anxiety. Methods: This study included a focus group (n=4) and a survey (n=56) of clinicians. Semistructured interviews were conducted with children and adolescents in an immunization clinic (n=3) and perioperative setting (n=65) and with parents and carers in an immunization clinic (n=3) and perioperative setting (n=35). Results: Qualitative data were examined to determine the experience and psychological needs and intervention and design strategies that may contribute to better experiences for children in three age groups (4-7, 8-11, and 12-17 years). Quantitative data were used to identify areas of priority for future VR interventions. Conclusions: We propose a set of ten design considerations for the creation of future VR experiences for pediatric patients. Enhancing patient experience may be achieved by combining multiple VR solutions through a holistic approach considering the roles of clinicians and carers and the temporality of the patient's experience. These situations require personalized solutions to fulfill the needs of pediatric patients before and during the medical procedure. In particular, communication should be placed at the center of preprocedure solutions, while emotional goals can be embedded into a procedure-focused VR app to help patients shift their focus in a meaningful way to build skills to manage their anxiety. ",
doi="10.2196/19752",
url="http://www.jmir.org/2020/7/e19752/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706671"
}


@Article{info:doi/10.2196/14973,
author="Moore, M. Courtney
and Wiehe, E. Sarah
and Lynch, O. Dustin
and Claxton, EM Gina
and Landman, P. Matthew
and Carroll, E. Aaron
and Musey, I. Paul",
title="Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 2): Patient- and Parent-Centered Outcomes of Decolonization",
journal="J Participat Med",
year="2020",
month="May",
day="20",
volume="12",
number="2",
pages="e14973",
keywords="patient-centered outcomes",
keywords="Staphylococcus aureus",
keywords="abscess",
keywords="decolonization",
keywords="human-centered design",
abstract="Background: Skin and soft tissue infections (SSTIs) due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) can lead to a number of significant known medical outcomes including hospitalization, surgical procedures such as incision and drainage (I\&D), and the need for decolonization procedures to remove the bacteria from the skin and nose and prevent recurrent infection. Little research has been done to understand patient and caregiver-centered outcomes associated with the successful treatment of MRSA infection. Objective: This study aimed to uncover MRSA decolonization outcomes that are important to patients and their parents in order to create a set of prototype measures for use in the MRSA Eradication and Decolonization in Children (MEDiC) study. Methods: A 4-hour, human-centered design (HCD) workshop was held with 5 adolescents (aged 10-18 years) who had experienced an I\&D procedure and 11 parents of children who had experienced an I\&D procedure. The workshop explored the patient and family experience with skin infection to uncover patient-centered outcomes of MRSA treatment. The research team analyzed the audio and artifacts created during the workshop and coded for thematic similarity. The final themes represent patient-centered outcome domains to be measured in the MEDiC comparative effectiveness trial. Results: The workshop identified 9 outcomes of importance to patients and their parents: fewer MRSA outbreaks, improved emotional health, improved self-perception, decreased social stigma, increased amount of free time, increased control over free time, fewer days of school or work missed, decreased physical pain and discomfort, and decreased financial burden. Conclusions: This study represents an innovative HCD approach to engaging patients and families with lived experience with MRSA SSTIs in the study design and trial development to determine meaningful patient-centered outcomes. We were able to identify 9 major recurrent themes. These themes were used to develop the primary and secondary outcome measures for MEDiC, a prospectively enrolling comparative effectiveness trial. Trial Registration: ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658 ",
doi="10.2196/14973",
url="http://jopm.jmir.org/2020/2/e14973/"
}


