Medication Education Provided to School-Aged Children: A Systematic Scoping Review.

OBJECTIVES: To characterize the educational interventions regarding prescription and nonprescription medication use for school-aged children, we systematically reviewed evidence of programs available for this age group. METHODS: Searches in PubMed, CINAHL, EMBASE, ERIC, and International Pharmaceutical Abstracts were conducted. Search terms focused on: population education, school-age children, and medications. Studies were excluded if they were specific to a particular disease state or class of medication, drugs of misuse and illicit drugs. Data extraction included study design, location, educational intervention and duration, research methods, and main findings. RESULTS: We found 14 studies representing 8 separate projects. Six projects were identified in the gray literature. Projects ranged from individual sessions to national programs. Quantitative studies showed improvement in knowledge, medication literacy, and confidence. The adoption of medication education strategies was dependent on the educator's comfort level and beliefs regarding medication safety. CONCLUSIONS: Credible medication education resources are available and have been shown to improve students' knowledge. There remains a need for multifaceted implementation and evaluation strategies. Strategies and resources are available to implement interventions in communities to address medication education in school-age children. Frameworks should be used to facilitate the implementation of effective health promotion strategies around safe-medication use for school-aged children.

Midline location of tumour is a risk factor for postoperative vomiting in children requiring posterior fossa tumour resection.

Children requiring posterior fossa brain tumour surgery form a unique and significant neuro-oncology population. Postoperative vomiting (POV) is a problem for these children. Also, severe vomiting that is refractory to treatment has been seen clinically in these children, but it is not well described in the literature. A subgroup of children requiring surgery for posterior fossa brain tumours (n=153) from a larger six-year retrospective chart audit (n=249) at two Canadian children's hospitals were reviewed for the presence of no, mild, moderate, and severe POV. Inter-rater reliability was established at 94% following a blinded process of comparing POV severity rankings between two data collector/researchers. Discrepancies were resolved through discussion in order to establish a consensus severity score. Findings from multivariable logistic regression analyses indicated that when age and intraoperative use of ondansetron were controlled for, the location of a tumour in a midline location had no overall effect (adjusted OR=1.37, 95% confidence interval: 0.64-2.96, p=0.43), but greater odds of severe vomiting (adjusted OR=7.08, 95% confidence interval: 2.56-19.64, p<0.001). These results support theories of modulation of vomiting by the medullary midline and clinical observations that children with midline posterior fossa tumours are at greater risk for severe refractory vomiting. The development of clinical practice guidelines and further research to study the effectiveness of novel, multimodal antiemetic therapies are required for this patient population.

Children's vomiting following posterior fossa surgery: A retrospective study.

BACKGROUND: Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated. METHODS: A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting. RESULTS: The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to <17) were less likely to vomit by 120 hours after surgery than other age groups; those who received desflurane, when compared to all other volatile anesthetics, were more likely to vomit, yet the use of ondansetron with desflurane decre kelihood. Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk). Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane. Nausea was not well documented and was therefore not analyzed. CONCLUSION: The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative vomiting following craniotomy: two studies in children and young adults.

The purpose of this meta-analysis was to estimate the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative vomiting (POV) in pediatric craniotomy patients at 24 hours. By updating a previously published systematic literature search, we found a recently published pediatric study to combine with the one already identified. The two published randomized placebo-controlled trials were combined for a total of 135 participants aged 2 to 20 (79 treatment and 56 controls). The only study drug was ondansetron. The combined relative risk (RR) of vomiting was not statistically significant in the treatment group compared to the control group (RR = 0.77; 95% CI: 0.50-1.19). There was also no evidence of efficacy for ondansetron in reducing the use of rescue antiemetics in the treatment group compared to the control group (RR = .71; 95% CI: 0.34-1.49). While combining these randomized placebo-controlled trials did not show efficacy for ondansetron in preventing POV in craniotomy patients aged 2 to 20, a clinically significant effect cannot be excluded, as even the combined sample size remained small. Thus, there is no current evidence for or against this class of drugs for preventing POV in children after craniotomy, and clinical decision-making must be based on studies in other populations and clinical experience. Ongoing assessment of nausea and vomiting and ongoing evaluation of the effectiveness of treatments in individual children and young adults remains an essential part of perianesthesia and postoperative neuroscience nursing.

Prognostic models and risk scores: can we accurately predict postoperative nausea and vomiting in children after craniotomy?

Postoperative nausea and vomiting (PONV) is a problem for many children after craniotomy. Prognostic models and risk scores help identify who is at risk for an adverse event such as PONV to help guide clinical care. The purpose of this article is to assess whether an existing prognostic model or risk score can predict PONV in children after craniotomy. The concepts of transportability, calibration, and discrimination are presented to identify what is required to have a valid tool for clinical use. Although previous work may inform clinical practice and guide future research, existing prognostic models and risk scores do not appear to be options for predicting PONV in children undergoing craniotomy. However, until risk factors are further delineated, followed by the development and validation of prognostic models and risk scores that include children after craniotomy, clinical judgment in the context of current research may serve as a guide for clinical care in this population.

