Parental factors predicting unnecessary ambulance use for their child with acute illness: A cross-sectional study.

AIMS: To examine characteristics of parents of children with acute, albeit mild, illnesses who used ambulance transport unnecessarily. DESIGN: A cross-sectional study. METHODS: From 2016 - 2017, we recruited parents who visited the emergency room of a Japanese paediatric hospital and whose children were discharged without hospitalization. Participants whose children arrived by ambulance were classified as using ambulance services unnecessarily. Participants answered a questionnaire consisting of parents' characteristics, including health literacy scales and the Parents' Uncertainty regarding their Children with Acute Illness Scale. We conducted a receiver operating characteristic analysis to convert the Parents' Uncertainty regarding their Children with Acute Illness Scale results to binary scores. We analysed questionnaire responses using logistic regression analysis. RESULTS: Analysed data were from 171 participants. The cut-off score was 59 for the Parents' Uncertainty regarding their Children with Acute Illness Scale. Results of the logistic regression indicated that parents who did not use resources to obtain information regarding their child's illness, had low health literacy, were observing presenting symptoms for the first time in their child, or had high uncertainty, were significantly more likely to unnecessarily use ambulances. CONCLUSION: Publicizing available resources regarding child health information, social healthcare activities to raise parents' health literacy and providing explanations in accordance with parents' uncertainty, especially when confronting new symptoms in their child, might reduce unnecessary ambulance use. IMPACT: Of patients transported to hospitals by ambulance, the rate of paediatric parents with mild conditions has been found to be high. The study findings could contribute to the appropriateness of using ambulances and have implications for policymakers and healthcare providers, particularly in the Japanese paediatric emergency system. In particular, parental uncertainty, one of four significant characteristics, could be resolved in clinical settings. Generalization for global health services requires further research.

Resilience and difficulties of parents of children with a cleft lip and palate.

AIM: The present study explored the differences in emotional difficulties and resilience between fathers and mothers of a child with a cleft lip and palate. METHODS: Married couples were recruited who were accompanying their child with a cleft lip and palate (<12 years old) on regular visits to an outpatient clinic in a Japanese hospital. The participants were distributed an anonymous questionnaire that included items regarding emotional difficulties with the cleft lip and palate and a scale to measure resilience when caring for the children. In the data analysis, the paired t-test was used to compare the individuals within the couples. RESULTS: By analyzing the data of 64 couples who provided valid responses, two items with the highest mean score for the difficulties that were faced by both the father and mother of a child with a cleft lip and palate were: "I am worried about whether the child's teeth will be straightened" and "I am worried that the children could suffer due to their appearance." The mothers felt significantly more worry about their child's future and more guilt than did the fathers. In contrast, the fathers had greater resilience, in terms of problem-solving skills and recognition and acceptance than did the mothers. CONCLUSION: It is important that healthcare providers understand the difference between the fathers' and mothers' worries about their child with a cleft lip and palate. Specific support services should be offered to fathers with a high level of resilience, in terms of the acceptance of reality and problem-solving, which could increase their parenting ability.

Predictors of maternal state anxiety on arrival at a Japanese hospital outpatient clinic: a cross-sectional study.

AIMS AND OBJECTIVES: To identify the factors that predict maternal state anxiety when mothers and their sick children visit the outpatient unit of a paediatric hospital. BACKGROUND: While previous studies have focused on predictors of anxiety in mothers with ill children, the existing literature is limited in study design, research timing, respondent characteristics, sample size and data analysis. DESIGN: A cross-sectional design with self-administered questionnaires. METHODS: Mothers were recruited from the outpatient unit of a Japanese paediatric hospital (N = 1077). Participants' state anxiety scores were collected using the Japanese version of Spielberger's State-Trait Anxiety Inventory. The independent variables were the mothers' and sick children's background information. RESULTS: Participants were 1077 mothers; 990 provided valid responses. Mothers' mean state anxiety score was 49·72. Significant predictors of maternal anxiety were mothers' childrearing anxiety, child age, the sick child having a fever, sick child having siblings, having a person providing childrearing support, the mother's first visit to the hospital, out-of-hours visit and severity of the child's illness. The overall model explained 21·6% of the variance (multiple regression analysis). CONCLUSIONS: As various factors predicted maternal anxiety, identifying methods to address these factors may reduce maternal state anxiety. RELEVANCE TO CLINICAL PRACTICE: There is potential for improved understanding of the predictors of maternal state anxiety to aid in the development of materials that would best measure anxiety. The present findings may also suggest some means of providing appropriate information and support to anxious mothers. Our findings cannot demonstrate causation, however, and teaching methods and supportive practices were not investigated; therefore, a qualitative study on the concrete content of maternal anxiety and an intervention study to create support services for anxious mothers is required. In addition, prospective or longitudinal studies are also important for investigating causation.

