High Parental Satisfaction Research Articles

Influence of five-in-one management mode on disease prevention and control of school children with asthma

Objective: To investigate the influence of five-in-one management mode(standardized asthma treatment, asthma diary, peak expiratory flow (PEF) monitoring, reasonable diet and physical exercise) on disease prevention and control of school children with asthma. Methods: From April to October 2018, 70 children with asthma in clinical remission were selected from Affiliated Hospital of Qingdao University using randomized controlled study design. These children were randomly divided into study group and control group, with 35 cases in each group. In the study group, 5 cases were lost to follow-up, and 30 cases were actually enrolled. In the control group, 6 cases were lost to follow-up, and 29 cases were actually enrolled. Children in the control group received routine medication and regular outpatient consultation, and children in the study group received the five-in-one asthma management model. In the first time of seeing a doctor, after 3 months and 6 months of follow-up, asthma control test score, medication compliance index score and lung function index (forced expiratory volume in 1 second (FEV1), PEF were evaluated respectively.Parental satisfaction, asthma acute episodes, weight, height and biochemical index were recorded during the 6 months of follow-up. Pulmonary function index, asthma control score and body mass index of overweight children with asthma were compared with t-test, medication compliance was compared with chi-square test, and the rank sum test was used for the comparison of the number of emergency visits of asthma attacks and parents' satisfaction. Results: A total of 59 children with asthma were included, among them 30 were in the study group (8.1±1.5) years old and 29 in the control group (9.2±1.1) years old. After 3 months of follow-up, FEV1, PEF, asthma control score in the study group were (86.3±1.5)%, (83.3±2.4)%, (24.7±2.6) points respectively; and in the control group, FEV1, PEF, asthma control score were (84.4±2.5)%, (82.2±1.9)%, (21.1±1.3) points respectively. The indicators in the study group were higher than those in the control group (t=3.62, 1.97, 6.64, P<0.05). After 6 months of follow-up, FEV1, PEF, asthma control score in the study group were (88.4±2.3)%, (85.4±2.2)%, (26.8±1.8) points respectively; and in the control group, FEV1, PEF, asthma control score were (85.5±1.9)%, (83.2±1.7)%, (22.5±1.4) points respectively. The indicators in the study group were significantly higher than those in the control group (t=5.34, 4.24, 10.41, P<0.05). During the 6-month follow up, the number of emergency visits of asthma attacks in the study group and in the control group were 0.42(0.36, 0.51) and 0.92(0.72, 1.27) respectively. The indicator in the study group was significantly lower than that in the control group (Z=3.21, P<0.05). After 3 months of follow-up, the proportions of children with good compliance in the study group and control group were 67% (20/30) and 62% (18/29), the proportions of poor compliance were 27% (8/30) and 34% (10/29), the proportions of non-compliance were 7% (2/30) and 7% (2/29). There were no statistically significant differences (χ(2)=0.14, 0.43, 0.00, P=0.71, 0.51, 0.97). After 6 months of follow-up, the proportions of children with good compliance in the study group and control group were 87% (26/30) and 69% (20/29), the proportion of poor compliance were 10% (3/30) and 28% (8/29), the proportion of non-compliance were 3% (1/30) and 7% (2/29), There were no statistically significant differences (χ(2)=2.70, 3.00, 0.39, P=0.10, 0.08, 0.53). After 6 months of follow-up, the number of great satisfaction, satisfaction and dissatisfaction in the study group were 20, 10 and 0 respectively, the satisfaction rate was 100%, meanwhile those indicators in the control group were 4, 15 and 10 respectively, the satisfaction rate was 66%, The indicator in the study group was significantly higher than that in the control group (Z=4.60, P<0.05). Conclusions: The application of "five-in-one" asthma management model (standardized asthma treatment, asthma diary, PEF monitoring, reasonable diet and physical exercise) for school-age children with asthma can significantly improve lung function, as well as reduce the number of acute asthma attacks. It has a high parent satisfaction, therefore it should be recommended for clinical implementation.

Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux.

