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The aim of this pilot study was to assess: (1) the feasibility and acceptability of a Mindfulness-Based Virtual Reality (MBVR) intervention among children and young adults with Inflammatory Bowel Disease (IBD), and (2) the preliminary efficacy of MBVR on key psychological (anxiety) and physical (pain) outcomes. Participants were 62 children to young adults with IBD (M = 15.6 years; 69.4% Crohn’s disease; 58% male) recruited from an outpatient pediatric IBD clinic. Participants completed a baseline assessment, underwent the 6-min MBVR intervention, completed a post-intervention assessment and study satisfaction survey, and provided qualitative feedback. Results suggest strong feasibility and acceptability. Participants reported high levels of satisfaction with MBVR including high levels of enjoyment (M = 4.38; range 1–5) and relaxation (M = 4.35; range 1–5). Qualitative data revealed several key themes including participants interest in using MBVR in IBD medical settings (e.g., hospitalizations, IBD procedures, IBD treatments), as well as in their daily lives to support stress and symptom management. Preliminary analyses demonstrated improvements in anxiety (t = 4.79, p = 0.001) and pain (t = 3.72, p < 0.001) following MBVR. These findings provide initial support for the feasibility and acceptability of MBVR among children and young adults with IBD. Results also suggest MBVR may improve key IBD outcomes (e.g., anxiety, pain) and highlight the importance of conducting a randomized controlled trial and more rigorous research to determine intervention efficacy.
Anava Wren; Nicole Neiman; Thomas Caruso; Samuel Rodriguez; Katherine Taylor; Martine Madill; Hal Rives; Linda Nguyen. Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study. Children 2021, 8, 368 .
AMA StyleAnava Wren, Nicole Neiman, Thomas Caruso, Samuel Rodriguez, Katherine Taylor, Martine Madill, Hal Rives, Linda Nguyen. Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study. Children. 2021; 8 (5):368.
Chicago/Turabian StyleAnava Wren; Nicole Neiman; Thomas Caruso; Samuel Rodriguez; Katherine Taylor; Martine Madill; Hal Rives; Linda Nguyen. 2021. "Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study." Children 8, no. 5: 368.
Inflammatory Bowel Disease (IBD) is a chronic and relapsing inflammatory disorder of the gastrointestinal tract
Anava Wren; Michele Maddux. Integrated Multidisciplinary Treatment for Pediatric Inflammatory Bowel Disease. Children 2021, 8, 169 .
AMA StyleAnava Wren, Michele Maddux. Integrated Multidisciplinary Treatment for Pediatric Inflammatory Bowel Disease. Children. 2021; 8 (2):169.
Chicago/Turabian StyleAnava Wren; Michele Maddux. 2021. "Integrated Multidisciplinary Treatment for Pediatric Inflammatory Bowel Disease." Children 8, no. 2: 169.
Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.
Anava Wren; Alexandra Ross; Genevieve D’Souza; Christina Almgren; Amanda Feinstein; Amanda Marshall; Brenda Golianu. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children 2019, 6, 33 .
AMA StyleAnava Wren, Alexandra Ross, Genevieve D’Souza, Christina Almgren, Amanda Feinstein, Amanda Marshall, Brenda Golianu. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children. 2019; 6 (2):33.
Chicago/Turabian StyleAnava Wren; Alexandra Ross; Genevieve D’Souza; Christina Almgren; Amanda Feinstein; Amanda Marshall; Brenda Golianu. 2019. "Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids." Children 6, no. 2: 33.
