Exploring the Effects of Nurse-Led Health Education on Parental Knowledge and Child Health Outcomes in Congenital Heart Surgery: A Quasi-Experimental Study.

Invited Commentary

Commentary: Regionalization of congenital heart surgery. If you don't know where you are going, you'll end up someplace else

Introduction: Congenital heart diseases (CHDs) are the most common congenital anomalies, and almost one-third of patients require an intervention in the neonatal period or first year of life. Unlike low- and middle-income countries (LMICs), the survival of patients with CHD in high income countries is over 90%. The aim of this study was to compare the different congenital heart surgery (CHS) outcomes databases and analyze geographical variations. Methods: We analyzed the STS-CHSD (North America), the ECHSA, the ECHSA (Only Europe), and the IQIC for CHD (LMICs) databases between 2016 and 2019. All databases include aggregated data consisting of the 10-benchmark CHS and CHS grouped by mortality risk categories. For each database and condition, we extracted the number of participants, number of operations, postoperative length of stay (LOS), and mortality, comparing regional findings. Results: Compared to ECHSA, STS-CHSD database had more operations (32066 vs 14327) despite lower participant numbers. 50% of surgeries in LMIC were VSD closure, while the STS database reported the largest number of complex interventions. Mortality was lowest in North America for all the operations. LMICs had the shortest LOS, while North America had the longest LOS for almost all the benchmark operations. (Figure) However, the relevance of LOS is limited due to lack of data on demographic findings like age at surgery and gestation. Conclusions: The analysis of these three databases, accounting for limitations of aggregate data, highlight the differences in the CHS outcomes among world regions, reflecting the geographical difference of the population. Furthermore, it emphasizes the critical need to develop collaborative databases to improve global outcomes.

ObjectiveTo evaluate the efficacy of a psychoeducation program for parents of children with ADHD in enhancing adherence to pharmacological treatment and improving clinical symptoms.MethodsWe developed a psychoeducation program based on the theory of planned behavior (TPB). Eighty-nine children with ADHD were cluster randomly assigned for their families to receive 3 months of well-structured psychoeducation (intervention group, n=44) or only general clinical counseling (control group, n=45). Parents in the intervention group were given an expert lecture (with slides and a parent manual), attended two expert-guided parent group sessions, and were invited to join a professional-guided online community. Measurement of parents’ knowledge about ADHD, components of the TPB model, and child ADHD symptoms were taken before and after intervention. Medication adherence was assessed thoroughly at the end of the first and third months. Satisfaction with the psychoeducation program was assessed only in the intervention group. Two-independent-samples t-test, ANOVA, and chi-square test were employed to compare differences between groups.ResultsCompared to the control group, medication adherence in the intervention group was significantly higher after 1 and 3 months (97.7% intervention vs 75.6% control, P=0.002, and 86.4% intervention vs 53.3% control, P=0.001, respectively). Accordingly, the ADHD rating scale scores were lower in the intervention group than the control group after intervention (33.7±5.4 vs 45.1±7.9, P=0.008). Greater improvements in parents’ knowledge about ADHD and many components of the TPB model were observed in the intervention group, especially increased intention to adhere to medication, compared to the control group (P<0.001).ConclusionThis psychoeducation program had a positive impact on both medication adherence and clinical symptoms of ADHD children. It could be considered as a potential beneficial supplement to clinical practice.

Monitoring Risk-Adjusted Outcomes in Congenital Heart Surgery: Does the Appropriateness of a Risk Model Change With Time?

To review the findings and discuss the implications of different ICU care models on morbidity and mortality in pediatric patients after congenital heart surgery. The electronic PubMed database was used to perform the clinical query, as well as to search for additional pertinent literature. The article by Burstein DS et al "Care Models and Associated Outcomes in Congenital Heart Surgery. Pediatrics 2011; 15:77-81" was selected for critical appraisal and literature review. The authors evaluated in-hospital mortality, postoperative length of stay, and postoperative complications in pediatric patients after congenital heart surgery and compared the odds of these outcomes by model of care received (cardiac ICU or mixed ICU). The data for the study was extracted from the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) database. Overall, the cardiac ICU group represented hospitals with higher surgical volumes and included more patients with high-risk defects. After multivariate analysis, the adjusted in-hospital mortality was not associated with the care model (cardiac ICU vs. ICU). The only significant finding was a lower morality in the STS-EACTS risk category 3 (odds ratio, 0.47 [95% CI, 0.25-0.86]). There were no significant differences between groups for adjusted postoperative length of stay or postoperative complications. This paper suggests that the composition of the ICU is not a critical factor in determining outcomes after congenital heart surgery. Other factors, such as expertise of the nurses, physicians, and surgeons, as well as technical performance, should be considered.

This study showed that the most positive impact on children's health outcomes occurred when combining health education of caregivers, regarding children's respiratory infections, with a rhinopharyngeal clearance protocol in children with URTI. What is Known: • Upper Respiratory Tract Infections are very common in children but still do not have an effective pharmacological treatment. • This generates a great burden of disease for the child and families, increasing the use of antibiotics. What is New: • This study is the first one that aims to analyze the effects of caregivers' health education in comparison to non-pharmacological intervention in acute respiratory infections in children. • It shows a positive impact on children's health outcomes, empowering caregivers regarding their child's health and reducing the burden of disease, medical consultations and the use of antibiotics.