Purpose: Endoscopic dextranomer/hyaluronic acid (Dx/HA) injection is a common treatment for vesicoureteral reflux (VUR) with excellent reported short-term clinical success rates. Long-term outcomes are less well-defined. We assessed long-term outcomes and parental satisfaction after Dx/HA injection for primary VUR with >5-year follow-up.Materials and Methods: Families of all patients who underwent Dx/HA injection for primary VUR at our institution between 2008 and 2012 were contacted for telephone interview. Data collected by phone included parental satisfaction and presence and severity of UTIs pre-operatively and post-operatively. Patient demographics, radiographic VUR data, need for secondary surgery, and surgical indications were obtained through chart review.Results: Five hundred and seventy-five patients underwent Dx/HA injection for primary VUR between 2008 and 2012. Ninety-nine (17.2%) of these patients' parents were successfully contacted and interviewed. Median follow-up time from surgery to survey was 8.4 (IQR 6.8–9.6) years. Secondary surgery was performed in 13/99 (13.1%), most commonly repeat Dx/HA injection. Seven patients (7.1%) underwent secondary Dx/HA injection for persistent VUR without UTIs at a median of 0.35 (IQR 0.33–0.77) years post-operatively. Five patients (5.1%) underwent Dx/HA injection (n = 3) or ureteral reimplantation (n = 2) for VUR with febrile UTIs (fUTIs) at a median of 2.2 (IQR 1.3–5.1) years. One patient had ureteral reimplantation for symptomatic obstruction 2.8 years after initial surgery. Only 3/99 (3.0%) required open or laparoscopic surgery after Dx/HA injection. Eighty-three families (84.7%) reported ≥1 fUTIs pre-operatively. Of these, only 9/83 (10.8%) reported fUTIs post-operatively, for an overall clinical success rate of 89.2%. Clinical success was 93.1% in patients whose pre-operative fUTIs were treated outpatient and 80.0% in those hospitalized at least once for fUTI treatment pre-operatively. Ninety-four percent of parents were highly satisfied, 2.4% partially satisfied, and 3.5% dissatisfied.Conclusions: Endoscopic injection with Dx/HA for primary VUR appears to have good long-term clinical success rates and high parental satisfaction, mirroring our previously reported short-term results. Post-operative ureteral obstruction is rare but may occur years post-operatively, justifying initial sonographic surveillance, and repeat imaging in symptomatic patients.

Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge.

Feeding dysfunction is a common consequence of prematurity and illness in neonates, often requiring supplemental nasogastric (NG) or gastrostomy (GT) feeding tubes. A standardized approach to the discharge of infants receiving home enteral nutrition (HEN) is currently lacking. The Home Enteral Feeding Transitions (HEFT) program was developed to identify patients eligible for HEN and create a standard discharge process. A structured tool helped determine discharge timing and route, and a dedicated outpatient clinic was created for infants discharged on HEN. Demographic, inpatient, and outpatient data were prospectively collected and compared with a historical cohort. A total of 232 infants discharged from our neonatal intensive care unit (NICU) over 9 months met inclusion criteria. Ninety-eight (42%) were discharged with HEN, 68 NG and 30 GT, compared with 134 (58%) receiving full oral feeds. This represented a 10% increase in HEN utilization (P=0.003) compared with our historical control group. Median HEN length of stay was 31.5 days compared with our historical average of 41 days (P=0.23). Frequency of emergency department visits and admissions because of HEN was unchanged postintervention. Parents were satisfied (8.6/10), and 98% said they would choose HEN again. The median time to NG discontinuation after discharge was 13.5 days, with an estimated cost savings of $2163 per NICU day. Our program is the first of which we know to use a standard care-process model to guide the decision-making and utilization of HEN at NICU discharge. HEFT shows that HEN at NICU discharge can be safe and effective, with high parental satisfaction.

Post-Traumatic Stress, Quality of Life and Alcohol Use Problems among Out-of-School Youth.