Despite more women undergoing treatment for breast cancer and increased survival rates, many women suffer from anxiety and physical symptoms (e.g., pain, fatigue) surrounding diagnosis and surgery. Research investigating the efficacy of psychosocial interventions for breast cancer patients during this period is limited. This randomized controlled pilot study examined the effect of a brief lovingkindness meditation intervention on these key outcomes. Participants were 60 women who underwent core needle breast biopsy, received an abnormal biopsy result, and underwent breast surgery (White = 73.6%; African American = 22.6%; Asian American = 3.8%; Age M = 56). Participants were randomly assigned to one of three treatment conditions at breast biopsy: (1) lovingkindness meditation, (2) music, and (3) usual care. Assessments of anxiety, pain, fatigue, physiologic reactivity, and self-compassion occurred prior to patients’ biopsy, following biopsy, 1 week after receipt of biopsy results, and 1 week following breast surgery. Multilevel modeling analyses demonstrated that lovingkindness meditation significantly improved pain (p = 0.02), self-compassion (p = 0.004), and heart rate (p = 0.02) over time compared to control conditions. There was a trend for anxiety (p = 0.05). Music significantly improved pain (p = 0.04) compared to usual care. These findings provide preliminary evidence for the feasibility and efficacy of a lovingkindness meditation intervention for breast cancer patients during the diagnostic and surgical period. Improving psychological and physical well-being during this time frame has the potential to improve longer-term health outcomes during adjuvant treatment and survivorship. Interventions that cultivate positive adjustment during the diagnostic and surgical period of breast cancer are an important area of future research.
Anava A. Wren; Rebecca A. Shelby; Mary Scott Soo; Zenzi Huysmans; Jennifer A. Jarosz; Francis J. Keefe. Preliminary efficacy of a lovingkindness meditation intervention for patients undergoing biopsy and breast cancer surgery: A randomized controlled pilot study. Supportive Care in Cancer 2019, 27, 3583 -3592.
AMA StyleAnava A. Wren, Rebecca A. Shelby, Mary Scott Soo, Zenzi Huysmans, Jennifer A. Jarosz, Francis J. Keefe. Preliminary efficacy of a lovingkindness meditation intervention for patients undergoing biopsy and breast cancer surgery: A randomized controlled pilot study. Supportive Care in Cancer. 2019; 27 (9):3583-3592.
Chicago/Turabian StyleAnava A. Wren; Rebecca A. Shelby; Mary Scott Soo; Zenzi Huysmans; Jennifer A. Jarosz; Francis J. Keefe. 2019. "Preliminary efficacy of a lovingkindness meditation intervention for patients undergoing biopsy and breast cancer surgery: A randomized controlled pilot study." Supportive Care in Cancer 27, no. 9: 3583-3592.
As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: 1) Review the current practice of opioid-reduction during pharmacological therapies; and 2) highlight concrete opioid weaning strategies and management of opioid withdrawal.
Genevieve D’Souza; Anava A. Wren; Christina Almgren; Alexandra C. Ross; Amanda Marshall; Brenda Golianu. Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use. Children 2018, 5, 163 .
AMA StyleGenevieve D’Souza, Anava A. Wren, Christina Almgren, Alexandra C. Ross, Amanda Marshall, Brenda Golianu. Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use. Children. 2018; 5 (12):163.
Chicago/Turabian StyleGenevieve D’Souza; Anava A. Wren; Christina Almgren; Alexandra C. Ross; Amanda Marshall; Brenda Golianu. 2018. "Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use." Children 5, no. 12: 163.
As clinicians have begun to provide targeted pharmacotherapy for children with inflammatory bowel disease (IBD) several ethical challenges have arisen. In this paper we review 3 challenges related to applying a precision health approach to pediatric IBD populations: selection of a disease monitoring method pharmacotherapy optimization and economic considerations in clinical decision making.
Anava A. Wren; K. T. Park. Targeted Dosing as a Precision Health Approach to Pharmacotherapy in Children with Inflammatory Bowel Disease. AMA Journal of Ethics 2018, 20, E841 -848.
AMA StyleAnava A. Wren, K. T. Park. Targeted Dosing as a Precision Health Approach to Pharmacotherapy in Children with Inflammatory Bowel Disease. AMA Journal of Ethics. 2018; 20 (9):E841-848.
