Going to the hospital can be scary for children, especially when they must go through a painful procedure. Doctors, nurses, and other health professionals may use special distraction techniques to help take children’s minds off the pain. There is a cool new way to help distract children from painful procedures. It is called virtual reality (VR). A study was done at a children’s hospital that specializes in bone care. The researchers wanted to know if VR was easy to use at the hospital to help the children deal with pain. The study included 44 children who had different kinds of procedures done, like having a needle put in their vein, removing stitches, having blood taken, and more. The researchers concluded that VR can help. VR is fast and easy to use, almost everyone liked it, and it works. To help with pain relief, virtual reality has all the ingredients to be a recipe for success!

Osteogenesis imperfecta (OI) is a rare skeletal disorder that increases a patient's susceptibility to bone fracture. One complication commonly associated with fractures in this population is the occurrence of non-union leading to pseudoarthrosis. In this case series, three cases of non-union of the distal humerus leading to pseudoarthrosis in the pediatric OI population are presented. One case presents a successful attempt at treatment, one case presents a failed attempt at treatment, and the third case presents a patient's refusal to get treated. Furthermore, a literature review highlighting other institutions' attempts, successes, and failures at treating this clinical entity is presented. Combining the data retrieved from our institution and others, this review demonstrates that there is currently no standard for treating these patients. Additionally, based on the small case series and literature review presented in this article, definitive guidelines for the treatment of pseudoarthrosis of the distal humerus in pediatric OI patients cannot be outlined. However, our findings suggest that both non-surgical and surgical treatments could be viable options for patients with asymptomatic pseudoarthrosis of the distal humerus.

The hospital is an environment that may induce both anxiety and pain in hospitalized children and their families. The use of games and distraction offers a solution to better manage anxiety and pain. The objective of the present paper is to introduce “A Friend for Life,” a multi-platform game based on the creation of customized avatars to help children hospitalized in the hematology-oncology unit cope with their everyday pain and anxiety. This smartphone and virtual reality application uses the IKEA Effect and transmedia storytelling to improve child engagement in the game. This game was developed as part of AVATAR, a research project that combines collaborative action research with co-design. The project is led by our multidisciplinary team with relevant experience in nursing, pediatrics, hematology-oncology, and new technology. Also, our team includes a former patient and a former patient’s parent. In this paper, we introduce our serious game, “A Friend for Life”, and the collaborative development method that was used in the prototyping phase. Additionally, we will outline our hypothetical conceptual framework and its underlying concepts. Finally, we discuss the game's limitations and directions for future research.

Purpose: Three-dimensional printing has evolved into a cost-effective and accessible tool. In orthopedic surgery, creating patient-specific anatomical models and instrumentation improves visualization and surgical accuracy. In pediatric orthopedics, three-dimensional printing reduces operating time, radiation exposure, and blood loss by enhancing surgical efficacy. This review compares outcomes of three-dimensional printing–assisted surgeries with conventional surgeries for upper and lower extremity pediatric surgeries. Methods: A complete search of medical literature up to August 2023, using Ovid Medline, EMBASE, Scopus, Web of Science, and Cochrane Library was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Broad search terms included “pediatrics,” “orthopedic,” and “3D-printing.” Eligible studies were assessed for intraoperative time, blood loss, and fluoroscopy exposure. Results: Out of 3299 initially identified articles, 14 articles met inclusion criteria. These studies included 409 pediatric patients, with ages averaging 9.51 years. The majority were retrospective studies (nine), with four prospective and one experimental study. Studies primarily utilized three-dimensional printing for navigation templates and implants. Results showed significant reductions in operative time, blood loss, and radiation exposure with three-dimensional printing. Complication occurrences were generally lower in three-dimensional printing surgeries, but there was no statistical significance. Conclusions: Three-dimensional printing is an emerging technology in the field of orthopedics, and it is primarily used for preoperative planning. For pediatric upper and lower extremity surgeries, three-dimensional printing leads to decreased operating room time, decreased intraoperative blood loss, and reduced radiation exposure. Other uses for three-dimensional printing include education, patient communication, the creation of patient-specific instrumentation and implants. Level of evidence: Level III