@Article{info:doi/10.2196/14974,
author="Moore, M. Courtney
and Wiehe, E. Sarah
and Lynch, O. Dustin
and Claxton, EM Gina
and Landman, P. Matthew
and Carroll, E. Aaron
and Musey, I. Paul",
title="Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 1): Development of a Decolonization Toolkit With Patient and Parent Advisors",
journal="J Participat Med",
year="2020",
month="May",
day="20",
volume="12",
number="2",
pages="e14974",
keywords="Staphylococcus aureus",
keywords="MRSA",
keywords="abscess",
keywords="decolonization",
keywords="human-centered design",
keywords="communication design",
abstract="Background: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections affect many healthy children. A significant number of these children are hospitalized and require surgical incision and drainage (I\&D). Once sent home, these children and families are asked to complete burdensome home decolonization and hygiene procedures in an effort to prevent the high rate of recurrent infections. Objective: This component of the Methicillin-resistant Staphylococcus aureus Eradication and Decolonization in Children (MEDiC) study aimed to develop a toolkit to assist MEDiC study participants in completing MRSA decolonization and hygiene procedures at home (the MEDiC kit). Methods: In all, 5 adolescents (aged 10-18 years) who had undergone an I\&D procedure for a skin infection and 11 parents of children who had undergone an I\&D procedure for a skin infection were engaged in a 4-hour group workshop using a human-centered design approach. The topics covered in this workshop and analyzed for this paper were (1) attitudes about MRSA decolonization procedures and (2) barriers to the implementation of MRSA decolonization and hygiene procedures. The team analyzed the audio and artifacts created during the workshop and synthesized their findings to inform the creation of the MEDiC kit. Results: The workshop activities uncovered barriers to successful completion of the decolonization and hygiene procedures: lack of step-by-step instruction, lack of proper tools in the home, concerns about adverse events, lack of control over some aspects of the hygiene procedures, and general difficulty coordinating all the procedures. Many of these could be addressed as part of the MEDiC kit. In addition, the workshop revealed that effective communication about decolonization would have to address concerns about the effects of bleach, provide detailed information, give reasons for the specific decolonization and hygiene protocol steps, and include step-by-step instructions (preferably through video). Conclusions: Through direct engagement with patients and families, we were able to better understand how to support families in implementing MRSA decolonization and hygiene protocols. In addition, we were able to better understand how to communicate about MRSA decolonization and hygiene protocols. With this knowledge, we created a robust toolkit that uses patient-driven language and visuals to help support patients and families through the implementation of these protocols. Trial Registration: ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658 ",
doi="10.2196/14974",
url="http://jopm.jmir.org/2020/2/e14974/"
}


@Article{info:doi/10.2196/14601,
author="Farias, Nathan
and Rose-Davis, Benjamin
and Hong, Paul
and Wozney, Lori",
title="An Automated Text Messaging System (Tonsil-Text-To-Me) to Improve Tonsillectomy Perioperative Experience: Exploratory Qualitative Usability and Feasibility Study",
journal="JMIR Perioper Med",
year="2020",
month="Jan",
day="15",
volume="3",
number="1",
pages="e14601",
keywords="short message service",
keywords="tonsillectomy",
keywords="pediatric otolaryngology",
keywords="perioperative care",
abstract="Background: Inexperience and forgetting perioperative care instruction are significant drivers of parental stress during pediatric tonsillectomy care. With the widespread use of mobile technology, parents now desire a system that provides them with information that is timely, accessible, and comprehensive. Tonsil-Text-To-Me (TTTM) is a text messaging system that sends out automated and timed texts to parents of children who are undergoing tonsillectomy. Objective: The objective of this study was to pilot-test TTTM to assess for feasibility and usability and collect suggestions for system improvements desired by parents from a pediatric otolaryngology text message service. Methods: Parents of pediatric patients who were being scheduled for tonsillectomy with or without adenoidectomy were prospectively enrolled. An exploratory qualitative study using a semistructured interview guide was performed after parents received the automated texts 2 weeks before and 1 week after their child's surgery. Results: A total of 7 parents were interviewed (data saturation was reached). Participants were all of maternal relation to the patient. Overall, all parents felt that the TTTM service was an improvement to the current standard model of information delivery. Parents also reported that the text messages reduced their anxiety and improved their performance when caring for their children during the perioperative period. No parents expressed privacy concerns about receiving texts and regarding the information included in the messages. Service suggestions showed that parents were eager for more information and had a high threshold for message reception regarding their child's surgical care. Conclusions: All parents expressed enthusiasm for a text message service during their child's tonsillectomy perioperative period. The care instructions and reminders provided to parents via automated and timed text messages may be a strategy to improve information delivery in a simple and accessible format that could empower families in their own health care. ",
doi="10.2196/14601",
url="https://periop.jmir.org/2020/1/e14601",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393931"
}


@Article{info:doi/10.2196/12028,
author="Birnie, A. Kathryn
and Campbell, Fiona
and Nguyen, Cynthia
and Lalloo, Chitra
and Tsimicalis, Argerie
and Matava, Clyde
and Cafazzo, Joseph
and Stinson, Jennifer",
title="iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="22",
volume="3",
number="2",
pages="e12028",
keywords="postoperative pain",
keywords="smartphone",
keywords="mobile applications",
keywords="mHealth",
keywords="pain management",
keywords="self-management",
keywords="adolescent",
abstract="Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care. ",
doi="10.2196/12028",
url="http://formative.jmir.org/2019/2/e12028/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008704"
}


@Article{info:doi/10.2196/11684,
author="Ashmore, Jonathan
and Di Pietro, Jerome
and Williams, Kelly
and Stokes, Euan
and Symons, Anna
and Smith, Martina
and Clegg, Louise
and McGrath, Cormac",
title="A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Apr",
day="18",
volume="2",
number="1",
pages="e11684",
keywords="virtual reality",
keywords="MRI",
keywords="anxiety",
abstract="Background: A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. Objective: The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. Methods: A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA. Results: The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. Conclusions: Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process. ",
doi="10.2196/11684",
url="http://pediatrics.jmir.org/2019/1/e11684/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518319"
}