Objective Post-traumatic stress symptoms (PTSS) in out-of-school youths (OSYs) may be influenced by alcohol use, but there is a lack of evidence explaining how PTSS affect alcohol use problems in OSYs. The present study aimed to investigate the relationships among PTSS, quality of life, and alcohol use in OSYs. Methods In total, 125 OSYs (46.4% male) in South Korea completed the Korean Version of the Child Report of Post-Traumatic Symptoms (CROPS), the KIDSCREEN-27 Quality of Life Measure for Children and Adolescents, and the Alcohol Use Disorders Identification Test-Consumption. Results Mean CROPS score was 18.7 (SD=11.6); 37.6% were problem drinkers. Quality of life in the domain of parent relations and autonomy significantly mediated the relationship between PTSS and alcohol use problems. OSYs with high parental satisfaction and autonomy were less likely to have alcohol use problems even with PTSS. Conclusion Family assessments and therapeutic approaches are needed for OSYs with both PTSS and alcohol use problems.

Early discharge of premature infants < 37weeks gestational age with nasogastric tube feeding: the new standard of care?

Most premature infants are hospitalised until they no longer need monitoring of vital parameters and are independent of nasogastric tube feeding (NTF). Hospital admission time easily reaches a length of multiple months in extremely preterm infants, but also in late preterms, in whom drinking may be the only problem, hospital admission time can reach weeks. This is a very stressful time for both parents and child. Parents in the Albert Schweitzer Hospital (ASH) are taught to give their child NTF. When monitoring is no longer necessary, the child can be discharged with NTF, with home care by paediatric nurses. In this study duration of NTF at home, safety of the procedure and parental satisfaction with NTF at home were evaluated. Duration of NTF at home was compared to admission time from cessation of monitoring till discharge independent of NTF in infants born in two comparable hospitals where discharge with NTF is not standard care. Median duration of NTF at home in the ASH infants was 9days. In the control group, median admission time after cessation of monitoring was 9days. No complications related to NTF at home were noted. Ninety-six percent of parents regarded NTF at home as safe and would repeat it in the future.Conclusion: NTF at home in premature infants shortens hospital admission time, is safe and results in high parental satisfaction rates. What is Known: • Premature infants are most often hospitalised until they are no longer dependent on NTF. Hospital admission time therefore easily reaches a length of multiple months for the extremely preterm infant. This can be a very stressful time for both parents and child. What is New • Making discharge with NTF in otherwise stable premature infants possible, by teaching parents the procedure and by providing home care by paediatric nurses. • NTF at home in premature infants is safe, limits hospital admission time and has high parental satisfaction rates.

The (Extremely) Picky Eaters Clinic: A Pilot Trial of a Seven-Session Group Behavioral Intervention for Parents of Children With Avoidant/Restrictive Food Intake Disorder

Excessive and impairing picky eating is a common problem among children for which there is little published research on efficacious psychosocial treatment. Extant research largely concerns single-case studies, or small samples of very young children, who are typically treated in hospital settings. This paper reports on outcomes of 21 children (ages 4–11) described by their parents as extremely picky eaters who met criteria for avoidant/restrictive food intake disorder not associated with a developmental disorder, other eating disorder, or other eating-related anxiety disorder (e.g., specific phobia of vomiting or choking). Seven cohorts of two to four families each took part in a seven-session manualized parent-only group treatment in an outpatient setting. This group treatment focused on training parents to serve as effective coaches for daily in-home exposures to nonpreferred foods, as well as in components of parent management training to reduce problematic mealtime behaviors. Parents completed standardized feeding measures to assess picky eating and associated problem mealtime behaviors at pretreatment, posttreatment, and at 3-month follow-up, as well as a satisfaction measure at posttreatment. Results showed excellent feasibility and adherence by parents and high parent satisfaction with treatment. Paired t tests to measure within-group change showed significant pre–post treatment reductions in picky eating scales with moderate to large effect sizes. Gains were maintained at 3-month follow-up. Findings indicate that a relatively brief group treatment that focuses specifically on training parents to facilitate and carry out food exposures and contingency management procedures in their homes is associated with reductions in functionally impairing picky eating and related negative mealtime behaviors in elementary school-age children.

