Experiences of caregivers of children with cancer in Malawi: A qualitative study.

BACKGROUND: Studies have shown that caregivers of children with cancer experience challenges when caring for their children. To date, no studies have examined the experience of caregivers of children with cancer in Malawi, a low-income country in sub-Saharan Africa. Hence, this study aimed to explore the experiences of caregivers of Malawian children receiving cancer treatment. METHODS: This explorative qualitative study used semi-structured interviews to collect data from 22 caregivers of children receiving cancer treatment. The data were analysed using qualitative content analysis. RESULTS: Five themes emerged from the QCA. The caregivers perceived their children's cancer as a burden, a form of psychological torture and a disruptor of family routines and social lifestyles. They also reported self-isolation due to the stigma that they faced in the course of caring for their children and a need for informational, psychosocial, spiritual and financial support. CONCLUSION: Caregivers of Malawian children with cancer experience physical and psychosocial challenges as they are caring for their children with cancer. Developing appropriate interventions would enable nurses to offer optimal support to these caregivers in dealing with these challenges and meeting their needs effectively.

The moderating effects of nurses' background characteristics on the relationship between family-centred care perception and practice for hospitalized children and their families in Malawi.

PURPOSE: Globally, limited information is available on the relationship between the perception and practice of family-centered care (FCC), and the moderating effects of nurses' background characteristics on this relationship. This study investigated the relationship between FCC perception and FCC practice and the moderating effects of the nurses' background characteristics on this relationship. DESIGN AND METHODS: A cross-sectional study was conducted using a two-stage stratified sampling method. Data were collected from 444 nurses using the Family Centered Care Questionnaire-Revised and analyzed using IBM SPSS Version 25. The Hayes PROCESS macro model, version 3, was integrated into SPSS to examine the moderating effects at a significance level of 0.05. RESULTS: The response rate was 98%, and a statistically significant positive association was found between FCC perception and FCC practice (r = 0.353, p < .001). Gender of a nurse (ΔR2 = 0.0206, p < .002), having children (ΔR2 = 0.0231, p < .001), experience (ΔR2 = 0.0107, p = .028), and working in a medical-surgical ward (ΔR2 = 0.0208, p = .008) had a statistically significant moderating effect on the relationship between FCC perception and FCC practice. CONCLUSION: These findings provide minimal evidence of the existence of non-modifiable moderators of FCC. Future studies with modifiable moderators are therefore needed. PRACTICE IMPLICATIONS: Understanding the moderating effects of nurses' background characteristics on the relationship between FCC perception and FCC practice may facilitate the development of FCC interventions that favor these background characteristics and facilitate the integration of FCC into routine policies and practices.

Effectiveness of psychoeducation interventions in reducing negative psychological outcomes and improving coping skills in caregivers of children with cancer: A systematic review and meta-analysis.

PURPOSE: Psychoeducation interventions (PEIs) have been used as an adjunct treatment for negative psychological outcomes in caregivers of children with cancer. This systematic review and meta-analysis aimed to evaluate the evidence on the effectiveness of PEIs in reducing anxiety and depressive symptoms and improving health-related quality of life (HRQoL) and coping skills in caregivers of children with cancer. METHOD: Ten English databases were searched to identify studies on PEIs for caregivers of children with cancer. Studies inclusion criteria were as follows: (1) participants who were caregivers of children with cancer receiving treatment; (2) psychoeducational interventions assessing anxiety, depressive symptoms, HRQoL, and coping outcomes; and (3) usual care, waitlist, or active control as a control group. Meta-analysis and narrative synthesis were used to analyse data. RESULTS: Fourteen randomised control trials were included. PEIs have a beneficial effect on anxiety levels (SMD: -0.59, 95% CI [-0.92, -0.25], p = 0.0007), quality of life (SMD: -0.31, 95% CI [-0.00, -0.61], p = 0.05) and depressive symptoms (SMD: -1.18, 95% CI [-2.08, -0.28], p = 0.01) immediately post-intervention. The effect of PEIs was maintained at long-term follow-up on depressive symptoms (SMD: -0.52, 95% CI [-1.54, -0.36], p = 0.0004). Similarly, the synthesised data suggest that PEIs are effective in improving coping skills. CONCLUSION: The review provides evidence that PEIs effectively reduce negative psychological outcomes and improve coping skills in caregivers of children with cancer. However, due to methodological flaws and heterogeneity of the interventions evaluated, more research is needed to determine the most effective PEI design and improve the quality of evidence.

