Providing parents with information before anaesthesia: what do they really want to know?

BACKGROUND: Videotapes presenting information concerning children's anaesthesia are often based on what the makers of the videotape believe the parents want to know rather than what parents actually want to know. They frequently do not take into account the parent's coping style. Two common parental coping styles are information-seeking (monitoring) and information-avoiding (blunting). METHODS: We wished to take parent needs into account when making our local videotape and accordingly constructed a questionnaire designed to elicit these needs. RESULTS: Of the parents questioned, 55% wanted more extensive preoperative information and 41% of parents wanted a videotape as part of this preparation. Information about premedication, induction of anaesthesia, side-effects of anaesthesia and postoperative pain management were sought by more than 70% of parents. Parents had concerns about induction of anaesthesia, emergence from anaesthesia and postoperative pain and nausea. When asked a question concerning preference about being present at the induction of anaesthesia, 90% of parents wanted to be present at the induction and 75% of parents thought that their child should receive a premedicant. The number of parents requesting to be present at the induction decreased to 72% after an explanation about the purpose and effects of premedication. There was no correlation between the coping style of the parent and the responses given to the questions. There was no correlation between the level of education and the coping style of the parent. CONCLUSIONS: The use of a questionnaire of parental attitudes towards information and anaesthesia provided a useful tool in the production of a video as part of our preoperative preparation. Our videotape has proved a success with staff and parents and children and enhances the quality of our service. Its popularity stems from the fact that it addresses what the parents want to know and also conveys what the staff of this hospital would like the parents to know.     

Hypertension: pathophysiology and treatment

Arterial hypertension is a major cause of morbidity and mortalitybecause of its association with coronary heart disease, cerebrovasculardisease and renal disease. The extent of target organ involvement(i.e. heart, brain and kidneys) determines outcome. North Americanstudies have shown that hypertension is a major contributorto 500 000 strokes (250 000 deaths) and 1 000 000 myocardialinfarctions (500 000 deaths) per annum.     

Children's perception and interpretation of anxiety-related physical symptoms

The present study examined children's perception and interpretation of anxiety-related physical symptoms in a sample of 4-12-year-old primary school children (N = 129). Children were presented with neutral scenarios in which the main character experienced an anxiety-related physical symptom (e.g., hands trembling, heart beating very fast), and asked to attribute various emotions to this character. Children were also interviewed about idiosyncratic experiences with anxiety-related physical symptoms. Results showed that physical symptoms were associated with a broad range of emotions. "Hands trembling", "heart beating fast", and "difficulties with breathing" were the only symptoms that were more frequently linked to fear than to other emotions. Furthermore, developmental patterns were found for fear-related interpretations of physical symptoms. That is, from the age of 7, children more frequently associated physical symptoms to fear. Finally, children reported to experience anxiety-related physical symptoms in daily life, although frequently not in relation to fearful situations and circumstances.     

Influence of caloric restriction on the development of atherosclerosis in nonhuman primates: progress to date

Caloric restriction (CR) has been observed to retard aging processes and extend the maximum life span in rodents. In an effort to evaluate the effect of this nutritional intervention on physiologic variables in higher species, several nonhuman primate trials are ongoing. In particular, a study evaluating the independent effect of CR on the extent of atherosclerosis was initiated in 1993 in 32 adult cynomolgus monkeys. Therefore, the trial was designed to achieve identical cholesterol intake after animals were randomized to a control group or a calorie-restricted group (30% reduction from baseline caloric intake). The animals were routinely evaluated for glycated proteins, plasma insulin and glucose levels, insulin sensitivity, and specific measures for abdominal fat distribution by CT scans over a 4-year interval. The results from 4 years of intervention demonstrate that CR improves cardiovascular risk factors (such as visceral fat accumulation) and improves insulin sensitivity. In contrast to other primate studies with normolipidemic animals, CR had no independent effects on plasma lipid levels and composition in the presence of equivalent amounts of dietary cholesterol intake. Preliminary analysis of atherosclerotic lesion extent in the abdominal aorta has failed to demonstrate differences between control animals and CR animals. Follow- up studies are being conducted to determine the effect of CR on atherosclerosis extent in coronary and carotid arteries.      

Inherited disorders of 3-methylcrotonyl CoA carboxylation

The clinical course of 4 patients who had reduced activities of 3-methylcrotonyl CoA carboxylase (also called 3-methylcrotonylglycinuria) is described. Two children presented with a metabolic acidosis, one in the neonatal period and the other with episodes of acidosis that started in the second year of life. In the other 2 children neurological symptoms were prominent, one having infantile spasms and the other developmental regression with a skin rash and alopecia. Three of the children responded well to oral biotin and dietary protein restriction but the fourth, despite a biochemical response to biotin, has a severe neurological handicap. The clinical presentation of inborn errors of 3-methylcrotonyl CoA carboxylase is variable. Metabolic acidosis may not be conspicuous and instead neurological features may predominate.     

Suspected poisoning in children. Study of the incidence of true poisoning and poisoning scare in a defined population in North East Bristol

The distinction between true and suspected poisoning in children has not been made clear in previous work on childhood poisoning. A study of suspected poisoning in children under 15 years of age in a defined population of North East Bristol from November 1970 to July 1973 carried out by the Health Education Council Medical Research Division included 53,000 child-years at risk. The number of suspected poisonings was 3-4/1000 population aged under 15 years per year, with a higher incidence in younger age groups. Detailed investigation of the circumstances of the accidents carried out by a multidisciplinary team showed that at least 65%, and possibly as many as 78% were poisoning scares and not true poisoning. The evidence used by the casualty doctor and by the parents to diagnose poisoning was explored, and in many cases was circumstantial. Children with fathers in nonmanual occupations were over-represented. This may reflect differences in patterns of utilization behaviour rather than true differences in incidence.     

The prospects for renal xenotransplantation

Summary: Xenotransplantation of non-human organs into human recipients has long been proposed as a possible strategy to overcome the acute shortage of donor organs. However, vascular organ transplants to humans from phylogenetically disparate species such as the pig are not currently possible due to a rapid rejection process termed hyperacute rejection. This process is initiated by the binding of host pre-formed 'natural antibodies' to the donor vascular endothelium, activation of the host complement system and activation or injury of the donor endothelial cells, leading to intravascular coagulation and loss of the graft due to ischaemic necrosis within minutes to hours of engraftment. Prevention of natural antibody binding and complement activation is viewed as paramount to preventing hyperacute rejection. Even if hyperacute rejection can be prevented, further barriers to successful discordant xenografts such as delayed xenograft rejection and a donor-directed cell-mediated rejection process will still represent major obstacles. This review examines recent advances being made in the various areas of xenograft research and the potential clinical application of pig-to-human xenografts that these strategies may bring.