Effectiveness of aromatherapy in decreasing maternal anxiety for a sick child undergoing infusion in a paediatric clinic.

OBJECTIVES: We examined whether aromatherapy involving inhalation of yuzu (Citrus ichangensis×Citrus reticulata) oil was effective in decreasing mothers' anxiety for her sick child receiving an infusion at a paediatric clinic. DESIGN: Controlled clinical trial. SETTING: Mothers of sick children who arrived at the hospital were asked to complete an anonymous questionnaire. After a doctor examined the child and confirmed the necessity for infusion, the mothers who agreed to participate in our study were allocated to an aromatherapy or a control group. INTERVENTIONS: A diffuser was filled with yuzu oil before the subjects entered the aromatherapy room. The mother was shown how to use the aromatherapy diffuser while the child was receiving an infusion in the same room. Fifteen minutes after entering the room, the mothers were asked to complete an another questionnaire. MAIN OUTCOME MEASURES: We measured the mother's anxiety with the state anxiety score from the State-Trait Anxiety Inventory. RESULTS: There were 60 subjects in the aromatherapy group and 61 in the control group. Both groups were well balanced in terms of demographic characteristics. Using analysis of variance, we demonstrated a significant difference in two-factor interactions between the control and aromatherapy groups. Maternal state anxiety was significantly lower in the aromatherapy than in the control group. CONCLUSIONS: Inhalation of yuzu oil was shown to decrease maternal anxiety for a sick child. A multicentre randomized controlled trial or double-blind study is necessary to obtain objective evidence of this benefit of aromatherapy.

Pediatric falls: effect of prevention measures and characteristics of pediatric wards.

AIM: This study aimed to identify the effect of fall prevention measures and characteristics of wards on the rate of pediatric falls. METHODS: Data on study variables were collected using a cross-sectional design and questionnaires of 603 randomized general hospitals in Japan. Among the hospitals that were contacted, 252 (41.8%) returned their questionnaires. The questionnaires included the annual number of falls, whether fall prevention measures were implemented, and characteristics of the wards. Data were analyzed from questionnaires from 162 of the hospitals, which included those that answered the number of falls. RESULTS: The pediatric fall rate was 1.36/1000 patient-days. Facilities were more likely to have a lower fall rate if they had a longer "length of stay" (P < 0.001), "shared information in high-risk patients and monitored them carefully" (P < 0.001), had higher totals for the "number of study sessions for novice nurses" (P = 0.01),and "used a pamphlet to educate patients and caregivers regarding appropriate use of side rails" (P < 0.001). Facilities that had a "playroom" (P < 0.001), higher "novice nurse-to-nurse ratio" (P < 0.001), and those at which "caregivers were necessary for hospitalization" (P = 0.04) were more likely to have a higher fall rate. CONCLUSION: The results of the present study suggest that education of parents and novice nurses on fall prevention is the most effective method of reducing pediatric falls. It is important to implement intensive fall prevention for high-risk patients and develop valid pediatric fall risk assessment tools.

Experiences of parents' with children receiving long-term home parenteral nutrition.

BACKGROUND: Home parenteral nutrition (HPN) was introduced in the early 1970s. Parents with children receiving HPN are involved in their children's treatment and strive to resolve difficult problems in adapting to their new lifestyles. This study investigates the positive views acquired by parents' regarding their experiences with their children who are receiving long-term HPN. METHODS: Participants were parents of preschool-aged children who had been receiving total parenteral nutrition for 1-6 years. In-depth interviews were conducted during which parents were questioned about their experiences during the process of providing HPN for their children. Qualitative content analysis was applied to the data. RESULTS: It seemed useful to apply the concept of resilience; therefore, we classified the categories according to factors named in previous research studies on resilience. All parents showed increased resilience in the face of HPN-related demands. CONCLUSIONS: The planning and provision of care could be aided by the conceptualization of subjects' experiences as a process during which they have needs for support and information exchange. To approach this problem appropriately, health-care professionals need to assess both children and parents on a continuous basis. Medical professionals should plan the care of ill children in advance so that appropriate help and support for their families can be provided. Better care for ill children needs to be accompanied by lasting relationships between parents and health-care professionals.

