疫苗注射的过程干预措施：随机对照试验和半随机对照试验的系统评价
Process Interventions for Vaccine Injections: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials.
作者信息
Pillai Riddell Rebecca, Taddio Anna, McMurtry C Meghan, Shah Vibhuti, Noel Melanie, Chambers Christine T
机构信息
*Department of Psychology, York University †Department of Psychiatry, the Hospital for Sick Children ‡Department of Psychiatry, University of Toronto §§Departement of Neonatology ∥Child Health and Evaluative Sciences, Hospital for Sick Children §Leslie Dan Faculty of Pharmacy, University of Toronto ‡‡Faculty of Medicine, University of Toronto ††Mount Sinai Hospital, Toronto ¶Department of Psychology, University of Guelph, Guelph #Children's Health Research Institute, Children's Hospital **Department of Paediatrics, Western University, London, ON ¶¶Department of Pediatrics and Psychology, Faculty of Science, Dalhousie University ##IWK Health Centre, Halifax, NS, Canada ∥∥Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.
出版信息
Clin J Pain. 2015 Oct;31(10 Suppl):S99-108. doi: 10.1097/AJP.0000000000000280.
BACKGROUND
This systematic review evaluated the effectiveness of process interventions (education for clinicians, parent presence, education of parents [before and on day of vaccination], and education of patients on day of vaccination) on reducing vaccination pain, fear, and distress and increasing the use of interventions during vaccination.
DESIGN/METHODS: Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Critical outcomes were pain, fear, distress (when applicable), and use of pain management interventions. Data were extracted according to procedure phase (preprocedure, acute, recovery, combinations of these) and pooled using established methods. Analyses were conducted using standardized mean differences (SMD) and risk ratios (RR).
RESULTS
Thirteen studies were included. Results were generally mixed. On the basis of low to very low-quality evidence, the following specific critical outcomes showed significant effects suggesting: (1) clinicians should be educated about vaccine injection pain management (use of interventions: SMD 0.66; 95% confidence interval [CI]: 0.47, 0.85); (2) parents should be present (distress preprocedure: SMD -0.85; 95% CI: -1.35, -0.35); (3) parents should be educated before the vaccination day (use of intervention preprocedure: SMD 0.83; 95% CI: 0.25, 1.41 and RR, 2.08; 95% CI: 1.51, 2.86; distress acute: SMD, -0.35; 95% CI: -0.57, -0.13); (4) parents should be educated on the vaccination day (use of interventions: SMD 1.02; 95% CI: 0.22, 1.83 and RR, 2.42; 95% CI: 1.47, 3.99; distress preprocedure+acute+recovery: SMD -0.48; 95% CI: -0.82, -0.15); and (5) individuals 3 years of age and above should be educated on the day of vaccination (fear preprocedure: SMD -0.67; 95% CI: -1.28, -0.07).
CONCLUSIONS
Educating individuals involved in the vaccination procedure (clinicians, parents of children being vaccinated; individuals above 3 y of age) is beneficial to increase use of pain management strategies, reduce distress surrounding with vaccination, and to reduce fear. When possible, parent presence is also recommended for children undergoing vaccination.
背景
本系统评价评估了过程干预措施（对临床医生的教育、家长陪伴、对家长的教育[接种疫苗前及接种当天]以及对患者接种当天的教育）在减轻接种疫苗时的疼痛、恐惧和痛苦以及增加接种过程中干预措施使用方面的效果。
设计/方法：采用广泛的检索策略对数据库进行检索，以识别相关的随机和半随机对照试验。关键结局指标为疼痛、恐惧、痛苦（如适用）以及疼痛管理干预措施的使用情况。根据程序阶段（程序前、急性阶段、恢复阶段、这些阶段的组合）提取数据，并使用既定方法进行汇总。采用标准化均数差（SMD）和风险比（RR）进行分析。
结果
纳入了13项研究。结果总体不一。基于低至极低质量的证据，以下特定关键结局显示出显著效果，表明：（1）应对临床医生进行疫苗注射疼痛管理方面的教育（干预措施的使用：SMD 0.66；95%置信区间[CI]：0.47，0.85）；（2）家长应陪伴（程序前痛苦：SMD -0.85；95%CI：-1.35，-0.35）；（3）应在接种疫苗前对家长进行教育（程序前干预措施的使用：SMD 0.83；95%CI：0.25，1.41；RR为2.08；95%CI：1.51，2.86；急性阶段痛苦：SMD，-0.35；95%CI：-0.57，-0.13）；（4）应在接种当天对家长进行教育（干预措施的使用：SMD 1.02；95%CI：0.22，1.
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