Nurses' and Families' perceptions and practices and factors influencing the implementation of family-centred care for hospitalised children and their families.

AIMS AND OBJECTIVES: To explore the perceptions of family-centred care among nurses and the family members of hospitalised children and investigate the facilitators of and barriers to the implementation of family-centred care in Malawi. BACKGROUND: In Malawi, approximately 34% of children have long-term illnesses that require hospitalisation. Family-centred care ensures that the delivery of healthcare is grounded in partnerships between healthcare providers, patients and their families, which can improve the psychological well-being of families. However, there is lack a good understanding of how families and nurses perceive this concept, its facilitators and the barriers. DESIGN: This was an exploratory qualitative study. Data were analysed deductively and inductively using the five-step qualitative content analysis method. METHODS: Twenty-nine nurses and 31 families were recruited. Data were collected through in-depth, semi-structured and face-to-face individual interviews. The study was reported using the COREQ checklist. RESULTS: Both nurses and families of hospitalised children recognised the importance of nurse-family partnerships in family-centred care. Four themes emerged as follows: Perceptions of family-centred care, elements of family-centred care, facilitators of family-centred care and barriers to family-centred care. Specific information to families and the religious beliefs of families were identified as important facilitator and barrier to family-centred care, respectively. CONCLUSION: The implementation of family-centred care is promising in Malawi, as it is positively perceived by nurses and families, and its implementation is consistent with the Institute for Patient and Family-Centred Care Framework. RELEVANCE TO CLINICAL PRACTICE: Our findings present the best practices, gaps and challenges in the context of a low-income country regrading implementation of family-centred care. Education programmes on family-centred care are crucial for sustaining the current gains.

Discrepancies between nurses' current and perceived necessary practices of family-centred care for hospitalised children and their families: A cross-sectional study.

PURPOSE: This study investigated (1) the discrepancies between the nurses' current and perceived necessary practices of family-centred care (FCC), and (2) the nurses' demographic characteristics associated with current and perceived necessary practices of FCC for hospitalised children and their families in Malawi. DESIGN AND METHODS: A cross-sectional study involving 444 nurses was conducted. The Family-Centred Care Questionnaire-Revised was used to examine the discrepancies between the nurses' current and perceived necessary practices of FCC. Univariate and multivariate statistical analyses were performed to identify the nurses' demographic characteristics associated with current and perceived necessary practices of FCC. RESULTS: The total mean score of the nurses' current practices of FCC (M = 34.78, SD = 7.06) was significantly lower than that of the nurses' practices of FCC that were perceived as necessary (M = 38.63, SD = 5.60, p < 0.001). The nurses who were over 40 years of age (regression coefficient, ß = 9.162, p = 0.014), had a postgraduate qualification (ß = 23.314, p < 0.001), were separated or widowed (ß = 9.661, p = 0.029), had a Tumbuka cultural background (ß = 12.984, p < 0.001), were Seventh-day Adventist members (ß = 8.863, p = 0.026), and worked in mission hospitals (ß = 16.401, p = 0.021) were more likely to implement current practices of FCC. Conversely, the nurses who were members of the Moslem, Buddhist, or Hindi religious denomination (ß = 6.587, p = 0.040), had a Tonga or Ngonde cultural background (ß = 6.625, p = 0.046), and were nurse midwife technicians (ß = -23.528, p = 0.012) were more likely to implement practices of FCC that they perceived as necessary. CONCLUSION: Significant differences between the nurses' current and perceived necessary practices of FCC suggested that there were barriers to implementing necessary practices of FCC. The nurses' cultural and religious backgrounds were predictors of current practices of FCC, and this finding could direct the future development and testing of FCC interventions in Malawi. PRACTICE IMPLICATIONS: Continued educational activities and research on the factors that contributed to the discrepancies between the nurses' current and perceived necessary practices of FCC and their impact on FCC in Malawi are critical.

Health-Related Quality of Life of Nurses Caring for Hospitalised Children and Their Families: A National Cross-Sectional Study.