What are the risk factors for nausea and vomiting after neurosurgery? A systematic review.

In their practice of post-operative neurosurgical care, nurses frequently encounter the problem of post-operative nausea and vomiting (PONV). Knowledge of risk factors for PONV can help nurses to identify groups of patients who may encounter PONV and develop related therapeutic guidelines. The purpose of this systematic review was to identify and summarize risk factor research for PONV after neurosurgical procedures. Of 272 papers identified through a systematic search, 13 studies met the criteria for this review. These studies varied considerably in their outcome measurements, risk factors studied, and target populations. The timeframe of observation (for prospective studies) or chart review (for retrospective studies) ranged from one hour after surgery to the entire length of the hospital stay. For these reasons, it was difficult to compare results among the studies. Overall, the methodological quality of the studies was fair, with few studies controlling for confounders and many with limited explanations of how the risk factors and/or outcomes were measured. Despite these limitations, many authors looked at unique risk factors for neurosurgical patients such as location of surgery (i.e., infratentorial versus supratentorial), awake versus general anesthesia, and use of fat grafting for cerebral spinal fluid leak in transsphenoidal procedures. The findings may challenge traditional thinking about risk factors for PONV and guide future studies.

Effectiveness of teaching an early parenting approach within a community-based support service for adolescent mothers.

A single blind, pre-test, post-test design was used to test the effectiveness of the Keys to Caregiving Program in enhancing adolescent mother-infant interactions. Participants were sequentially allocated to groups in order of referral. The outcome was the enhancement of maternal and infant behaviors that exhibited mutual responsiveness as measured by the Nursing Child Assessment Teaching Scale. Issues with recruitment and collaboration with the community agencies made achieving a desirable sample size difficult. Pre-tests and post-tests were completed for 13 participants. While the sample size was insufficient to confidently establish whether or not the Keys to Caregiving produced a between groups treatment effect, mothers within the treatment group evidenced significantly greater contingent responsiveness over time than those within the control group.

The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative nausea and vomiting after craniotomy: a meta-analysis.

The purpose of this meta-analysis was to assess the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative nausea and vomiting in neurosurgical patients at 24 and 48+ hours. After a systematic search, 7 published randomized placebo controlled trials involving 448 craniotomy patients (222 treatment, 226 control) were included in the meta-analysis. Study drugs included ondansetron, granisetron, and tropisetron. The cumulative incidence of emesis was significantly reduced in the treatment group at 24 hours [relative risk (RR)=0.50, 95% confidence interval (CI): 0.38-0.66] and 48+ hours (RR=0.52, 95% CI: 0.36-0.75). There were no differences between the treatment and control groups in the cumulative incidence of nausea at 24 hours (RR=0.76, 95% CI: 0.54-1.06) and 48+ hours (RR=0.81, 95% CI: 0.62-1.06). The cumulative incidence of both nausea and vomiting continued to increase after 24 hours in both groups. Despite the ability of 5-HT3 receptor antagonists to reduce emetic episodes, future investigations should seek to address the control of postoperative nausea and to reduce further postoperative emesis in this population.

Deciding on surgery: supporting parents of infants with craniosynostosis.

Families face a difficult decision when choosing whether or not to have surgery for their infant with isolated craniosynostosis. While the skull deformity may not affect the child's physical health, growth, or development, it may have psychosocial impacts on a child's social-emotional development, self-esteem, and interpersonal interactions. Parents are challenged to balance surgical risks with potentially positive effects on their child's psychosocial health. The purpose of this research study was to explore parental decision-making related to surgery for isolated craniosynostosis, and to identify strategies that facilitate their decision-making. A thematic content analysis of focus group interview data revealed four themes that encapsulated the process of parental decision-making. The decision for some parents was agonizing. However, others found the decision relatively straightforward. In all cases, parents spent time thinking and gathering information. Certain critical events helped parents make their decision. Parents identified a number of strategies that would be helpful to the decision-making process.

Pharmacology review: the role of ondansetron in the management of children's nausea and vomiting following posterior fossa neurosurgical procedures.

The management of nausea and vomiting is fundamental to the post-operative nursing care of children. Children who have neurosurgical procedures, especially those that involve the posterior fossa, are likely to experience nausea and vomiting in the post-operative period. The proximity of brainstem emetic centres to the surgical site compounds the usual post-operative risk factors for nausea and vomiting. Ondansetron is discussed as an agent that may be more effective than the traditionally-used antiemetics, such as dimenhydrinate and metoclopramide, in this population. Nurses must advocate for effective therapeutic measures to manage children's post-operative nausea and vomiting. Advocacy requires knowledge of high-risk groups, accurate assessment, timely intervention, and thorough evaluation of pharmacological and non-pharmacological measures.