The eXpectations of Parents regarding Anesthesiology Study (XPAS) from a parental perspective: a two-phase observational cross-sectional cohort study

Background

Uncertainty concerning anesthetic procedures and risks in children requiring anesthesia may cause concerns in parents and caregivers.

Aims

To explore parental expectations and experiences regarding their child's anesthesia using questionnaires designed with parental input.

Methods

This observational cross-sectional cohort study included parents (including caregivers) of children undergoing anesthesia in a tertiary pediatric referral university hospital. The study consisted of two phases. In Phase 1, we developed three questionnaires with parental involvement through a focus group discussion and individual interviews. The questionnaires focused on parental satisfaction, knowledge, concerns, and need for preparation regarding their child's anesthesia. In Phase 2, independent samples of parents completed the questionnaires at three time points: before the preanesthesia assessment (T1), 2 days after the preanesthesia assessment (T2), and 4 days after the anesthetic procedure (T3).

Results

In Phase 1, 22 parents were involved in the development of the questionnaires. The three questionnaires contained 43 questions in total, of which 10 had been proposed by parents. In Phase 2, 78% (474 out of 934) parents participated at T1, 36% (610 out of 1705), at T2 and 34% (546 out of 1622) at T3. Parental satisfaction scores were rated on a visual analogue scale for the preanesthesia assessment with a median of 87/100, and with a median of 90/100 for the anesthetic procedure (0: not satisfied and 100: satisfied). Parental concerns were rated with a median of 50/100 (0: no concerns and 100: extremely concerned). Parental answers from the questionnaire at T2 revealed significant knowledge deficits, with only 73% reporting that the anesthesiologist was a physician. Parents preferred to receive more information about the procedure, especially regarding the intended effects and side effects of anesthesia.

Conclusions

Overall, parental satisfaction scores regarding the pediatric anesthesiology procedure were high, with a minority expressing concerns. Parents indicated a preference for their child's anesthesiologist to visit them both before and after the anesthetic procedure. Parental expectations regarding anesthesia did not completely correspond with the information provided; more information from the clinician about the intended effects and side effects of anesthesia was desired.     

Who cares?—The unrecognised contribution of homecare nurses to care trajectories

Background

Organisation of patients' trajectories is a critical element of nursing practice. However, nursing practice is mainly expressed in terms of direct patient care, while the practices through which care is organised have received little attention, are poorly acknowledged and lack formal recognition.

Aim

To examine the management of care trajectories as provided by homecare nurses.

Design

We conducted focus group interviews with 29 Danish homecare nurses. The analysis drew on the evidence based and theoretically informed framework care trajectory management. Care trajectory management is conceptualised as comprising of three organisational components: (1) Trajectory awareness, (2) Trajectory working knowledge and (3) Trajectory articulation.

Findings

The organising work of homecare nursing is both complex and unpredictable requiring advanced organisational, collaborative and clinical competences to secure concerted actions in alignment with the needs of the individual patient. Without having any formal obligation homecare nurses took on the responsibility for the coordination of the different activities of the professional actors, and for securing concerted actions. Care trajectory management as provided by homecare nurses reflected a high degree of commitment for patients and illustrated that this type of organising work was driven by the values of the humanistic ethos of nursing.

Conclusion

The study highlights the strength of the invisible and ongoing organising work of homecare nurses. Care trajectory management in homecare reflects the moral foundation of nursing. Consequently, the professional logic of nursing reflected as direct patient care alone is too narrow. We need to acknowledge the organising work of patients' trajectories as a core task equal to direct patient care. Our study highlights the need for articulating the organising work of homecare nurses and for presenting problematic organisational structures to policymakers and managers. If not, the important organisational work of homecare nurses is at the risk of remaining invisible.     

The Contribution of Nutrients of Concern to the Diets of 18-to-30-Year-Old Australians from Food Prepared Outside Home Differs by Food Outlet Types: The MYMeals Cross-Sectional Study

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, (n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.     