Traumatisme du lit unguéal — une série de 76 cas

Nail bed trauma is a commonly overlooked part of fingertip reconstruction. To evaluate outcomes of nail bed injuries treated with different reconstructive techniques. We conducted a retrospective chart review of 76 patients who underwent nail bed reconstructions due to trauma between January 2000 and August 2017. In our series, 32 patients (42.10%) underwent suturing of the nail bed (SNB)+ 25 patients (32.89%) underwent suturing of the nail bed associated with an osteosynthesis of the distal phalanx (SNBOst)+ 19 (25%) received a nail bed graft in the ER (NBGE). Outcomes assessed were growth (0 = no growth+ 1 = partial growth+ 2 = normal growth), size (0 = less than 25%+ 1 = between 25 and 50% and 2 = >50% of the size of the contralateral nail) and shape (0 = significant deformity on the horizontal and vertical planes+ 1 = vertical deformity, 2 = no deformity) of the nail compared to the contralateral finger. The results obtained by the sum of scores were classified as good (5–6), acceptable (3–4) and poor as previously described by Foucher et al. Were assessed in patients with at least 12 months of follow-up. The results were considered “good” in all patients who underwent SNB and in those who underwent SNBOst associated with an osteosynthesis of the distal phalanx. “Good” results were also achieved in 57.9% of patients who underwent NBGE. “Acceptable” results were obtained in 42.1% of patients grafted in the ER. In a British study (Mignemi et al.) of 46 pediatric nail bed lacerations, simple suturing with either Vicryl-Rapide or PDS associated with nail replacement as a splint resulted in high patient parent satisfaction. A recent retrospective study (Weinand et al.) of 401 patients showed fewer nail deformities in patients with nail trauma (344 compression injuries, 44 amputations and 13 avulsion injuries) treated with native nail splints as compared to silicone splinting. In our series, patients treated with simple suturing of the nail bed—both those with and without associated finger fractures—and patients who underwent reconstruction of the entire nail bed showed improved outcomes compared to those treated with nail bed grafts.

Perceived Collective Efficacy and Parenting Competence: The Roles of Quality of Life and Hope.

Parents' perceptions of their parenting competence predict successful implementation of parenting tasks and contribute to their interest and involvement in parenting and to their children's development. Thus, identifying factors that contribute to parents' perceptions of parenting competence can help inform efforts to promote children's safety and well-being. The present study employs social disorganization theory to examine the relationship between collective efficacy and parents' sense of competence, measured along two dimensions: parental efficacy and parental satisfaction. It examines the direct association between the two constructs and whether the association is mediated by parent perceptions of their quality of life (QOL) and sense of hope. Data were collected from 198 parents residing in a neighborhood in southern Tel Aviv, Israel. The analyses indicated that high collective efficacy was directly associated with high parental efficacy, but not with high parental satisfaction. Using structural equationmodeling, a mediation model was found whereby higher collective efficacy was associated with (a) higher QOL, which in turn was related to a greater sense of hope, which was linked with higher parental efficacy; and (b) higher QOL, which was directly associated with higher parental satisfaction. The findings provide further support to the idea that neighborhood characteristics play an important role in parents' ability to care for their children.

Orientação e treinamento de pais: uma vivência clínica

This study aimed to implement and verify the effectiveness of the ‘Parent Orientation and Training Program’, which guides and empowers parents so that they learn to manage the contingencies of their educational practices. It is known that behavior modification techniques have been increasingly employed in the context of Neuropsychology. The article describes a clinical experience in which twenty – six parents participated in eight meetings. Qualitative data, obtained through an evaluation form, revealed high parental satisfaction. The qualitative analysis of the parents’ reports showed that they underwent a process of self-knowledge and presented changes, such as: increased participation and involvement in the childrens’ lives, establishment of clear and consistent rules, greater appreciation of appropriate child behaviors and increased frequency of praise for part of the parents with decrease or abandonment of the use of slaps. The therapeutic approach based on the training, reached its objectives, emphasizing that work of positive attention, prevention and intervention with the parents are necessary to increase the quality in the family interaction.