PURPOSE: Health-related quality of life (HRQoL) continues to be understudied among nurses in developing countries. This study aimed to assess (1) the HRQoL of nurses in Malawi caring for hospitalised children and their families, and (2) the nurses' demographic characteristics associated with their HRQoL. DESIGN AND METHODS: The cross-sectional study was carried out at 23 hospitals in Malawi, and 203 nurses participated, resulting in a 96% response rate. The Medical Outcomes Study 36-Item Short Form Health Survey was used to collect data. The physical and mental health component scores were evaluated and compared with those in a Cyprus study as the population norm. Both univariate and multivariate analyses were performed, with the significance level set at 0.05. RESULTS: The nurses' HRQoL was moderately impaired; however, the mean scores of both the physical and the mental health components of the nurses in the Cyprus study were statistically lower than those of the Malawian nurses (t = 36.541, p < 0.001 and t = 19.477, p < 0.001, respectively). Age was independently associated with a better physical health status (ß = 29.949, p = 0.038), while female nurses were more likely to report a negative physical health status compared with male nurses (ß = -97.481, p = 0.002). CONCLUSION: The findings suggested that the Malawian nurses were affected by work-related stress, which affected their mental and physical health status. The current findings represent preliminary data, and as such further studies on the association between work-related factors and HRQoL are needed. PRACTICE IMPLICATIONS: Knowledge of HRQoL from the perspective of nurses can help healthcare organisations to develop interventions to limit the negative impacts of work-related stress on nurses caring for children.

The Scope of Family-Centred Care Practices, and the Facilitators and Barriers to Implementation of Family-Centred Care for Hospitalised Children and their Families in Developing Countries: An Integrative Review.

PROBLEM: Limited knowledge exists regarding the scope practices and implementation from developing countries. This integrative review aims to report research on the scope of FCC practices, facilitators and barriers to the FCC implementation for hospitalised children and their families in developing countries. ELIGIBILITY CRITERIA: Qualitative, quantitative, mixed-method studies, reports, systematic reviews and integrative reviews reporting implementation, barriers and facilitators of FCC, published in English between 2008 and 2018, from developing countries were evaluated. Joanna Briggs Institute Appraisal Tools were used for methodological assessment. SAMPLE: Eleven studies from developing countries met the inclusion criteria. Four studies were randomised controlled trials, five were cross-sectional, one was a quasi-experimental while one was a qualitative study. RESULTS: The scope of FCC research focuses on information sharing, family participation, and respect and dignity and FCC implementation focuses on practices and perceptions, measurement and impact of FCC. Both personal and health system facilitators and barriers exist but their influence on FCC implementation is limited. Research on needs of families and hospitalised children is also limited. CONCLUSION: FCC practice and research are still in infancy stage in developing countries. There is limited understanding on scope of FCC practices, the needs of parents and children, and the influence of facilitators and barriers. IMPLICATIONS: The limited findings reported in this review support the need for international collaboration to FCC to critique FCC research and integrate it with other philosophies such as child and family centred care and child centred care as is the case in some developed countries.

Ten cold clubfeet.

Background and purpose - Idiopathic clubfeet are commonly treated with serial manipulation and casting, known as the Ponseti method. The use of Plaster of Paris as casting material causes both exothermic and endothermic reactions. The resulting temperature changes can create discomfort for patients. Patients and methods - In 10 patients, we used a digital thermometer with a data logger to measure below-cast temperatures to create a thermal profile of the treatment process. Results - After the anticipated temperature peak, a surprisingly large dip was observed (Tmin = 26 °C) that lasted 12 hours. Interpretation - Evaporation of excess water from a cast might be a cause for discomfort for clubfoot patients and subsequently, their caregivers.

Long-term outcomes of slipped capital femoral epiphysis treated with in situ pinning.

PURPOSE: Slipped capital femoral epiphysis (SCFE) is the commonest hip disorder in adolescents. In situ pinning is commonly performed, yet lately there has been an increase in procedures with open reduction and internal fixation. These procedures, however, are technically demanding with relatively high complication rates and unknown long-term outcomes. Nevertheless, reports on long-term results of in situ fixation are not equivocal. This study evaluates the possible higher risk of worse outcome after in situ pinning of SCFE. METHODS: All patients treated for SCFE with in situ fixation between 1980 and 2002 in four different hospitals were asked to participate. Patients were divided into three groups, based on severity of the slip. Patients were invited to the outpatient clinic for physical examination and X-rays, and to fill out the questionnaires HOOS, EQ5D, and SF36. ANOVA and chi-squared tests were used to analyze differences between groups. RESULTS: Sixty-one patients with 78 slips filled out the questionnaires. Patients with severe slips had worse scores on HOOS, EQ5D, and SF36. 75 % of patients with severe slips had severe osteoarthritis, compared to 2 % of mild and 11 % of moderate slips. CONCLUSION: Hips with mild and moderate SCFE generally had good functional and radiological outcome at a mean follow-up of 18 years, and for these hips there seems to be no indication for open procedures. However, severe slips have a significantly worse outcome, and open reduction and internal fixation could therefore be considered.