Chicago/Turabian StyleAnava A. Wren; K. T. Park. 2018. "Targeted Dosing as a Precision Health Approach to Pharmacotherapy in Children with Inflammatory Bowel Disease." AMA Journal of Ethics 20, no. 9: E841-848.
Background Opioids are commonly prescribed for relief in inflammatory bowel disease (IBD). Emerging evidence suggests that adolescents and young adults are a vulnerable population at particular risk of becoming chronic opioid users and experiencing adverse effects. Objectives This study evaluates trends in the prevalence and persistence of chronic opioid therapy in adolescents and young adults with IBD in the United States. Method A longitudinal retrospective cohort analysis was conducted with the Truven MarketScan Database from 2007 to 2015. Study subjects were 15–29 years old with ≥2 IBD diagnoses (Crohn’s: 555/K50; ulcerative colitis: 556/K51). Opioid therapy was identified with prescription claims within the Truven therapeutic class 60: opioid agonists. Persistence of opioid use was evaluated by survival analysis for patients who remained in the database for at least 3 years following index chronic opioid therapy use. Results In a cohort containing 93,668 patients, 18.2% received chronic opioid therapy. The annual prevalence of chronic opioid therapy increased from 9.3% in 2007 to 10.8% in 2015 (P < 0.01), peaking at 12.2% in 2011. Opioid prescriptions per patient per year were stable (approximately 5). Post hoc Poisson regression analyses demonstrated that the number of opioid pills dispensed per year increased with age and was higher among males. Among the 2503 patients receiving chronic opioid therapy and followed longitudinally, 30.5% were maintained on chronic opioid therapy for 2 years, and 5.3% for all 4 years. Conclusion Sustained chronic opioid use in adolescents and young adults with IBD is increasingly common, underscoring the need for screening and intervention for this vulnerable population.
Anava A Wren; Rachel Bensen; Lindsay Sceats; Melody Dehghan; Helen Yu; Jessie J Wong; Donna MacIsaac; Zachary M Sellers; Cindy Kin; K T Park. Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015. Inflammatory Bowel Diseases 2018, 24, 2093 -2103.
AMA StyleAnava A Wren, Rachel Bensen, Lindsay Sceats, Melody Dehghan, Helen Yu, Jessie J Wong, Donna MacIsaac, Zachary M Sellers, Cindy Kin, K T Park. Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015. Inflammatory Bowel Diseases. 2018; 24 (10):2093-2103.
Chicago/Turabian StyleAnava A Wren; Rachel Bensen; Lindsay Sceats; Melody Dehghan; Helen Yu; Jessie J Wong; Donna MacIsaac; Zachary M Sellers; Cindy Kin; K T Park. 2018. "Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015." Inflammatory Bowel Diseases 24, no. 10: 2093-2103.
Pediatric inflammatory bowel disease is an autoimmune disease that causes chronic inflammation of the gastrointestinal mucosa. There is emerging evidence that the brain–gut connection affects inflammatory bowel disease (IBD) patients more than previously thought. This is evidenced by comorbid mood disorders, irritable bowel symptoms concurrent with quiescent IBD, and the potential of psychosocial stressors to trigger IBD flares. Mind–body interventions such as psychotherapy, relaxation, mindfulness, biofeedback, yoga, and clinical hypnosis offer an adjunct to standard medical treatment for IBD. We will review the current evidence base for these mind–body interventions in the treatment of pediatric IBD, illustrate a case study, and offer suggestions for future research for this promising field.
Ann Ming Yeh; Anava Wren; Brenda Golianu. Mind–Body Interventions for Pediatric Inflammatory Bowel Disease. Children 2017, 4, 22 .
AMA StyleAnn Ming Yeh, Anava Wren, Brenda Golianu. Mind–Body Interventions for Pediatric Inflammatory Bowel Disease. Children. 2017; 4 (4):22.
Chicago/Turabian StyleAnn Ming Yeh; Anava Wren; Brenda Golianu. 2017. "Mind–Body Interventions for Pediatric Inflammatory Bowel Disease." Children 4, no. 4: 22.