ABSTRACT
Objective: Epilepsy-related stigma is a global problem, yet there has been an inadequate focus on children and adolescents. The purpose of this study was to determine the status quo of stigma and its determinants among children and adolescents with epilepsy in China. Methods: A multicenter cross-sectional study was conducted across nine hospitals in eight cities within six provinces in China from 10 October 2023 to 15 June 2024. Participants included patients aged 8 to 18 years with epilepsy and their caregivers. Felt stigma was assessed with the Kilifi Stigma Scale for Epilepsy (KSSE). Social support and self-efficacy were collected through the Social Support Rating Scale (SSRS) and the Generalized Self-Efficacy Scale (GSES). The data were analyzed using t-tests, analysis of variance (ANOVA), Spearman correlation analysis, and multiple linear regression analysis. Results: The study enrolled 281 children and adolescents, with a mean age of 12.25 years (SD = 2.56), including 46.6% females. A total of 35.6% participants had self-reported felt stigma. The mean KSSE score is 9.58 (SD = 7.11). Meanwhile, stigma scores correlated strongly with reduced social support (r = -0.55, p < 0.01) and self-efficacy (r = -0.43, p < 0.01). Place of residence (rural vs. non-rural), academic performance (average and above vs. fair or poor), region (western region vs. non-western region), duration of epilepsy (≤5 years vs. >5 years), drug-resistant epilepsy (yes vs. no), comorbidities (yes vs. no), social support and self-efficacy are major influencing factors among the complex factors influencing the felt stigma among children and adolescents. Conclusion: Medical staff should be more aware of stigma among children and adolescents with epilepsy, especially those who live in rural and western areas, have poor academic performance, have epilepsy duration of more than 5 years, have drug-resistant epilepsy, and have comorbidities, who are at higher risk of stigma. It is recommended that effective measures be taken to alleviate stigma by improving children and adolescents' self-efficacy and providing more social support for them and their families.
ABSTRACT
Aims: To gain insight into the readiness for evidence-based practice of self-management support during transition for adolescents with epilepsy among pediatric nurses, and to explore the promoting and hindering factors. Design: A mixed-methods design with an explanatory sequential approach was employed. Setting: Three specialty children's hospitals in southwest regions of China. Methods: In phase 1, a total of 126 participants were included in the Survey of Clinical Readiness of Evidence-Based Nursing Assessment (CREBNA) from Dec 2022 to Feb 2023. Total scale and subscale scores were calculated. In phase 2, we developed the interview outline based on the analysis of the quantitative results. In-depth interviews (n = 15) were conducted from Feb 2023 to Apr 2023 to explain and supplement the quantitative phase results. Results: The total score of CREBNA indicated that teams have good readiness and capacity for implementation of evidence-based nursing practice Compared with the norm. The scores of the three subscales of evidence factors, organizational environment, and promoting factors were normal. In subsequent interviews and integration, we extracted four themes based on the Knowledge-To-Action (KTA) framework: 1. organization barriers (incentive mechanism, interdisciplinary cooperation process, information aids); 2. operational barriers (Exemplary evidence-based practice, time pressure, gaps in patient and family understanding of evidence); 3. individual-level barriers (evidence-based and professional knowledge reserve, professional autonomy, shared decision-making roles, dependence on habitual clinical behaviors); and 4. facilitating factors (leadership commitment, self-management identity, transition service needs, patient- and family-centered care culture). A conceptual model was constructed based on the KTA. Conclusion: It is feasible to carry out evidence-based practice of nurse-led self-management support in transition preparation. Nursing researchers and managers should carry out knowledge selection and tailoring based on barriers at the organizational, operational, and individual levels to promote favorable factors and improve the smooth transition of adolescents with chronic diseases.
ABSTRACT
Background: This study aimed to explore the risk factors of catheter-related thrombosis (CRT) in children in Southwest China who underwent central venous catheter (CVC) insertion. Methods: An observational cohort study was conducted at a single tertiary center in southwest China between November 2019 and February 2020. All patients who received a CVC were enrolled and Doppler-ultrasound examination was performed weekly until CVC removal. All patients in this study were hospitalized and were observed and followed up in this hospital. Patient demographics, medication, biochemical indexes, catheter maintenance practice, activities after CVC placement data were analyzed. The Kaplan-Meier method was used to calculate the incidence of CRT, and the Cox regression model was used to analyze the factors influencing CRT. Results: A total of 594 children were included in the study, and the median indwelling time was 10 days, with the shortest being 1 day and the longest 60 days. The overall incidence of CRT was 26.60% (158/594), the 15-day cumulative incidence rate was 30.81%, and the 45-day cumulative incidence rate was 46.27%. After 45 days, the incidence of CRT further increased. Age <12 months [hazard ratio (HR), 1.654; 95% confidence interval (CI): 1.171-2.338], use of 20% mannitol or glycerol fructose (HR, 1.593; 95% CI: 1.058-2.398), CVC placement by a pediatric intensive care unit (PICU) doctor (HR, 1.921; 95% CI: 1.347-2.740), placement length ≥9 cm (HR, 1.633; 95% CI: 1.142-2.336), and D-dimer >1.5 mg/L (HR, 1.451; 95% CI: 1.044-2.015) were risk factors for CRT. Limb exercises (HR, 0.660; 95% CI: 0.469-0.929) after placement was a protective factor for CRT. Conclusions: The incidence of CRT was higher in children with CVCs, and the key duration of CRT monitoring should be within 15 and 45 days after placement. Patients with age <12 months, using 20% mannitol or glycerol fructose, insertion length ≥9 cm, D-dimer >1.5 mg/L before placement are more likely to happen CVC-CRT than other patient, and it is necessary to be highly vigilant and take preventive measures.