Peripheral venous catheter related complications are common among paediatric and neonatal patients.

AIM: The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC-related complications. METHODS: We included PVCs in 2032 children - 484 neonatal and 1548 paediatric - from 12 inpatient units. Data were retrieved from the patient record system, and predictors for complications were explored using logistic regression analyses. RESULTS: Just over one-third (35.4%) of the PVCs were removed due to complications, in particular infiltration and occlusion (51.9 and 48.4/1000 PVC days, respectively). PVC survival time was shorter in neonatal than paediatric patients (4 versus 5 days), and infiltration was more frequent in neonatal patients (92.8 versus 38.7/1000 PVC days). Infiltration was associated with younger age (odds ratio 0.97) for neonatal patients and with younger age (OR 0.96), insertion in the bend of the arm (OR 1.48) or ankle (OR 2.81) for paediatric patients. Occlusion was, both for neonatal and paediatric patients, associated with longer dwell time (OR 1.32 and 1.22 respectively), insertion in the ankle (OR 5.00 and 3.51) or foot (OR 3.47 and 1.99). CONCLUSION: PVC-related complications, particularly infiltration and occlusion, were more common in hospitalised children but decreased with the child's age.

A study of non-response in a questionnaire survey of parents' views of paediatric care.

The aim of this study was to examine whether there were differences in quality ratings between respondents and non-respondents to a questionnaire concerning parents' views of paediatric care. This study also examined whether quality ratings differed when questionnaire respondents were asked to reassess certain aspects of hospital care in a follow-up questionnaire. A total of 1094 questionnaires were distributed to parents at the hospital. Three weeks later, follow-up questionnaires were sent home to a random sample of 140 parents who had visited the hospital during the 2 weeks when the main questionnaire was distributed. Forty-six per cent of respondents to the follow-up questionnaire had never received the original questionnaire in hospital, while only seven individuals in the follow-up sample were active non-respondents. Analysis of variance revealed that respondents to the follow-up questionnaire who had never received the main questionnaire did not differ significantly from respondents to the main questionnaire in their ratings of key quality domains. There were no statistically significant differences in quality ratings between parents who responded to both questionnaires and parents who responded to the main questionnaire. For hospital management, it is important to be able to trust questionnaire results. Non-response bias can jeopardize the validity of questionnaire results, which is why studies of non-response are important. The current study pinpoints a number of difficulties that need to be considered when conducting investigations of non-response.

Quality of paediatric care: application and validation of an instrument for measuring parent satisfaction with hospital care.

OBJECTIVE: To apply and validate an adapted version of an existing adult patient questionnaire in a study of parental satisfaction with paediatric care in a university hospital. DESIGN: A cross-sectional, anonymous questionnaire study. A total of 912 questionnaires were distributed to parents by hospital staff during a 2-week period. SETTING: A university children's hospital in Stockholm, Sweden. STUDY PARTICIPANTS: Six hundred and twenty-four parents whose children were receiving care at the hospital during a 2-week period in April of 1999. MAIN OUTCOME MEASURES: The 63-item questionnaire uses eight main measurement indices and an overall quality rating to define parental satisfaction with paediatric care. Measures of the instrument's reliability and validity were established by comparison with results of a pilot study conducted 1 year earlier on the paediatric departments of two regional Swedish hospitals. All measures were compared to reliability and validity estimates in the original patient questionnaire. RESULTS: A total of 624 questionnaires were returned, a response rate of 68%. The instrument demonstrated good reliability and validity. Reliability estimates for all eight indices were greater than 0.70 and consistent over time. Inter-index correlations were generally lower than 0.60, indicating index independence. Of the nine parameters measured, parents were most satisfied with staff attitudes, care processes and medical treatment. Parents' ratings were lowest for accessibility and staff work environment. CONCLUSION: This study presents a valid and reliable questionnaire instrument for measuring parental views of paediatric hospital care. The instrument measures the quality of paediatric care from a broader perspective than previously existing parent questionnaires.

Psoralenamines. 3. Synthesis, pharmacological behavior, and DNA binding of 5-(aminomethyl)-8-methoxy-, 5-[[(3-aminopropyl)oxy]methyl]-, and 8-[(3-aminopropyl)oxy]psoralen derivatives.

A series of derivatives of 5-(aminomethyl)-8-methoxypsoralens, 8-[(3-aminopropyl)oxy]psoralens, and 5-[[[3-(tri-methylammonio)propyl]methyl]-8-methoxypsoralen has been synthesized and their potential as PUVA reagents examined. While the DNA association constants of selected psoralens were found to be 10(5)-10(6)L mol-1, corresponding to efficient binding, flow linear dichroism studies indicated that only the 8-substituted psoralens bind to DNA by intercalation. Furthermore, the ability to photoinduce interstrand cross-links in calf thymus DNA, in vitro, was as efficient as that of 8-methoxypsoralen for the 8-substituted psoralens, which were up to 25 times as efficient as the 5-substituted psoralens. Four of the psoralens studied were radiolabeled and used to study photobinding to DNA. Analogously to the cross-binding results, the 8-substituted psoralens were more efficiently photobound than the 5-substituted, while only slight differences were found in the photobinding-cross-linking ratio. The photoreactivity of the aminopsoralens toward cyclohexene and 2'-deoxythymidine was enhanced compared to that of 8-methoxypsoralen, the effect being most pronounced when the amino group is close to the furocoumarin ring system. Most of the new compounds were less photocytotoxic than 8-methoxypsoralen to NHIK 3025 cells, in vitro, and they caused less light-induced DNA interstrand cross-linking, in situ, in these cells. A clear correlation between the photocytotoxicity and the DNA cross-linking ability of the psoralens was observed. Several of the derivatives showed more pronounced effects in the light-dependent skin thickening (inflammatory) test on mice than 8-methoxypsoralen. No correlation between DNA cross-linking capacity, in vitro, and skin phototoxicity was found for this series of psoralens.