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Importance: The inclusion of digital therapeutics (eg, virtual reality [VR] systems) for the management of pain and anxiety associated with routine acutely painful medical procedures may have a substantial impact on treatment adherence and improve long-term health outcomes among young patients., Objective: To determine whether a VR intervention decreases pain and anxiety among patients undergoing peripheral intravenous catheter (PIVC) placement compared with standard care in the pediatric setting., Design, Setting, and Participants: This randomized clinical trial was conducted from April 12, 2017, to July 24, 2019, among 107 patients aged 10 to 21 years who were undergoing PIVC placement in 2 clinical settings (a radiology department and an infusion center) at an urban pediatric academic medical center in the US. Patients, caregivers, and clinicians completed pre-PIVC and post-PIVC placement questionnaires measuring patient pain, anxiety, and anxiety sensitivity; only participants with complete data from before and after PIVC placment were included in the analyses., Interventions: Patients were randomized to receive standard care (simple distraction techniques [eg, music, coloring, singing, and talking] and the application of numbing cream) or a VR intervention using a balanced computer-generated randomization scheme stratified by sex. All patients who received the VR intervention were offered concurrent standard care; however, VR plus standard care was not specifically examined., Main Outcomes and Measures: Primary outcomes were patient pain (measured by the Faces Pain Scale-Revised) and anxiety (measured by a visual analogue scale) reported by the patient, caregiver, and clinician after PIVC placement. Outcomes were analyzed using generalized linear modeling with backward stepwise selection for final model building., Results: A total of 107 patients (median age, 14.7 years [interquartile range, 12.8-16.9 years]; 63 male participants [58.9%]) completed the clinical trial; 54 patients received standard care, and 53 patients also received the VR intervention. Patients who received the VR intervention compared with standard care had significantly lower mean post-PIVC anxiety scores when patient-reported (1.85 points [95% CI, 1.28-2.41 points] vs 3.14 points [95% CI, 2.59-3.68 points]; P < .001) and clinician-reported (2.04 points [95% CI, 1.37-2.71 points] vs 3.34 points [95% CI, 2.69-3.99 points]; P = .002). Patients in the VR group vs the standard care group also had significantly lower mean post-PIVC pain scores when patient-reported (1.34 points [95% CI, 0.63-2.05 points] vs 2.54 points [95% CI, 1.78-3.30 points]; P = .002), caregiver-reported (1.87 points [95% CI, 0.99-2.76 points] vs 3.01 points [95% CI. 1.98-4.03 points]; P = .04), and clinician-reported (2.05 points [95% CI, 1.47-2.63 points] vs 3.59 points [95% CI, 2.97-4.22 points]; P < .001). Aside from lower levels of baseline pain and anxiety, no demographic variables among patients in the VR group were associated with lower levels of post-PIVC pain and anxiety., Conclusions and Relevance: In this randomized clinical trial, patients undergoing PIVC placement who received a VR intervention experienced significantly less anxiety and pain compared with those who received standard care. The use of patient, caregiver, and clinician data provided a variety of subjective information, as well as observable and objective data regarding perceived pain and anxiety beyond patient reporting alone., Trial Registration: ClinicalTrials.gov Identifier: CHLA-15-00549.

Background: Pain is a primary reason for medical cannabis use among young adults, however little is known about the patterns of pain in this group. This study identified pain profiles among young adult cannabis users and examined related antecedents and distal outcomes., Methods: Past 30-day cannabis users aged 18-26, both medical cannabis patients and non-patients, were enrolled in Los Angeles in 2014-2015. A latent class analysis was used to identify pain classes based on history of chronic pain conditions and recent non-minor pain. The study assessed the predictors of membership in pain classes and examined the association of classes with recent mental health characteristics, cannabis use motives and practices., Results: Three classes were identified: Low pain (56.3%), Multiple pain (27.3%), and Nonspecific pain (16.4%). In adjusted models, lifetime insomnia was associated with membership in Multiple pain and Nonspecific pain classes versus the Low pain class. Medical cannabis patients and Hispanics/Latinos were more likely to belong to the Multiple pain class than the other classes. Regarding recent outcomes, the Multiple pain and Nonspecific pain classes were more likely than the Low pain class to use cannabis to relieve physical pain. Additionally, the Multiple pain class had a higher probability of psychological distress, self-reported medical cannabis use, consuming edibles, and using cannabis to sleep compared to one or both other classes., Conclusion: Findings suggest that young adult cannabis users can be separated into distinct groups with different pain profiles. The Multiple pain profile was associated with medically-oriented cannabis use motives and practices.

The relationship between neighborhood/individual characteristics and pediatric intensive care unit (PICU) outcomes is largely unexplored. We hypothesized that individual-level racial/ethnic minority status and neighborhood-level low socioeconomic status and minority concentration would adversely affect children's severity of illness on admission to the PICU. Retrospective analyses (1/1/2007-5/23/2011) of clinical, geographic, and demographic data were conducted at an academic, tertiary children's hospital PICU. Clinical data included age, diagnosis, insurance, race/ethnicity, Pediatric Index of Mortality 2 score on presentation to the PICU (PIM2), and mortality. Residential addresses were geocoded and linked with 2010 US Census tract data using geographic information systems geocoding techniques. Repeated measures models to predict PIM2 and mortality were constructed using three successive models with theorized covariates including the patient's race/ethnicity, the predominant neighborhood racial/ethnic group, interactions between patient race/ethnicity and neighborhood race/ethnicity, neighborhood socioeconomic status, and insurance type. Of the 5,390 children, 57.8% were Latino and 70.1% possessed government insurance. Latino children (β = 0.31; p < 0.01), especially Latino children living in a Latino ethnic enclave (β = 1.13; p < 0.05), had higher PIM2 scores compared with non-Latinos. Children with government insurance (β = 0.29; p < 0.01) had higher PIM2 scores compared to children with other payment types and median neighborhood income was inversely associated with PIM2 scores (β = -0.04 per $10,000/year of income; p < 0.05). Lower median neighborhood income, Latino ethnicity, Latino children living in a predominantly Latino neighborhood, and children possessing government insurance were associated with a higher severity of illness on PICU admission. The reasons why these factors affect critical illness severity require further exploration.