Wireless ambulatory urodynamic study: A 6‐year retrospective review in a tertiary paediatric urological referral centre

AimUrodynamic study is a functional assessment of the lower urinary tract. It has an essential role in the evaluation of paediatric patients with lower urinary tract symptoms, be it due to neurogenic or nonneurogenic causes. Since 2013, we have introduced wireless ambulatory form of the study. In the present study, we performed a baseline review of our paediatric urodynamic service within a 6‐year period to determine its indications, outcomes and complications.Patients and MethodsA retrospective review of all urodynamic studies performed between August 2011 and April 2017 in patients &lt;18 years of age was performed. Demographics, including age and sex, and indications were collected. Urodynamic parameters, including type of catheter used, presence of detrusor overactivity, bladder compliance, end‐fill detrusor pressure, maximum voiding detrusor pressure, postvoid residual bladder volume and bladder emptying efficiency, were collected. Complications from either catheter insertion or the urodynamic study itself were documented.ResultsSixty‐seven studies were done between the study period in 55 patients (16 females and 39 males). Fifty‐eight ambulatory studies with natural and conventional fill were performed since 2013. The median age at study was 2.1 years (range 0.1–17 years). Indications included myelodysplasia (61 per cent, n = 41 studies), bilateral high‐grade vesicoureteric reflux (18 per cent, n = 12), dysfunctional voiding (15 per cent, n = 10) and patient with posterior urethral valve (6 per cent, n = 4). Suprapubic catheters were used in 62 studies in patients with urethral sensation, and transurethral catheters were used in five studies. Overall, 53 studies were considered abnormal (79.1 per cent). No complications resulted from suprapubic catheter insertion or urodynamic studies.ConclusionAmbulatory urodynamic studies using our unit’s protocol remain safe and child friendly, with minimal complications and high patient and parent satisfaction.

Use of ketamine sedation for the management of displaced paediatric forearm fractures.

AIMTo determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department.METHODSFollowing an agreed interdepartmental protocol, fractures of the radius and ulna (moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and post manipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also undertaken.RESULTSDuring the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate (3), fractures of both radius and ulna (6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthesia, each case performed under ketamine sedation was associated with a saving of £1470, the overall study saving being £14700.CONCLUSIONKetamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced fractures of the radius and ulna, with high parent satisfaction rates.

Latino parents in dual language immersion programs: why are they so satisfied?

ABSTRACT Educators (school administrators, teachers, district officials, etc.) often use parental satisfaction ‘as one indicator of school success or one outcome of school effectiveness’ [Parkes, J., and T. Ruth. 2011. “How Satisfied are Parents of Students in Dual Language Education Programs? (Me parece maravillosa la gran oportunidad que le están dando a estos niños).” International Journal of Bilingual Education and Bilingualism 14 (6): 701–718]. Parent satisfaction is particularly attended to in educational settings where participation is voluntary (such as magnet or charter schools, for example). This article examines Latino parental satisfaction in four Oregon dual language immersion (DLI) schools. If past research, and our findings, are accurate, then researchers and educators can convincingly conclude that Latino parents are highly satisfied with bilingual education programs in general, and DLI programs in particular, and there is no need for improvement. We argue, however, that uncritically reporting high levels Latino parental satisfaction in bilingual programs can lead educators to become complacent to these parents’ concerns. Latino parental satisfaction must be viewed through multiple lenses in order to avoid silencing their voices in DLI settings.

Expanding Access to Clinical Services for Toddlers with Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a neurodevelopmental disorder typically diagnosed in the toddler and preschool years. Intensive early intervention (EI) using applied behavior analytic procedures is the evidenced-based intervention most effective in improving developmental outcomes. Unfortunately, there are numerous barriers to accessing EI services for toddlers with ASD. This article addresses (a) the process of developing an EI program using primarily applied behavior analytic services with multidisciplinary health care providers, (b) a description of the service delivery provided, (c) educational and training programs to increase qualified staff, and (d) advocacy efforts to improve community capacity. The EI program has sustained growth, improved child developmental outcomes, served as a training ground for EI providers, and yielded high parent satisfaction ratings. Suggestions for continued advocacy, education, research, and policy development related to the lack of access to EI for children with ASD is offered for pediatric health care providers.