Conservative treatment of a pathological fracture in a 3-year-old boy with primary hyperoxaluria type I.

Primary hyperoxaluria type I is a rare inherited disease that presents a disturbed metabolism of glyoxylate. Consequently, patients suffer from hyperoxaluria, leading to renal failure and subsequent skeletal calcium oxalate deposition. Areas with high concentrations of calcium oxalate, so-called dense metaphyseal bands, are at risk for pathological fracturing. The primary disease is treated by combined liver-kidney transplantation, although pathological fracturing also occurs in the posttransplant period. In the current case, we present a 3-year-old boy with a pathological fracture of his right femur, 2 years after liver-kidney transplantation. We opted for a conservative regime, leading to good fracture healing. As there are limited data in the literature regarding treatment of fractures in these patients, it is important to notify the outcome of conservative treatment of pathological fractures in patients with primary hyperoxaluria type I.

Long-term results of the posteromedial release in the treatment of idiopathic clubfoot.

BACKGROUND: Short-term follow-up studies show good results in foot function, after surgical treatment of idiopathic clubfeet. Long-term follow-up studies are rare and probably represent a mixture of experience of different treating orthopedic surgeons. The purpose of this study is to present the long-term results of the posteromedial release (PMR) in congenital clubfoot treatment of 1 treating surgeon. MATERIALS AND METHODS: Thirty-eight patients with 58 clubfeet had an a la carte PMRe, performed by 1 experienced pediatric orthopedic surgeon before the age of 2 years. This group had a mean follow-up of 16 years (range 13 to 24 years). All patients were interviewed and examined. Thereafter, the standing anteroposterior and lateral radiographs of the feet were taken. The results of the treatment were graded according to the system of Laaveg and Ponseti, and with the radiographs the grade of osteoarthritis was determined. The results were compared with the controlateral normal feet. RESULTS: In 53 feet, the mean rating was 80.6 points (range 43 to 97), according to the system of Laaveg and Ponseti. There were 15 excellent, 17 good, 13 fair, and 8 poor results. The majority of patients had the limitation of foot function with a significant decrease in dorsiflexion of 31% and a significant decrease of pronation-suppination of 24%. The grade of osteoarthritis was consistently higher in the clubfeet than in the controlateral normal feet. Five feet (9%) needed an additional bony procedure because of pain and overcorrection of the clubfeet. This was considered to be a failure of the surgical treatment. CONCLUSION: In our study population, PMR will lead to stiff, and therefore to clinical not fully functional, feet after a follow-up of 16 years. LEVEL OF EVIDENCE: Therapeutic level III.

Reliability of popliteal angle measurement: a study in cerebral palsy patients and healthy controls.

UNLABELLED: The popliteal angle is a widely used clinical measure for hamstring contracture in cerebral palsy (CP) patients and in healthy individuals. The reliability of popliteal angle measurement is being questioned. The aim of this study is to determine the reliability of popliteal angle measurement by means of visual and goniometric assessment. METHODS: Three different observers measured the popliteal angle in 15 CP patients and 15 healthy volunteers. In each subject, popliteal angles were visually estimated and measured with a blinded goniometer twice by all observers with approximately 1 hour between measurement sessions. RESULTS: All intraclass correlation coefficients (ICCs) were lower in the CP group compared with healthy controls. The ICC for intraobserver differences was higher than 0.75 for both groups. The ICC for interobserver reliability of visual estimates and goniometric measurements was low for both groups. Intermethod ICC was higher than 0.75 for both groups. CONCLUSIONS: Measurements in the CP group seemed to be less reliable than measurements in the control group. Intraobserver reliability is reasonable for both groups, but lower in CP patients than in controls. Interobserver reliability of both visual estimates and goniometrical measurements is poor. No significant differences in reliability have been found between visual estimation and goniometric measurement. Because of poor interobserver reliability of popliteal angle measurement, this should not be the only variable in clinical decision making in CP patients.

Prevention of pin tract infection in external stainless steel fixator frames using electric current in a goat model.