Stress can have detrimental effects on nurse residents' levels of job satisfaction, compassion, fatigue, and burnout. This can lead to high turnover rates and poor quality of care among novice nurses. Therefore, it is critical to identify protective factors to prevent the onset of negative nurse outcomes (compassion fatigue, burnout, and job dissatisfaction) and to promote positive nurse outcomes (job satisfaction, compassion satisfaction). This study aimed to determine whether factors such as group cohesion and organizational commitment would be protective and moderate the association between stress exposure and posttraumatic stress symptoms and other negative nurse outcomes, thus facilitating positive outcomes. Findings showed that group cohesion was effective in moderating the negative effects of current stress exposure and posttraumatic stress symptoms on negative nurse outcomes, specifically on increased compassion fatigue and burnout, and reduced compassion satisfaction. In addition, organizational commitment was determined to promote positive nurse outcomes such as job satisfaction and compassion satisfaction. The study findings are promising, as retention of quality nurses is a significant problem for hospitals. Nurse managers and hospital administrators should be aware of the benefits of group cohesion and organizational commitment and strive to make the promotion of these factors a priority., (Copyright © 2014 Elsevier Inc. All rights reserved.)

March of the Living (MOTL) is a worldwide two-week trip for high school seniors to learn about the Holocaust by traveling to sites of concentration/death camps and Jewish historical sites in Poland and Israel. The mission statement of MOTL International states that participants will be able to "bolster their Jewish identity by acquainting them with the rich Jewish heritage in pre-war Eastern Europe." However, this claim has never been studied quantitatively. Therefore, 152 adolescents who participated in MOTL voluntarily completed an initial background questionnaire, a Jewish Identity Survey and a Global Domains Survey pre-MOTL, end-Poland and end-Israel. Results suggest that Jewish identity did not substantially increase overall or from one time period to the next.

Objective: To determine the relationship between stress indicators and state anxiety among pediatric emergency department (ED) patients, as a background to develop appropriate psychoeducational and behavioral interventions., Methods: Patients with nonchronic conditions aged 10 to 18 years completed questionnaires assessing demographics; (8) life stressors (LSs), such as death in family and marital separation/divorce; (10) anticipatory stressors (ASs) such as fear of needles, blood, or undressing; and the State Trait Anxiety Inventory for Children (a 20-item validated tool)., Results: One hundred patients completed the study: the mean age was 13.3 years; 56% were female; and 90% were Latino patients. Notable life stressors (mean, 1.83) included: change in school location (24%), change in school performance (29%), death in family (33%), and marital separation/divorce (48%). Common AS (mean, 4.76) included worry about shots (33%), strangers (41%), talking about personal problems (44%), separation from parents (51%), undressing (56%), hospitalization (57%), and pain (73%). Significant correlations were found between age and state anxiety (r, -0.21; P < 0.05), age and AS (r, -0.38; P < 0.001), and AS and state anxiety (r, 0.20; P < 0.05). Patients with clinical state anxiety (36%) were more likely to be in the ED with a complaint of pain and/or trauma, had significantly more AS (t, 2.1; P < 0.05), and worry about parental separation (χ, 5.5; P < 0.05) and blood tests (χ, 4.9; P < 0.05) than patients with subclinical state anxiety., Conclusions: The ED experience produces fear/anxiety, particularly in younger patients with a chief complaint of pain and/or trauma. Findings may lead to the development of psychoeducational and behavioral interventions that focus on anxiety reduction.

Objectives: Chronic pain and fatigue are common physical complaints among children and adolescents. Both symptoms can interfere considerably with daily life by affecting sleep and eating habits, engagement in physical and social activities, and school participation. The aim of this study was to examine the potential mediational role of fatigue in the relationship between pain and children's school functioning and overall health-related quality of life (HRQOL)., Methods: Children seeking outpatient pain management services at two urban children's hospitals were recruited for this study. The combined sample includes 80 children and adolescents between the ages of 8 and 18 years (M=13.89, SD=2.57), 72.5% female, and their caregivers. The Pediatric Quality of Life Inventory (PedsQL 4.0) was used to assess HRQOL and the related PedsQL Multidimensional Fatigue Scale provided a comprehensive measure of fatigue., Results: On the basis of Preacher and Hayes' mediation model (2004), fatigue functioned as a mediator between pain and overall HRQOL on the basis of both self and caregiver proxy reports. Fatigue functioned as a mediator between pain and school functioning on the basis of the caregiver proxy report only. Additionally, moderate relationships were found between self and caregiver proxy reports of HRQOL and fatigue, although children self-reported less fatigue, better school functioning, and greater quality of life than did their caregivers., Discussion: Findings demonstrated that fatigue is a significant problem for many youth with chronic pain and may be an important target for clinical intervention.