Puppet Therapy with Pediatric Bone Marrow Transplant Patients

The authors' experience in developing and implementing a formof short-term puppet therapy for children undergoing bone marrowtransplantation is reviewed.     

Asthma counselling targeted to removal of domestic animals

OBJECTIVES:

To create and evaluate the efficacy of a short individualized educational intervention program, based on Prochaska’s transtheoretical model, for a six-month period in a population of adult asthma patients living with domestic animals but sensitized to these pets.

METHODS:

A randomized, controlled study using a pretested questionnaire was conducted at three different times (pretest, and at three and six months postintervention).

RESULTS:

Eleven members (29%) of the intervention group and eight members (21%) of the control group removed their pets within six months (χ²=3.23; P>0.35). The two groups showed similar improvements in their perception of the benefits of pet removal and in their level of belief that they could do it. The experimental group showed a greater improvement in knowledge acquisition about asthma and allergies than the control group (P<0.05). Both experimental and standard educational interventions were effective in facilitating progression through the stages of behavioural change.

CONCLUSION:

Overall, the results do not support the utility of behavioural change educational intervention, tailored to the transtheoretical model stage of the individual, in the context of convincing patients to remove their pets from their homes. However, the decision-making aid appears to be helpful in raising awareness of the problem of asthma and allergy in the patient, and in developing appropriate knowledge.     

Elaboration of a conceptual frame to explain fatigue secondary to a health difficulty and implications for nursing practice

Many definitions and conceptual frameworks were developed on fatigue related to health problems, mostly from scientific research among cancer patients. From a summary of a literature review, the first objective of this article is to describe different theoretical perspectives on the concept of fatigue. The second objective is to elaborate an integrative conceptual framework from the definitions chosen. The third objective is to describe different coping strategies and nursing interventions in relation with the conceptual framework. The literature review includes studies on fatigue in general with an emphasis on cancer related fatigue in particular. The review was conducted from 3 scientific data bases, Medline, Cinahl and Psychlit, for the last twenty years. The relevance of the conceptual framework for nursing intervention is discussed.     

Effect of Discontinuation of Manganese Supplementation From Home Parenteral Nutrition Solutions on Whole‐Blood Levels and Magnetic Resonance Imaging of the Brain: A 5‐Year Cohort Study

Background: Manganese (Mn) is included in current premixed multiple trace element (TE) additives for home parenteral nutrition (HPN). However, there is a risk of oversupplementation of Mn due to contamination from PN additives. Oversupplementation can produce Mn toxicity with neurologic symptoms and abnormalities on brain magnetic resonance imaging (MRI). In 2009, we reported that whole‐blood Mn levels were above the upper limit of normal in 16 HPN patients, with 81% having MRI findings. Subsequently, we removed Mn supplementation from all our HPN patients. We present a 5‐year follow‐up here. Methods: This is a prospective cohort study on 11 of the surviving 16 patients on HPN. All patients had Mn removed from PN and had yearly monitoring of blood Mn levels. Eight patients had a repeat MRI to evaluate for resolution of basal ganglia deposits. Patient demography, clinical history, and bloodwork were recorded. Results: Five of 6 patients who initially had elevated Mn levels had normal levels on follow‐up. All patients who had Mn levels measured serially had a decrease in levels; the mean percent decrease of Mn was 38.1% (range, 10.1%–53.8%). Two patients had elevated Mn despite the absence of supplementation. Six of 8 patients who had repeat MRIs had complete resolution abnormalities. Conclusions: Removal of Mn as an additive in HPN solutions resulted in resolution of MRI abnormalities in most patients. Over 5 years, all patients except for 1 maintained normal blood Mn levels. Therefore, Mn levels should be monitored and supplementation be individualized.     

Treatment patterns of venous thromboembolism in a real-world population: The Q-VTE study cohort

Background

Few studies have assessed treatment patterns of acute venous thromboembolism (VTE) in a real-world population. We aimed to describe anticoagulant treatment patterns for acute VTE using healthcare databases of Québec, Canada.

Methods

We used linked healthcare databases of the province of Québec, Canada to identify all incident cases of deep vein thrombosis (DVT) and pulmonary embolism (PE) between 2000 and 2009. We formed two patient cohorts, one with definite cases (definite VTE cohort, N = 40,776) and the other including cases with definite or probable VTE (any VTE cohort, N = 54,803) that were followed until death, end of health coverage, or end of study (December 31, 2009).

Results

In the definite cohort, 73.6% of subjects were dispensed an anticoagulant following the diagnosis of VTE. Of those who were dispensed a vitamin K antagonist (VKA), median duration of use was 61 days (interquartile range 89). VKA initiation was more likely in patients with pulmonary embolism than deep vein thrombosis alone (HR 1.62, 95% CI (1.58-1.66)). Among outpatients, those managed initially in the outpatient setting were less likely to initiate VKA therapy (HR 0.75, 95% CI (0.68-0.77)), while those requiring admission to hospital for VTE management were more likely to initiate (HR 1.81, 95% CI (1.76-1.87)). Findings were similar in the any VTE cohort.

Conclusion

Our study describes VTE treatment patterns in a real-world setting and suggests that there may be important gaps. These may include significant numbers of patients who did not initiate oral anticoagulant therapy, particularly in the outpatient setting, and shorter duration of oral anticoagulant use than recommended.     

Experiences of humor in pediatric nursing care

The results of qualitative research conducted in order to document the experience of nurses using humour with hospitalised children give us an insight into the social importance of humour. It helps to establish a relationship of trust between nurse and child, and also creates lasting bonds that persist well beyond the present.     

The Canadian Home Total Parenteral Nutrition (HTPN) Registry: vitamin K supplementation and bone mineral density

Background: Vitamin K supplementation improves bone health, and its absence might be associated with low bone mineral density (BMD). The authors aim to assess vitamin K supplementation practices in Canadian home parenteral nutrition (HPN) programs and their relationship with BMD. Methods: This is a cross‐sectional study of 189 patients from the Canadian HPN registry. Results: All 189 patients studied received M.V.I.‐12, which does not contain vitamin K. Of those, 41.3% were supplemented with 10 mg of intravenous vitamin K (VK+) weekly, whereas the others did not receive vitamin K except via lipid emulsion (VK?). Short bowel syndrome accounted for 69% of VK+ and 46% of VK? patients. On univariate analysis, VK+ patients had substantially lower body mass index (BMI) and received lower bisphosphonate infusion than did VK?patients. There were no statistically significant differences in HPN calcium or lipid content, liver function test results, age, sex, or reason for HPN between the 2 groups. Patients who were VK+ had higher lumbar spine T scores and hip T scores than did VK?patients. General linear modeling analysis, adjusted for BMI, age, PN magnesium, PN phosphate, PN calcium, and bisphosphonate as possible predictors of BMD, showed a trend toward better hip T scores (P = .063) for VK+ patients compared with VK? patients. Conclusion: In HPN patients supplemented with vitamin K, the trend toward a better hip BMD compared with no supplementation suggests a role for vitamin K in preserving BMD. This requires further study.