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Available from: Rebecca R Pillai Riddell, Oct 14, 2014

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Article: Reducing the pain of childhood vaccination: An evidence-based clinical practice guideline

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    • "c o m / l o c a t e / p a i n PAIN Ò 155 (2014) 1288–1292 According to the Knowledge-to-Action Framework [5], successful translation of research knowledge is based on development of knowledge tools that are subsequently customized and implemented within the local context. We developed a clinical practice guideline for vaccination pain management with accompanying educational resources, including a fact sheet and video [15]. We subsequently tailored and pilot-tested these resources with new parents [22]. "
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    ABSTRACT: Educating parents about ways to minimize pain during routine infant vaccine injections at the point of care may positively impact on pain management practices. The objective of this cluster randomized trial was to determine the impact of educating parents about pain in outpatient pediatric clinics on their use of pain treatments during routine infant vaccinations. Four hospital-based pediatric clinics were randomized to intervention or control groups. Parents of 2- to 4-month-old infants attending the intervention clinics reviewed a pamphlet and a video about vaccination pain management on the day of vaccination, whereas those in the control clinics did not. Parent use of specific pain treatments (breastfeeding, sugar water, topical anesthetics, and/or holding of infants) on the education day and at subsequent routine vaccinations 2 months later was the primary outcome. Altogether, 160 parent-infant dyads (80 per group) participated between November 2012 and February 2014; follow-up data were available for 126 (79%). Demographics did not differ between groups (P > 0.05). On the education day and at follow-up vaccinations, use of pain interventions during vaccinations was higher in the intervention group (80% vs 26% and 68% vs 32%, respectively; P < 0.001 for both analyses). Educating parents about pain management in a hospital outpatient setting leads to higher use of pain interventions during routine infant vaccinations.
    Pain 01/2015; 156(1):185-91. DOI:10.1016/j.pain.0000000000000021 · 5.21 Impact Factor
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    • "According to the Knowledge-to-Action Framework (7), the successful translation of research knowledge is based on the development of knowledge tools, such as clinical practice guidelines (CPGs), and their subsequent customization and implementation within the local context. To begin to address the identified knowledge-to-care gap in childhood vaccination pain management, we developed a CPG with recommendations for managing vaccination pain (8). We subsequently tailored and pilot-tested the CPG in different vaccination settings, including school-based public health immunization clinics. "
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    ABSTRACT: BACKGROUND:Analgesic interventions are not commonly administered during childhood vaccination, despite the fact that two-thirds of children are afraid of needles and one-tenth are noncompliant with immunization.OBJECTIVE:To explore children’s experiences of vaccination and preferences for analgesia.METHODS:A total of 17 children (four to 14 years of age) at an independent school in Toronto (Ontario) participated in three focus-group interviews. The majority had previous experience with pain management interventions during vaccination. Thematic content analysis was used to analyze interview transcripts.RESULTS:The findings were categorized into three main themes: experience of vaccination; roles and responsibilities regarding pain management; and impact of pain management. Children easily recalled previous vaccinations and discussed fear and distress experienced by themselves and others. Children believed that parents and immunizers should prepare them ahead of time and use interventions to manage and monitor pain. They also wanted adults to support their efforts to lead pain management. Children discussed benefits of managing pain, including reduced unnecessary suffering, improved vaccination experience, reduced risk of developing needle fears and reduced noncompliant behaviours. They were knowledgeable about strategies for reducing pain including distraction, topical anesthetics and injection techniques. They contrasted vaccination with and without pain management, and indicated a preference for pain management.CONCLUSION:Children reported that managing vaccination pain is important and that analgesic interventions should routinely be used. Incorporating pain management in the process of vaccination has the potential to improve children’s experiences with vaccination and promote more positive attitudes and behaviours.
    The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada 07/2014; 25(4):196-200. · 0.69 Impact Factor
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    • "We found that most infants were highly distressed during the injections. This is disappointing given that strong evidence clearly shows the pain-reducing effects of breastfeeding infants [18-20,35], sweet solutions [17,36], using nurse/clinician-led distraction and upright holding [3,22,23] and given the work that has gone into translating this knowledge to the public and health care profession [3,37]. It is however possible that the pain control measures apparent during vaccinations as seen in the posted videos are not representative of all vaccinations, as the act of videotaping precludes holding the infant, breastfeeding or administering sucrose unless a tripod or third party is available to operate the camera. "
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    ABSTRACT: Background Early childhood immunizations, although vital for preventative health, are painful and too often lead to fear of needles. Effective pain management strategies during infant immunizations include breastfeeding, sweet solutions, and upright front-to-front holding. However, it is unknown how often these strategies are used in clinical practice. We aimed to review the content of YouTube videos showing infants being immunized to ascertain parents’ and health care professionals’ use of pain management strategies, as well as to assess infants’ pain and distress. Methods A systematic review of YouTube videos showing intramuscular injections in infants less than 12 months was completed using the search terms "baby injection" and "baby vaccine" to assess (1) the use of pain management strategies and (2) infant pain and distress. Pain was assessed by crying duration and pain scores using the FLACC (Face, Legs, Activity, Cry, Consolability) tool. Results A total of 142 videos were included and coded by two trained individual viewers. Most infants received one injection (range of one to six). Almost all (94%) infants cried before or during the injections for a median of 33 seconds (IQR = 39), up to 146 seconds. FLACC scores during the immunizations were high, with a median of 10 (IQR = 3). No videos showed breastfeeding or the use of sucrose/sweet solutions during the injection(s), and only four (3%) videos showed the infants being held in a front-to-front position during the injections. Distraction using talking or singing was the most commonly used (66%) pain management strategy. Conclusions YouTube videos of infants being immunized showed that infants were highly distressed during the procedures. There was no use of breastfeeding or sweet solutions and limited use of upright or front-to-front holding during the injections. This systematic review will be used as a baseline to evaluate the impact of future knowledge translation interventions using YouTube to improve pain management practices for infant immunizations.
    BMC Pediatrics 05/2014; 14(1):134. DOI:10.1186/1471-2431-14-134 · 1.93 Impact Factor
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