Personal inhalable dust and endotoxin exposure among workers in an integrated textile factory

Abstract

The aim of this study was to determine personal exposure to inhalable dust and endotoxin levels among workers in an integrated cotton-processing textile factory and exposure variability across the different work sections. Full shift measurements were carried out using inhalable conical samplers with 37?mm glass-fiber filters. Personal inhalable dust was determined gravimetrically, and endotoxin levels were analyzed by kinetic chromogenic Limulus Amebocytes Lysate assay. The geometric means of personal dust and endotoxin concentrations were 0.75?mg·m^?3 and 831 EU·m^?3, respectively. The highest dust and endotoxin concentrations were observed in carding section (1.34?mg·m^?3 and 6,381 EU·m^?3, respectively). Altogether, 11% of dust and 89% of endotoxin samples exceeded workplace exposure limits. This study showed a moderate correlation between inhalable dust and endotoxin (r?=?0.450, p?<?0.001). Our findings indicate that low dust exposure does not guarantee a low exposure to endotoxin.     

Electroconvulsive stimulation results in long‐term survival of newly generated hippocampal neurons in rats

Electroconvulsive stimulation (ECS) is one of the strongest stimulators of hippocampal neurogenesis in rodents that represents a plausible mechanism for the efficacy of electroconvulsive therapy (ECT) in major depressive disorder. Using design‐based stereological cell counting, we recently documented an initial 2.6‐fold increase in neurogenesis following a clinical relevant schedule of ECS, a treatment also rescuing depression‐like behavior in rats. However, these results gave no demonstration of the longevity of newly generated neurons. The present study is a direct continuation of the previous work aiming to test the hypothesis that rats subjected to ECS in combination with chronic restraint stress (CRS) display increased formation of new hippocampal neurons, which have a potential for long‐term survival. Furthermore, using mediation analysis, we tested if an ECS‐induced increase in neurogenesis facilitates the behavioral outcome of the forced swim test (FST), an animal model of depression. The results showed that ECS in conjunction with CRS stimulates hippocampal neurogenesis, and that a significant quantity of the newly formed hippocampal neurons survives up to 12 months. The new BrdU‐positive neurons showed time‐dependent attrition of ～40% from day 1 to 3 months, with no further decline between 3 and 12 months. ECS did not affect the number of pre‐existing dentate granule neurons or the volume of the dentate granule cell layer, suggesting no damaging effect of the treatment. Finally, we found that, while ECS increases neurogenesis, this formation of new neurons was not associated to ameliorated immobility in the FST. This implies that other ECS‐induced effects than neurogenesis must be part of mediating the antidepressant action of ECS. Taken together, the results of the present study contribute to the basic understanding of the neurogenic effects of ECT, and demonstrate that ECS, neurogenesis and anti‐depressant behavior are not directly linked. © 2016 Wiley Periodicals, Inc.     

A comparison of the effects of p-glycoprotein inhibitors on the blood-brain barrier permeation of cyclic prodrugs of an opioid peptide (DADLE)

The objective of this study was to elucidate the role of P-glycoprotein (P-gp) in restricting the blood-brain barrier (BBB) permeation of cyclic prodrugs of the opioid peptide DADLE (H-Tyr-D-Ala-Gly-Phe-D-Leu-OH). The BBB permeation characteristics of these prodrugs and DADLE were determined using an in situ perfused rat brain model and in vitro cell culture model (MDCK-MDR1 cells) of the BBB. The activities of P-gp in these models were characterized using a known substrate (quinidine) and known inhibitors [cyclosporine A (CyA), GF-120918, PSC-833] of P-gp. Cyclic peptide prodrugs exhibited very poor permeation in both models. Inclusion of GF-120918, CyA, or PSC-833 in the brain perfusion medium or the cell culture medium significantly increased the permeation of these cyclic prodrugs. The order of potency of these P-gp inhibitors, as measured using the cyclic prodrugs as substrates, was, by in vitro MDCK-MDR1 cells: GF-120918 = CyA >or= PSC-833; and by in situ rat brain perfusion: GF-120918 > CyA = PSC-833. In conclusion, P-gp in the BBB is the major factor restricting the brain permeation of these cyclic prodrugs. MDCK-MDR1 cells can predict the order of potencies of the investigated P-gp inhibitors to enhance the rat BBB permeation of quinidine and the cyclic prodrugs.     