Young children rely on their parents with respect to oral health routines. However, parental knowledge on this topic is often insufficient. Well‐child care may be an excellent route to reach parents because almost all of them attend. To evaluate the effectiveness of an 8.5 min web‐based film about oral health, provided by well‐child care, a non‐blinded quasi‐experimental study was performed. Parents attending well‐child care clinics in the Netherlands were assigned to an intervention (n = 88) or control group (n = 41). The control group received care as usual. We measured parental knowledge of oral health with a questionnaire (range of scores 1–12) before and directly after the intervention, and 6 months later, and assessed differences between the intervention and the control group. Parental oral health knowledge improved after watching the film: the intervention group’s mean score of 11.1 (SD 1.3) was greater than the mean score of 7.1 (SD 2.0) of the control group (Cohen's d = 2.64). Scores remained higher in the intervention group 6 months after watching the film (mean 9.1, SD 1.3) than before (Cohen's d = 1.25). A web‐based educational film delivered in a well‐child care setting can be an effective way to address oral health and to improve parental knowledge.

Analysis of 14,843 Neonatal Congenital Heart Surgical Procedures in the European Association for Cardiothoracic Surgery Congenital Database

Invited Commentary

Clubfoot is the most common musculoskeletal birth defect, characterized by abnormal tendon and muscle development, leading to abnormal bone alignment of the feet. The Ponseti method is considered the gold standard in clubfoot treatment, and consists of a series of plaster castings, followed by 4 years of brace use. The most common cause of clubfoot relapse is nonadherence with the bracing protocol by the child's caretakers. The purpose of this study was to design, implement, and evaluate an educational bracing program for parents of children with clubfoot in an effort to improve bracing adherence. The educational bracing program for parents of children with clubfoot was designed with incorporation of findings from previous research, adult teaching methodology, and parental feedback. An educational brochure and a practice doll were created for use in educational sessions with parents during routine treatment visits. Two educational sessions were conducted with a health educator, employing identical questionnaires to assess changes in parental knowledge and skills upon completion of the program. Thirty parents completed the educational bracing program, and the majority reported increased knowledge and self-efficacy regarding the bracing protocol of the Ponseti method. In addition, the health practitioners who conducted the educational sessions witnessed an improved ability of all parents to apply the brace as directed, and to recognize and correct improper fit. Completion of the educational program by the parents resulted in immediate improvements in knowledge and skills related to clubfoot bracing. Given that noncompliance to the bracing protocol is the most common cause of clubfoot relapse, these immediate effects of the educational program are promising not only because they encourage proper brace use, but because these immediate improvements have the potential to reduce future rates of clubfoot relapse.

Effectiveness of a multifaceted intervention for the improvement of nutritional status and nutrition knowledge of children in poverty-stricken areas in Shaanxi Province, China

Parents of children with dyslexia experience more parenting stress and depressive symptoms than other parents. The purpose of this study was to evaluate the effects of a cognitive-behavioral group-based program for parents of dyslexic children on parenting stress levels, parent–child homework interactions and parental competencies. 39 children with dyslexia and their mothers were randomly assigned either to a cognitive-behavioral-therapy group or a waiting-list control group. The intervention lasted for 3 months. Mothers filled in the Parenting Stress Index and a paper–pencil questionnaire assessing dyslexia specific stress, conflicts in homework situations and competencies in dealing with dyslexia. Assessment took place before, immediately after, and 3 months following intervention. A multivariate analysis of variance revealed overall effectiveness of the program (partial η2 = .091), which can be mainly attributed to the reduction of parenting stress and dyslexia specific stress as well as an enhancement of parental competencies. Planned contrasts showed that effects could not be approved directly after the training but 3 months later, indicating a delayed effect. Future studies should examine program effects on mothers and fathers on the basis of a larger representative sample.

To develop the Preschool Children eHealth Cardiac Rehabilitation programme based on the Interaction Model of Client Health Behaviour, and to evaluate its effects on children after congenital heart surgery. A parallel two-arm randomised controlled trial was conducted. A total of 84 participants were recruited from July 2022 to June 2023 and randomly assigned to either the intervention group (n = 40) or control group (n = 44). The intervention group participated in a 3-month eHealth Cardiac Rehabilitation programme, while the control group received routine care. Outcomes were measured at baseline, 3 months post baseline (intervention endpoint), and 6 months post baseline. Eighty participants completed the study. Compared to the intervention group, the control group demonstrated significantly worse outcomes at both 3 and 6 months, including a higher risk of heart failure, lower left ventricular ejection fraction scores, and shorter 6-min walk distance tests. The intervention group engaged in significantly more vigorous physical activity. Significant between group differences were also observed in parental knowledge, attitudes, behaviours and trust levels. Additionally, the proportion of parents experiencing anxiety decreased significantly more in the intervention group by 6 months post baseline. This pioneering eHealth programme transforms home-based rehabilitation for preschool children with congenital heart disease, addressing a critical gap in accessible and long-term paediatric cardiac rehabilitation care. The use of eHealth programmes is valuable for improving paediatric cardiac rehabilitation by empowering parents, enhancing care continuity, and reducing barriers to accessing specialised services in paediatric care, especially in areas with limited medical resources. This study establishes the first validated eHealth framework for family-centred cardiac rehabilitation in preschool children following congenital heart surgery, addressing the critically low uptake of previously home-based rehabilitation. It also provides clinicians with a scalable solution for delivering care in underserved regions lacking access to specialised cardiac services. This study adhered to the CONSORT checklist guidelines for reporting randomised controlled trials. This study did not include patient or public involvement in its design, conduct, or reporting. This study was a randomised controlled clinical trial. The research protocol was registered with the China Clinical Trial Registration Center (registration number: ChiCTR2200062022; https://www.chictr.org.cn/showproj.html?proj=174261).

Improved medication adherence and health literacy in parents of children with ADHD: Effects of a targeted educational program.