Pin tract infections of external fixators used in orthopaedic reconstructive bone surgery are serious complications that can eventually lead to periostitis and osteomyelitis. In vitro experiments have demonstrated that bacteria adhering to stainless steel in a biofilm mode of growth detach under the influence of small electric currents, while remaining bacteria become less viable upon current application. Therefore, we have investigated whether a 100microA electric current can prevent signs of clinical infection around percutaneous pins, implanted in the tibia of goats. Three pins were inserted into the lateral right tibia of nine goats, of which one served for additional frame support. Two pins were infected with a Staphylococcus epidermidis strain of which one pin was subjected to electric current, while the other pin was used as control. Pin sites were examined daily. The wound electrical resistance decreased with worsening of the infection from a dry condition to a purulent stage. After 21 days, animals were sacrificed and the pins taken out. Infection developed in 89% of the control pin sites, whereas only 11% of the pin sites in the current group showed infection. These results show that infection of percutaneous pin sites of external fixators in reconstructive bone surgery can be prevented by the application of a small DC electric current.

Perioperative contamination in primary total hip arthroplasty.

UNLABELLED: All surgical procedures have the risk of microbial contamination. However, procedures in which prosthetic materials are involved have a high risk for future infectious problems because of the protection offered by the biofilm mode of growth. Studies of perioperative contamination have been done on involved surgical instruments, but whether these instruments transmit contamination to the prosthesis or future site of the prosthesis is not known. The aim of this study was to detect possible bacterial contamination in total hip arthroplasty through instruments that are used at the direct site of implantation during the primary procedure. Samples of the broaches used for preparing the acetabulum and femur, and samples of the reamed acetabular and femoral bone, were collected during 67 consecutive primary total hip arthroplasties in 67 patients. Broach samples were taken at the start and end of every reaming procedure. Four hundred two samples were taken, of which 26 were found to be positive for microorganisms. In 20 patients, at least one of these positive samples had been in direct contact with the actual prosthesis site, indicating that at least 30% of the involved patients had a possible bacterial contamination when leaving the operating theater. LEVEL OF EVIDENCE: Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients--with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

Exposure analysis of five fish-consuming populations for overexposure to methylmercury.

Mercury, in the form of methylmercury, is found in a myriad of fish species consumed by recreational and subsistence fishers around the world. Many agencies have attempted to address the issue of mercury consumption, resulting at times in the placement of advisories on waterways used for fishing. In this study, consumption rates of three Native American populations and two recreational fishing populations consuming freshwater or saltwater fish species were examined. These consumption rates were combined with fish contamination data to assess the level of exposure to methylmercury and to determine if any of these populations exceed a derived tolerable daily intake (TDI) for methylmercury (0.035 to 0.08 microg/kg/day). The TDI is unlikely to result in adverse health effects and is based on scientific studies investigating sensitive endpoints in children of mothers who consume fish over prolonged periods of time. Results from the exposure analysis indicate that many within the Native American populations exceed the TDI. This occurs even though the mercury concentrations in certain fish species are comparable to concentrations found in fish from open waters where "background" levels are assumed. Recreational anglers consuming freshwater species have exposure levels below the TDI as do nearly all anglers consuming saltwater species. Similar populations or populations having comparable consumption patterns of fish with equal or higher mercury levels in other areas will also exceed the TDI level for mercury. The public health implications of this exposure analysis are discussed.

The prognosis for end-stage renal failure in spinal cord injury and spina bifida--Australia and New Zealand, 1970-1991.

BACKGROUND: The outcome of patients with end-stage renal failure (ESRF) and spinal cord injury or disease has not been clearly documented. AIMS: The aim of this study was to define the prognosis and social consequences for patients with spinal cord injury or spina bifida (SB) treated for ESRF in Australia and New Zealand from 1970 to 1991. METHODS: Fifty patients (two groups: 25--spinal cord injury, 25--SB) were identified retrospectively by questionnaire to individual renal units. Additional information was obtained from the Australia and New Zealand Dialysis and Transplant Registry. Dialysis and transplant history, degree of disability and cumulative survival with integrated treatment were compared between the two groups. RESULTS: Haemodialysis was the most common form of treatment (75.8% of total treatment time in the spinal cord injury group and 66.1% in the SB group). Home or self-care dialysis for a period of more than six months was achieved in 68% of patients in each group. Ten year cumulative survival with integrated treatment was statistically better in the SB group (p < 0.01). In the 42% of all patients who underwent renal transplantation cumulative patient survival was 94% at one year and 82% at five years, with allograft survival being 73% and 70% respectively. In conclusion ESRF and spinal cord injury or SB has a good prognosis in the longer term with an integrated approach to treatment.