Acceptance, satisfaction and cost of an integrative anthroposophic program for pediatric respiratory diseases in a Swiss teaching hospital: An implementation report

BackgroundFor the pilot phase of an integrative pediatric program, we defined inpatient treatment algorithms for bronchiolitis, asthma and pneumonia, using medications and nursing techniques from anthroposophic medicine (AM). Parents could choose AM treatment as add-on to conventional care. Material and methodsTo evaluate the 18-month pilot phase, parents of AM users were asked to complete the Client Satisfaction Questionnaire (CSQ-8) and a questionnaire on the AM treatment. Staff feedback was obtained through an open-ended questionnaire. Economic data for project set-up, medications and insurance reimbursements were collected. ResultsA total of 351 children with bronchiolitis, asthma and pneumonia were hospitalized. Of these, 137 children (39%) received AM treatment, with use increasing over time. 52 parents completed the questionnaire. Mean CSQ-8 score was 29.77 (95% CI 29.04–30.5) which is high in literature comparison. 96% of parents were mostly or very satisfied with AM; 96% considered AM as somewhat or very helpful for their child; 94% considered they learnt skills to better care for their child. The staff questionnaire revealed positive points about enlarged care offer, closer contact with the child, more relaxed children and greater role for parents; weak points included insufficient knowledge of AM and additional nursing time needed. Cost for staff training and medications were nearly compensated by AM related insurance reimbursements. ConclusionsIntroduction of anthroposophic treatments were well-accepted and led to high parent satisfaction. Additional insurance reimbursements outweighed costs. The program has now been expanded into a center for integrative pediatrics.

Value of Soft Tissue Release Procedure around the Shoulder to Improve Shoulder Abduction in Birth Brachial Plexus Palsy and Analysis of the Factors Affecting Outcome.

A lack of shoulder abduction in spontaneously recovered birth brachial plexus palsy (BBPP) is a common presentation. We have performed a soft tissue release operation in these patients to remove the tethering effect of the tight and cocontracting shoulder adductors. This study was undertaken in order to assess the outcome of this surgical procedure. We performed a retrospective analysis of 120 patients who displayed spontaneous recovery from BBPP and subsequently underwent soft tissue release procedure to improve shoulder abduction. The operation involved release of the pectoralis major, latissimus dorsi (LD) and teres major (TM) with axillary nerve neurolysis and transfer of LD and TM to teres minor at a lower position. Outcomes were assessed at a minimum follow up of two years. The primary outcome measures were range of shoulder abduction and Mallet score. Parents were interviewed and their satisfaction was graded on a Likert scale. We also explored prognostic factors responsible for better outcomes namely, age at operation, extent of involvement; preoperative shoulder abduction range, internal rotation deformity, triceps power and Mallet score. The average patient age was 5.8 years(range 1-17). Follow up ranged from 2-6 years. Average preoperative shoulder abduction was 85° (range 30°-140°). Postoperatively the average shoulder abduction was 161° (range 80°-180°). The mean improvement in abduction was 76° (range 20°-110°) [p < 0.001]. Mallet score improved from 16.4 to 19.5 (p < 0.001). High parental satisfaction was recorded by Likert scale assessment. Regression analysis indicated a favourable outcome in patients who are younger, have a better preoperative abduction range and a preoperative triceps power > grade 3. Soft tissue release procedure employed in this series is effective in improving shoulder abduction. Patients who are of younger age, have better preoperative abduction and triceps power of > grade 3 are expected to achieve the best outcome.

Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial.