BACKGROUND:Innovative approaches are needed to address the self-management needs of youths with osteogenesis imperfecta (OI) transitioning into adult-oriented health care systems. Using a sequentially phased research approach, the goal is to design, develop, and test the usability of an innovative eHealth program called "Teens Taking Charge: Managing OI Online," hereafter named "Teens OI." This program seeks to optimize self-management, facilitate a successful transition to adult care, and address a critical gap in the quality of care for youths with OI.OBJECTIVE:The study objectives are to (1) design and develop an English and French version of the Teens OI and (2) test the usability of the Teens OI in terms of efficiency, effectiveness, and satisfaction from the perspectives of youths with OI and their parents.METHODS:A user-centered design is presently in progress to design and develop Teens OI. A "Website Design and Development Council" (ie, Council) has been convened, with 20 youths and parent dyads recruited and global experts surveyed at an international meeting. With unanimous support from the Council, usability testing of the Teens OI will ensue in 4 iterative cycles with 32 youth-parent dyads. All sociodemographic and usability metrics will be descriptively analyzed. All recorded interview and focus group data are analyzed using content analysis techniques involving an iterative process of data reduction, data display, conclusion drawing, and verification.RESULTS:As of December 2022, an 8-person, interdisciplinary Teens OI council, comprising 4 health care professionals, 3 youths and young adults with OI, and 1 parent, has been convened to oversee the design and development of Teens OI. Two cycles of interviews have been conducted with 10 youths with OI with or without their parents (n=6) from December 2021 to September 2022. Data analysis has been in progress since April 2022. Aim 2 is ethically approved and will commence following the completion of content development, expected by late July 2023. Preliminary analysis indicates that the following topics need to be prioritized for the youths: mental health, pain, accessibility, medical care, education, community, and parental care.CONCLUSIONS:The proposed study will design and develop a self-management and transitional care program for youths with OI in partnership with patients, caregivers, and health care professionals. This study leverages youths' openness to adopt eHealth technologies to meet their needs and has the potential to actively engage them to autonomously manage their lifelong conditions, and facilitate a successful transition to adult health care. Finally, the proposed study will also address a critical gap in the quality of care and the growing concern that the OI population transitioning from pediatric to adult care is at risk of various adverse events associated with the transition.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/47524.

AIMS This integrative review aimed to identify, analyse and synthesise studies investigating the clinical efficacy of virtual reality (VR) distraction for children undergoing varying painful and anxiety-inducing medical procedures across different hospital settings and to identify implications for research and clinical practice. BACKGROUND Virtual reality has been leveraged as a distraction tool in the healthcare setting to help patients manage procedural pain and anxiety. Initial studies in the burn wound care setting using VR as a non-pharmacological analgesia led to the use of VR during other medical procedures. DESIGN An integrative review of the literature was conducted following the PRISMA guidelines across four electronic databases. Published studies between 2000 and 2020 investigating the clinical efficacy of VR in managing paediatric procedural pain or anxiety were included for review. RESULTS Reviewed studies collectively included 2,174 patients aged 6 months-18 years used VR during burn wound care, post-burn physiotherapy, dental, needle-related and other procedures. Additionally, ten studies included samples with adults, for which paediatric data could not be isolated (n = 507). Overall, studies supported the efficacy of VR in managing procedural pain and anxiety in the paediatric setting. CONCLUSION Virtual reality is redefining pain management by immersing children in a virtual world, reducing pain and anxiety at the hospital. A notable gap was the neglected use of VR in children with chronic conditions receiving orthopaedic procedures as part of their standard care. RELEVANCE TO CLINICAL PRACTICE Ultimately, VR distraction will reduce the fear associated with medical interventions, preventing increased pain sensitivity, exacerbated anxiety and healthcare avoidance in adulthood. Nurses will play an important role in ensuring the smooth integration of VR in clinical practice by championing the technology and transferring evidence-based methods for VR use.

Medical procedures cause pain and anxiety in children. Distraction techniques, including virtual reality (VR), may be used in healthcare settings to reduce rates of undertreated procedural pain and anxiety. A mixed-methods, concurrent triangulation design was piloted at a pediatric orthopedic hospital to assess the feasibility, clinical utility, tolerability, and initial clinical efficacy of VR distraction during medical procedures received by patients with complex musculoskeletal conditions. Questionnaire, scale, interview, observation, and focus group data were collected from patients, their parents, and healthcare professionals. Triangulation of key quantitative and qualitative findings produced final themes and meta-themes. A total of 44 patients and their parents undergoing intravenous insertions (n = 30), pin removals (n = 7), blood draws (n = 3), Botox injections (n = 2), dressing change (n = 1), and urodynamic test (n = 1) were recruited along with 11 healthcare professionals performing the medical procedures. The following themes resulted from triangulation of data sources: VR intervention was (a) feasible because VR was easily implemented into the clinical workflow, (b) clinically useful as VR was accepted by stakeholders and easy to use, (c) tolerable as VR caused minimal discomfort, and (d) showed initial clinical efficacy in managing procedural pain and anxiety. These findings will inform policies and procedures for VR use in practice and a sustainable implementation across the [name of hospital removed for peer review] network.

