הכניסו את הליצנים
TRANSCRIPT
A DOCTOR AND CLOWN KNOW MORE THAN A DOCTOR ALONE
Shaare Zedek Medical Center, Jerusalem
HILLA BEN-PAZI, MD AVRAHAM COHEN
AVRAHAM COHEN
Case presentation: 8 year old girl referred for Botulinum toxin injections (BTX)
Underlying anxiety Emotional therapy -> still had anxiety Mother- anxious as well
Decided to perform injections with general anesthesia
PICU was canceled-> clown care 5th injection-> she did
not cry
She Laughed
Is there a need for clown care for injections in CP?
Methods- Visual analogue scale Valid Usually child rated Parent assessment
<5 years Cognitive impairment
1 2 3 4 5
Population:32 children age 6.7±4.5 years23 boys
Time line…
Before During After
VAS pain ratingclown care Vs control
ControlClown
before after1
2
3
4
5
3.56
4.56
3.41
2.84
p=.80
p=.003 VAS
VAS pain ratingclown care Vs control
ControlClown
before after1
2
3
4
5
3.56
4.56
3.41
2.84
p=.80
p=.003
Effect size 1.78
VAS
no correlation between pain before & after
0.5 1 1.5 2 2.5 3 3.5 4 4.5 50
1
2
3
4
5
VAS before
VA
S a
fter
Severe pain VAS>4/5vs non-severe pain VAS<4/5
Control (n=13) Clown (n=19)
non se-
vere68%
se-vere32%
Parameter Type III Sum of Squares df F Sig.
Corrected Model 29.965 9 2.700 .043
Intercept .009 1 .008 .932
Age 3.906 1 3.168 .095
Gender .234 1 .189 .670School attendance .182 1 .148 .706Communication skills .019 1 .015 .904
# Muscles .000 1 .000 .996
Upper Limb 1.757 1 1.425 .251
Sensitive sites 4.135 1 3.353 .087Report (parent/child) 7.355 1 5.965 .027
Clown care* 8.247 1 6.688 .021
Tests of Between-Subjects Effects
Take home message
Assess child tolerance to painEvaluate pain using validated toolsManage pain with effective tools
available
Traumatic manipulation Empowered
THANKS SUPPORT Tradis Gat Inc Magi Foundation
PHOTOSPublic Relations –SZMCChildren and Parents
RESEARCHERSNaama Kroyzer- Shapira, MA Yehuda Pollak, PhDRenana Lotem- Ophir, BA
DAY CARE STAFF Yael Greenberg