IntroductionAnesthesia induction is a stressful event for children and their parents, and may have potentially harmful consequences on the patient’s physiological and mental situation. Stressful anesthesia induction has psychological adverse effects that recur with repeated anesthesia, can lead to increased pediatric discomfort during the recovery period, and may even induce reactionary postoperative behavior. A randomized controlled trial was performed to assess the impact of parental presence during induction of anesthesia (PPIA) on preoperative anxiety of pediatric patients and their parents at three different times, cooperation of child with anesthesiologist at induction of anesthesia, and parental satisfaction.Patients and methodsA total of 96 pediatric patients undergoing elective minor surgery (ASA 1–2) were randomly divided into two groups. Both groups received oral midazolam (0.5 mg/kg) at least 20 minutes before surgery, but in the PPIA group, the parents were also present in the operating room until loss of consciousness of child at anesthesia induction. Anxiety in the patients (as measured by the modified Yale Preoperative Anxiety Scale [mYPAS]) and parents (as measured by the State and Trait Anxiety Inventory [STAI]), the Induction Compliance Checklist (ICC), and parental satisfaction (as measured by visual analog scale) were assessed.ResultsThere was no significant difference in the mean anxiety scores (mYPAS) of participants in the control and PPIA groups at ward T0 and upon arrival to operating room T1 (P>0.05). However, between the PPIA and control groups, mean mYPAS score was different at the time of induction of anesthesia T2 (35.5±16.6 vs 59.8±22.4; P<0.001). The ICC scores showed that perfect score was significantly different in the PPIA and control groups (66.6% vs 6.3%; P<0.01). The STAI scores of the parents in the two groups did not differ in T0, T1, and T2. The mean parental satisfaction score was higher in the PPIA group than in the control group (7.6±7.0 vs 5.8±6.1; P<0.01).ConclusionPPIA may reduce preoperative state anxiety of pediatric patients and improve quality of anesthesia induction based on ICC scores and higher parental satisfaction, but it does not impact on parental state anxiety.

Transanal Irrigation in the Treatment of Children With Intractable Functional Constipation.

The aim of the study was to assess the treatment efficacy of transanal irrigation and parental satisfaction in children with intractable functional constipation (FC) treated with Peristeen. Cross-sectional survey study among parents of children (age 0-18 years) treated with Peristeen for FC (based on the Rome III criteria). Anonymous questionnaires were sent out to parents via mail, these consisted of 25 self-developed, multiple-choice questions regarding the use of Peristeen, current gastrointestinal symptoms, adverse effects of Peristeen, concomitant medication use, and parental satisfaction. Out of 91 invited families, 67 (74%) returned the questionnaire. In total, 84% of patients experienced fecal incontinence prior to treatment. Out of all children who still used Peristeen at the time of survey (n = 49), fecal incontinence had resolved completely in 41%, 12% experienced occasional episodes of fecal incontinence (<1 episode per week) and the remaining 47% still experienced episodes of fecal incontinence regularly (≥1 time per week). A total of 28 children (42%) experienced pain during rectal irrigation, especially during insertion of the catheter, inflating the balloon, or during irrigation. Overall, 86% of the parents were satisfied with the result of transanal irrigation and 67% reported that they would continue using transanal irrigation for the treatment of their child's symptoms. Transanal irrigation may be effective in the treatment of children with FC and renders a high parental satisfaction. Future prospective studies, preferably RCTs, are necessary to further evaluate this treatment option.

Parent Mentors and Insuring Uninsured Children: A Randomized Controlled Trial

Six million US children are uninsured, despite two-thirds being eligible for Medicaid/Children's Health Insurance Program (CHIP), and minority children are at especially high risk. The most effective way to insure uninsured children, however, is unclear. We conducted a randomized trial of the effects of parent mentors (PMs) on insuring uninsured minority children. PMs were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. The primary outcome was obtaining insurance 1 year post-enrollment. We enrolled 237 participants (114 controls; 123 in PM group). PMs were more effective (P< .05 for all comparisons) than traditional methods in insuring children (95% vs 68%), and achieving faster coverage (median = 62 vs 140 days), high parental satisfaction (84% vs 62%), and coverage renewal (85% vs 60%). PM children were less likely to have no primary care provider (15% vs 39%), problems getting specialty care (11% vs 46%), unmet preventive (4% vs 22%) or dental (18% vs 31%) care needs, dissatisfaction with doctors (6% vs 16%), and needed additional income for medical expenses (6% vs 13%). Two years post-PM cessation, more PM children were insured (100% vs 76%). PMs cost $53.05 per child per month, but saved $6045.22 per child insured per year. PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

PLACEMENT OF PREFORMED METAL CROWNS ON CARIOUS PRIMARY MOLARS BY DENTAL HYGIENE/THERAPY VOCATIONAL TRAINEES IN SCOTLAND: A SERVICE EVALUATION ASSESSING PATIENT AND PARENT SATISFACTION.