Background: Children with osteogenesis imperfecta (OI) live in fear of fracturing a bone. As fractures are unpredictable, there is a need for tools and knowledge to immobilize a fracture during emergencies. Inspired by a patient recognized in their local OI community for fracture management, the aim of this patient-initiated project was to establish best practices for the safe handling of fractures, including the creation of an evidence-informed OI Splint Kit. Methods: A systematic review of the literature was conducted to identify kits and tools used to immobilize fractures during emergencies. An expert Task Force consisting of patients, clinicians, and decision makers was conjured to review the synthesized results. Priorities were delineated and a timeline was established to create the OI Splint Kit. The prototype underwent iterative cycles of modifications based on feedback from the Task Force. Results: Four electronic data bases were searched (Medline, CINHAL, PsychInfo, and Scopus), revealing zero publications pertaining to kits for fracture immobilization. The Task Force used their clinical expertise and patient experiences to develop the OI Splint Kit. The following items were included: splinting tools, bilingual educational material, instructional cards, video tutorials, and a memory card game. Conclusion: A gap remains in validated kits to assist in fracture immobilization during emergencies. A tangible and practical OI Splint Kit was developed to fulfill this need, based on inter-professional clinical expertise and patient experiential knowledge. The kit is subject to rigorous testing and ongoing quality evaluations, ensuring it will be suitable for use in various contexts.

Osteogenesis imperfecta (OI) is a rare genetic disorder of the bones caused by a mutation in Type I collagen genes. As adults with OI are aging, medical concerns secondary to OI may arise. This integrative review sought to review, appraise, and synthesize the clinical manifestations faced by adults with OI. Four electronic bibliographic databases were searched. Published quantitative, qualitative, and mixed-methods studies, as well as case reports from 2000 to March 2019, addressing a clinical manifestation in adulthood, were reviewed. Eligible studies and case reports were subsequently appraised using the Mixed Methods Appraisal Tool and Case Report Checklist, respectively. Twenty quantitative studies and 88 case reports were included for review regardless of the varying methodological quality score. These studies collectively included 2,510 adults with different OI types. Several clinical manifestations were studied, and included: hearing loss, cardiac diseases, pregnancy complications, cerebrovascular manifestations, musculoskeletal manifestations, respiratory manifestations, vision impairment, and other clinical manifestations. Increased awareness may optimize prevention, treatment, and follow-up. Opportunities to enhance the methodological quality of research including better design and methodology, multisite collaborations, and larger and diverse sampling will optimize the generalizability and transferability of findings.

AIMS:To examine the efficacy of an immersive virtual reality distraction compared with an active non-immersive distraction, such as video games on a tablet, for pain and anxiety management and memory of pain and anxiety in children requiring percutaneous bone pins and/or suture removal procedures.DESIGN:Three-centre randomized clinical trial using a parallel design with two groups: experimental and control.METHODS:Study to take place in the orthopaedic department of three children hospital of the Montreal region starting in 2019. Children, from 7-17 years old, requiring bone pins and/or suture removal procedures will be recruited. The intervention group (N = 94) will receive a virtual reality game (Dreamland), whereas the control group (N = 94) will receive a tablet with video games. The primary outcomes will be both the mean self-reported pain score measured by the Numerical Rating Scale and mean anxiety score, measured by the Child Fear Scale. Recalls of pain and anxiety will be measured 1 week after the procedure using the same scales. We aim to recruit 188 children to achieve a power of 80% with a significance level (alpha) of 5%.DISCUSSION:While multiple pharmacological methods have previously been tested for children, no studies have evaluated the impact of immersive virtual reality distraction for pain and anxiety management in the orthopaedic setting.IMPACT:Improved pain management can be achieved using virtual reality during medical procedures for children. This method is innovative, non-pharmacological, adapted to the hospital setting, and user-friendly.TRIAL REGISTRATION:NCT03680625, registered on clinicaltrials.gov.