ABSTRACT
We examined the use of shared medical appointments (SMA) for educating and counseling children with penile problems. Forty-eight families were seen over 4 months with 21 participating in the SMA group and 27 in the traditional group. Using a questionnaire to assess adequacy of education, there was no difference in the overall scores between groups with a mean of 6.64/7 in the SMA and 6.56/7 in the traditional setting. With the increasing demands on providers, an SMA offers a solution to caring for more patients with penile problems in an efficient manner without impacting family education and satisfaction.
Subject(s)
Appointments and Schedules , Circumcision, Male/methods , Patient Education as Topic/methods , Penile Diseases/surgery , Surveys and Questionnaires , Ambulatory Care/methods , Child , Counseling , Humans , Interdisciplinary Placement , Male , Patient Satisfaction , Penile Diseases/diagnosis , Risk Assessment , Treatment OutcomeABSTRACT
This study investigated the relationship of medical and non-medical fears to children's anxiety, pain, and distress during an invasive medical procedure, the voiding cystourethrogram. Parents of 34 children completed the Fear Survey Schedule-II prior to their child's procedure. Child distress behaviors during the procedure were audiotaped and coded using the Child-Adult Medical Procedure Interaction Scale-Revised. Ratings of child procedural anxiety and pain were obtained from children, parents, and examining technologists within minutes following the procedure. Associations were observed between medical fears, procedural anxiety (parent and staff reports), and coded distress behaviors. Findings may inform preparation efforts to reduce anxiety around invasive medical procedures.
Subject(s)
Child Behavior/psychology , Diagnostic Tests, Routine/psychology , Fear , Child , Child, Preschool , Female , Humans , Male , New York , Pain/psychology , Parents , Surveys and QuestionnairesABSTRACT
PURPOSE: We investigated the relationship between parental anxiety/coping strategies and girls' distress during VCUGs. METHODS: Parents of 32 girls (age 4-10, mean 5.8 years) completed a trait anxiety measure and a measure of parental reactions to children's distress. Post procedure, children, parents and radiology staff rated the level of anxiety, fear, pain and discomfort. RESULTS: Trends indicated that parents who reported increased anxiety rated their children as experiencing increased distress (r = 0.27, p = 0.071), similarly for medical staff ratings (r = 0.28, p = 0.061). Parents with lower trait anxiety scores reported using more emotion- and problem-focused coping strategies (r = -0.37 and r = -0.40, p < 0.05, respectively). These were related to children experiencing less procedural distress (r = -0.30, p = 0.054; r = -0.33, p = 0.037, respectively) and parents rated as less anxious by staff (r = -0.40, p = 0.014; r = -0.31, p = 0.047, respectively). CONCLUSIONS: There was a trend toward parental anxiety being related to their child's distress during VCUG. Parental coping strategies resulted in less distress among children and parents. Teaching coping techniques might obviate the need for sedation and help children deal with future stressors.
Subject(s)
Anxiety/psychology , Parents/psychology , Urography/psychology , Vesico-Ureteral Reflux/diagnostic imaging , Adaptation, Psychological , Anxiety/epidemiology , Anxiety/physiopathology , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Humans , Incidence , Parent-Child Relations , Retrospective Studies , Risk Assessment , Stress, Psychological , Urography/methodsABSTRACT
Studies suggest a correlation between constipation and urinary tract infections (UTIs) in children. Diagnoses and treatment of constipation are not clear. This clinical practice was documented in urology offices. Variation noted suggests more research is needed for evidence-based practice in this population.
Subject(s)
Constipation , Evidence-Based Medicine/organization & administration , Pediatrics/organization & administration , Practice Patterns, Physicians'/organization & administration , Urinary Tract Infections , Urology/organization & administration , Attitude of Health Personnel , Child , Constipation/complications , Constipation/diagnosis , Constipation/therapy , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Humans , Medical History Taking , Nurse Practitioners/organization & administration , Nurse Practitioners/psychology , Nursing Staff/organization & administration , Nursing Staff/psychology , Pediatric Nursing/organization & administration , Societies, Nursing , Specialties, Nursing/organization & administration , Surveys and Questionnaires , Time Factors , Treatment Outcome , United States , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapy , Urodynamics , UrographyABSTRACT
AIMS: Studies have shown cognitive problems in adults treated with anticholinergics. It is unclear if children are also susceptible to anticholinergic adverse effects. This study evaluates the effects of long-acting oxybutynin and tolterodine on short-term memory and attention in children with urgency and urge incontinence. METHODS: Children with urgency or urge incontinence were recruited to take part in a prospective, randomized double-blinded placebo controlled trial using long-acting oxybutynin or tolterodine. Patients underwent a baseline test of their memory/recall ability and attention span using a standardized developmental/neuropsychological assessment tool. They were then randomized to either medication or placebo with retesting in 2 weeks, at which time they were crossed. They were retested after the second 2 weeks. RESULTS: Fourteen children (9 boys and 5 girls), ranging in age from 5 to 11 (M = 7.7) participated in the study. Attention and memory scores increased over time in all children, however, the analyses showed no significant negative effects of anticholinergic medications on attention or memory. Indeed, though not statistically significant, trends were for improvement in test scores in both areas. CONCLUSIONS: Our results in a double blinded cross-over trial suggest that long-acting oxybutynin and tolterodine do not have a deleterious effect on children's attention and memory. Other cognitive functions may be affected.
Subject(s)
Attention/drug effects , Benzhydryl Compounds/adverse effects , Child Behavior/drug effects , Cholinergic Antagonists/adverse effects , Cognition/drug effects , Cresols/adverse effects , Mandelic Acids/adverse effects , Memory/drug effects , Phenylpropanolamine/adverse effects , Urinary Incontinence, Urge/drug therapy , Child , Cross-Over Studies , Double-Blind Method , Female , Humans , Male , Mental Recall/drug effects , Neuropsychological Tests , Prospective Studies , Time Factors , Tolterodine TartrateABSTRACT
OBJECTIVE: Previous studies have suggested a correlation between constipation and urinary tract infections (UTIs) in children. However, historical information about constipation may be unreliable and the relationship between a history of constipation and radiographic findings of fecal load is unclear. PATIENTS AND METHODS: A total of 133 children undergoing an abdominal X-ray were evaluated. Parents were asked to complete a questionnaire on bowel habits. Three observers using a documented objective scoring system evaluated plain films of the abdomen. The symptom and radiographic scores were compared with the history and each other. RESULTS: Out of the 133 children, 100 had documented previous UTIs and 33 did not. Children with prior UTIs had significantly more symptoms of constipation than those without prior UTIs (p<0.02). Children with a history of UTIs tended to have more fecal loading on radiographic studies than those without, although this difference was not statistically significant (p<0.11). When only children of >3 years old are evaluated, the trends persist, but neither were statistically significant (p<0.11 and 0.56, respectively). There was a poor correlation between the symptoms of constipation and fecal load on abdominal X-rays (correlation coefficient of 0.08). CONCLUSIONS: Our findings support the concept that children with UTIs have a higher rate of constipation, especially by history. However, diagnosing constipation in individual patients is difficult. Not only is there a poor correlation between history and radiographic findings of constipation in any individual patient, but at this time there is no gold standard.