The utility and acceptability of preformed metal crowns (PMC) for management of carious primary molars has been established in the literature and published guidance. The role of dental hygienist and therapists (DHT) in the evolving team model in primary care has been recognised as requiring further investigation. The importance of patient and parental acceptance is acknowledged in recent healthcare research. This study focuses on patient and parent acceptance of preformed metal crowns placed by DHTs. Prescription format is investigated and the availability of bitewing radiographs considered. Reflective assignments at the end of training gave an indication of DHTs views on increased professional autonomy and the issue of direct access. Patient and parent satisfaction following placement of PMCs by DHT vocational trainees (DHTVT) were evaluated. Data was collected in two audit rounds from 2013 to 2014 using a 'faces' scale for children and a Likert scale for parents following placement of PMCs on carious primary molars. 133 PMCs were placed (110 children) by 10 DHTVTs over an eight-month period. Overall, radiographs were available for 10.5% of cases. The data showed high levels of patient and parent acceptance of the use of PMCs. Low availability of radiographs may represent a missed diagnostic opportunity. PMC placement by DHTVTs resulted in high patient and parent satisfaction, comparable to other studies. Although caries has been declining over the last decade in Scotland, evidence shows that inequalities and a social gradient in experience of caries in children remain. There is a need for tools and strategies for the prevention, recognition, risk assessment, diagnosis, and management of caries in the primary dentition. These must be accessible, acceptable to children and their parents/carers, cost effective, affordable and applicable in the primary care general dental practice environment where most families are likely to be registered. The emerging theme of dentistry being provided in a team model with dental care professionals (DCPs) taking on an expanded role is under continuing review following the General Dental Council (GDC) announcements on 'direct access'. The Scottish Dental Hygiene and Therapy Vocational Training (DHTVT) programme is a one-year, elective, post-qualification training programme for Dental Hygiene and Therapy graduates run by NHS Education for Scotland (NES). In 2013-2014, DHTVTs were employed across six Scottish health board areas in hospital, salaried and independent settings in urban and rural locations. The elements of the programme involve a blend of clinical mentoring, web-based learning, case presentations, critical reading, reflective assignments and face-to-face theoretical and practical teaching across a number of modules. The aim of this project was to collect data to indicate patient and parental response following the placement of PMCs, collect data on the use of radiographs in children having PMCs placed and to investigate the role of dental therapists in the dental team. The data, once collated, was presented to DHTVTs to inform reflection on the management of carious primary molars and to raise awareness of issues relating to cost effectiveness of providing treatment in a primary care environment and critically appraise perceived barriers to the use of PMCs in the treatment of carious primary molars. Collated data has been presented to trainers in future cohorts to inform discussion amongst the group of trainers at induction days around dental team working, effective detection, diagnosis, risk assessment and prescription to DHTs.

Evaluation of shoulder function after secondary surgery in children with Neonatal Brachial Plexus Palsy.

Shoulder function in children with Neonatal Brachial Plexus Palsy (NBPP) can be impaired. Functional gain is possible by an internal contracture release and muscle tendon transfer (ICL+MTT) for external rotation. This study evaluates the functional results of this intervention. Assessments were done pre-operatively and 3, 6 and 12 months thereafter and included joint-mobility (ROM), muscle strength, arm function (Assisting Hand Assessment (AHA) and Mallet-score), Quality of Life (QoL) (Pediatric Outcome Data Collecting Instrument (PODCI)) and parental satisfaction. Changes were examined using Wilcoxon's Signed-Rank test and Cohen's effect size. Ten children (5 boys) aged 3-10 years who underwent a combined ICL+MTT (mm. Latissimus Dorsi/Teres Major) were included.Active and passive external rotation ROM and muscle strength improved (p < 0.05). Arm function improved according to the Mallet-score (Hand-to-Head, Hand-to-Mouth, External-Rotation) (p < 0.05) and the arm use and pace scales of the AHA (p < 0.05). The PODCI Upper Extremity/Physical Functioning and Global Functioning subscales also showed improvements (p < 0.05). Parents were highly satisfied concerning daily life activities and sports. ICL+MTT leads to improvement of ROM, strength, arm function, QoL and high parental satisfaction in this studies' patients and is therefore a good intervention to consider in children with NBPP with limited shoulder function.