The labeling of unsaturated γ‐hydroxybutyric acid by heavy isotopes of hydrogen: iridium complex‐mediated H/D exchange by C─H bond activation vs reduction by boro‐deuterides/tritides

3‐Hydroxycyclopent‐1‐ene‐1‐carboxylic acid (HOCPCA ( 1 )) is a potent ligand for high‐affinity γ‐hydroxybutyric acid binding sites in the central nervous system. Various approaches to the introduction of a hydrogen label onto the HOCPCA skeleton are reported. The outcomes of the feasible C─H activation of olefin carbon (C‐2) by iridium catalyst are compared with the reduction of the carbonyl group (C‐3) by freshly prepared borodeuterides. The most efficient iridium catalysts proved to be Kerr bulky phosphine N‐heterocyclic species providing outstanding deuterium enrichment (up to 91%) in a short period of time. The highest deuterium enrichment (>99%) was achieved through the reduction of ketone precursor 2 by lithium trimethoxyborodeuteride. Hence, analogical conditions were used for the tritiation experiment. [³H]‐HOCPCA selectively labeled on the position C‐3 was synthetized with radiochemical purity >99%, an isolated yield of 637 mCi and specific activity = 28.9 Ci/mmol.     

Effects of mental and physical demands on heart rate variability during computer work

The aim of the study was to evaluate the effect of physical and mental demands on heart rate variability- (HRV-) derived indices of autonomic activity. Ten healthy, female subjects performed two computer tasks: one with combined mental and physical demands and a reference task primarily consisting of physical demands. The combined task, which was performed once with a keyboard and once with a computer mouse, was a computerized version of the colour word conflict task (CWT). The CWT is highly mentally demanding due to the inherent perceptual conflict between a word stimulus and a colour stimulus. In the reference task (REF) the physical demands were comparable to CWT, while the mental demands were low. Finally, the subjects rested at the workplace (REST). Data on performance, heart rate (HR), mean arterial blood pressure (MAP), HRV, and urinary concentrations of catecholamines were obtained. The following frequency bands were applied for HRV: very low frequency (VLF, 0.00–0.04 Hz), low frequency (LF, 0.05–0.15 Hz), high frequency (HF, 0.16–0.40 Hz) and total power (TP, 0.00–0.40 Hz). Indices of sympathetic nervous activity (I_SNS) and parasympathetic nervous activity (I_PNS) were estimated as normalized powers in LF and HF bands: I_SNS=LF/(TP–VLF) and I_PNS=HF/(TP–VLF). Values are expressed as normalised units (nu). There was an increase in I_SNS during CWT [mouse: 0.490 (0.052) nu [ave (SEM)] and keyboard: 0.476 (0.039) nu] and REF [mouse: 0.453 (0.059) nu and keyboard: 0.489 (0.047) nu] compared to REST [0.397 (0.047) nu], but no difference between CWT and REF. Corresponding decreases were observed for I_PNS. HR and MAP were higher during CWT compared to REST. No effects were observed for excreted amounts of catecholamines. There were no differences between the computer mouse and the keyboard condition for I_SNS and I_PNS. In conclusion, an increase in I_SNS and a decrease in I_PNS were found in response to a physically demanding reference computer task. Addition of mental demands did not elicit any further effect on I_SNS and I_PNS, suggesting a significant influence of the physical rather than the mental demands during computer work. Electronic Publication     

BMI and BMI SDS in childhood: annual increments and conditional change

Background Early detection of abnormal weight gain in childhood may be important for preventive purposes. It is still debated which annual changes in BMI should warrant attention.

Aim To analyse 1-year increments of Body Mass Index (BMI) and standardised BMI (BMI SDS) in childhood and explore conditional change in BMI SDS as an alternative method to evaluate 1-year changes in BMI.

Subjects and methods The distributions of 1-year increments of BMI (kg/m²) and BMI SDS are summarised by percentiles. Differences according to sex, age, height, weight, initial BMI and weight status on the BMI and BMI SDS increments were assessed with multiple linear regression. Conditional change in BMI SDS was based on the correlation between annual BMI measurements converted to SDS.

Results BMI increments depended significantly on sex, height, weight and initial BMI. Changes in BMI SDS depended significantly only on the initial BMI SDS. The distribution of conditional change in BMI SDS using a two-correlation model was close to normal (mean = 0.11, SD = 1.02, n?=?1167), with 3.2% (2.3–4.4%) of the observations below ?2 SD and 2.8% (2.0–4.0%) above +2 SD.

Conclusion Conditional change in BMI SDS can be used to detect unexpected large changes in BMI SDS. Although this method requires the use of a computer, it may be clinically useful to detect aberrant weight development.