Background Hospitalized children face pain and anxiety associated with the environment and procedures. Objective This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible. Methods Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies. Results A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety. Conclusion Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.

Background The hospital can provoke significant feelings of pain, fear, and anxiety in children. Being in a new setting, often separated from loved ones and undergoing multiple medical procedures may elicit negative emotions. Complementary treatments may minimize these feelings and facilitate a more positive experience for children in hospital. Objectives This systematic review aims to explore the impact of music, play, pet, and art therapy on pain and anxiety in paediatric patients in hospital. Design/Methods Databases MEDLINE, CINAHL, Cochrane Library, and EMBASE were searched from database inception to November 2020 and reference lists were screened. Randomized control trials (RCTs) of paediatric patients evaluating the impact of music, pet, play, and/or art therapy on pain and/or anxiety were eligible for inclusion. Study setting was limited to the hospital (inpatient/outpatient) and/or emergency department. No restrictions were placed on the comparator. Duplicate studies were removed, and abstract and full-text screening was completed independently and in duplicate by reviewers. Reviewers extracted data from eligible studies into predeveloped REDCap forms independently and in duplicate. A narrative synthesis was used to summarize study findings using the synthesis without meta-analysis (SWiM) guidelines. Quality of evidence was then assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies for each intervention and outcome. Results 761 documents were identified and 30 RCTs were included, covering music (n=15), play (n=13), and pet (n=3) therapy. One study examined music and play therapy. No art therapy studies were identified. Studies took place in the inpatient setting (n=18), outpatient setting (n=5), a combination of both inpatient and outpatient (n=3), and the emergency department (n=4). Most studies (n=25, 83%) evaluated patients’ pain and/or anxiety before, during, and/or after undergoing procedures in hospital such as surgery, venipuncture, and imaging. There was high certainty of evidence for play therapy in reducing pain and moderate certainty for music and pet therapy. Moderate certainty of evidence supported music and play therapy in reducing anxiety; however, pet therapy was found to have little to no significant difference. None of the interventions were found to increase pain or anxiety. Conclusion Complementary therapies such as music, play, and pet therapy should be utilized in parallel to medical treatments in paediatric patients receiving care in hospital to mitigate pain and anxiety in addition to promoting a positive hospital experience.

Introduction: Venous thromboembolism (VTE) is one of the leading causes of morbidity and mortality during pregnancy and the postpartum periods. Despite that, the prevention and management of VTEs in pregnant patients remains an area of great debate, particularly among those with a personal VTE history. There is no solid evidence behind the current practice guidelines on the prevention of VTE in pregnancy as most data comes from studies focusing on non-pregnant patients or from small studies. It has been suggested that without low molecular weight heparin (LMWH) thromboprophylaxis, women with a personal history of VTE may have a 2% to 10% absolute risk of developing recurrent VTE during a subsequent pregnancy. We conducted a systematic review to evaluate the risk of VTE recurrence during pregnancy for pregnant patients with prior personal history of VTE and the effect of LMWH on such risk. Materials and Methods: MEDLINE and EMBASE were searched between January 2000 to December 2020. We included studies that evaluated pregnant patients with previous personal VTE history (deep vein thrombosis (DVT) and pulmonary embolism (PE) only) that assessed venous thromboembolism recurrence and/or bleeding complication and/or pregnancy outcomes. Study selection and data extraction was conducted by 3 reviewers and discrepancies resolved by consensus. A meta-analysis of proportions was done through a Freeman-Tukey transformation using random effect models. Groups were analyzed according to prophylaxis strategy. Heterogeneity between studies was assessed by Cochrane Q and Higgins I 2 analyses. Publication bias was assessed using Eggers' tests and funnel plot. Results. Of 6934 potential studies, 27 were included in this systematic review. The studies included 3631 pregnant patients with a previous history of DVT or PE, regardless of the presence of thrombophilia. We found a wide variability in thromboprophylaxis practices which included mostly low molecular weight heparin using weight-based, risk category-based, anti-Xa based, fixed, or trimester-adjusted doses . In studies that categorized patients into provoked, estrogen associated and unprovoked, most patients had an estrogen-associated previous VTE. The estimated pooled proportions of VTE recurrence were 2.7% (95% CI 1.8-3.7; I 2 55.5%) in patients who were consistently on anticoagulation during pregnancy (pre- and post-partum), 2.6% (95% CI 0.6-5.9; I 2 not estimable) in patients who received anticoagulation in the postpartum period only, and 25.3% (95% CI 8.9-46.6; I 2 93.2%) in patients who were not on anticoagulation. No comparison could be done on the different dosage strategies due to the limited number of studies and wide variety of strategies. Due to limited data available, bleeding complications and pregnancy outcomes could not be assessed. Conclusion. In patients with a previous VTE history receiving prophylactic anticoagulation (either both pre- and post-partum or post-partum only), the estimates of VTE recurrence were significantly lower than that for patients who did not receive prophylaxis, however, a direct comparison was not possible. The optimal thromboprophylaxis strategy remains unknown. Disclosures No relevant conflicts of interest to declare.

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Background and Aims Treatment options for proctitis are limited. To assist trial design for novel therapeutics, we conducted a systematic review and meta-analysis of proctitis randomized controlled trials (RCTs) to quantify placebo rates and identify factors influencing them. Methods We searched MEDLINE, EMBASE and CENTRAL from inception to June 2021. Placebo-controlled trials of pharmacological interventions for proctitis were eligible. Placebo clinical response and remission rates for induction and maintenance trials were extracted and pooled using a random-effects model. Mixed-effects meta-regression was used to evaluate the impact of patient and study-level characteristics. Results Twenty RCTs (17 induction and 4 maintenance phases) were included. The most common intervention was aminosalicylates and most studies investigated topical medications. The pooled placebo clinical response and remission rates for induction trials were 28% (95% CI 22-35%; n=17) and 20% (95% CI 12-32%; n=9), respectively. Pooled placebo endoscopic response and remission rates were 32% (95% CI 26-39%, n=12) and 18% (95% CI 9-33%, n=6), respectively. For maintenance trials, the pooled placebo clinical remission rate was 29% (95% CI 16-46%, n=17). Trials published after 2005 and trials with a longer duration of follow-up were associated with significantly lower placebo response rates. Nineteen of 20 studies were assessed as unclear risk of bias reflecting the historical nature of trials. Conclusions Placebo response and remission rates in proctitis trials are influenced by trial phase and the endpoint being assessed. These contemporary rates will inform trial design for novel therapeutics for treatment of proctitis, which is a large unmet need.