Transcutaneous PCO2 monitors are more accurate than end-tidal PCO2 monitors.

PURPOSE: The accuracy of monitors for measuring transcutaneous PCO2 (TcPCO2), end-tidal PCO2 (EtPCO2), and nasal EtPCO2 was evaluated. METHODS: The measuring devices included a TcPCO2 monitor (TCM3; Radiometer Trading), an EtPCO2 monitor (Ultima; Datex-Ohmeda), and a nasal EtPCO2 monitor (TG-920P; Nihon Kohden). The sensor electrode of the TCM3 TcPCO2 monitor was applied to the skin of the subject's upper arm. A sampling tube attached to the proximal end of the tracheal tube was connected to the Ultima EtPCO2 monitor. The miniature sensor of the TG-920P nasal EtPCO2 monitor was attached to the nostril. The values obtained were compared with direct measurements of arterial PCO2 (PaCO2) obtained by means of an ABL700 blood gas analyzer (Radiometer Trading) in surgically treated patients. The means +/- 2 SD of the differences between variables were calculated. RESULTS: The TcPCO2 monitor (0.19 +/- 4.8 mmHg, mean +/- 2-SD) was more accurate than the EtPCO2 monitor (-4.4 +/- 6.5 mmHg, mean +/- 2-SD) in patients receiving artificial ventilation via an endotracheal tube and the TcPCO2 monitor was also more accurate than the nasal EtPCO2 monitor (-6.3 +/- 9.8 mmHg, bias +/- 2-SD) in patients breathing spontaneously. CONCLUSION: We found that the TcPCO2 monitor was more accurate than the EtPCO2 or nasal EtPCO2 monitor in surgically treated patients.

Establishment and some characteristics of epoxomicin (a proteasome inhibitor) resistant variants of the human squamous cell carcinoma cell line, A431.

A431 resistant variants to epoxomicin (EXM) were established, showing 4.0-6.7 times more resistance to EXM than parental A431P. Both variants demonstrated increased expression of the beta-subunit molecules of 26S proteasome with approximately 2.5 times increased activity. In variant cells, cyclin B and P34cdc2 were over-expressed, whereas P21WAF1 was expressed at a similar level to A431P. Because of the proteasome inhibitor acting as a G2/M blocker, results are to the advantage of resistant cells proliferating in the presence of an inhibitor under a severe environment. Variant cells showed increased expression of epidermal growth factor receptor (EGFR) and decreased expression of mRNA, but also slight accumulation of protein of c-Cbl, which is a negative regulator of EGFR possessing ubiquitin ligase activity to desensitize EGF signaling. UbcH7, acting intimately with c-Cbl, was decreased in level compared to A431P. These phenomena can be regarded as one of the causes of prevention of c-Cbl-mediated down-regulation of EGFR in variant cells, enabling them to live. The anti-apoptotic Bcl-2 mainly consisted of a phosphorylated form with resistance to proteasomal degradation, suggesting that Bcl-2 phosphorylation occurred independently of its apoptotic function. Variant cells showed resistance not only to EXM, but to the 5 proteasome inhibitors, while demonstrating collateral sensitivity to doxorubicin.

[One-lung anesthesia was successfully maintained by means of Fogarty Catheter in infants].

We experienced one-lung anesthesia using Fogarty catheter as a selective bronchial blocker in two infants. First case was a one-year and ten month-old female who underwent partial resection of the right middle lobe for her giant lung cyst under general anesthesia. Second case was an eight-month-old male who underwent thoracoscopic resection of his left mediastinal tumor under general anesthesia. One-lung anesthesia was successfully established with Fogarty catheters for both cases. Size of the catheter and its balloon was decided beforehand by measuring the diameter and length of the trachea and both bronchi based on the image obtained from computerized tomography (CT) in both cases. Therefore, surgical field was well visible during operation. There was no accidental episode in perioperative period. Bronchoscopy with ultra-thin fiberscope and X-ray fluoroscopy is useful to decide the position of Fogarty catheter and its balloon. Our means is recommendable for maintenance of one-lung anesthesia in infant.