Determining the factors affecting chemotherapy-induced nausea and vomiting in children with cancer

PURPOSE

We evaluated the factors affecting chemotherapy-induced nausea and vomiting (CINV) in children with cancer.

DESIGN AND METHODS

This cross-sectional study was conducted with 62 children aged 9 to 18 years old with a solid tumor who received chemotherapy for the first time, and their parents. Data were collected using a data collection form, the State-Trait Anxiety Inventory for Children, the Beck Anxiety Inventory, the Spielberger State-Trait Anxiety Inventory, and the Baxter Retching Faces Scale. Data were analyzed using Spearman's correlation and logistic regression analyses.

RESULTS

Risk factors related to the child, treatment, and parent were examined. Child-related factors were determined as diagnosis (odds ratio [OR] = 5.5), time since diagnosis (OR = 1.9, OR = 4.7), pretreatment anxiety of the child (r = 0.439, r = 0.422), and past experience of nausea and vomiting before treatment (OR = 1.2). Treatment-related factors involved anti-emetic prophylaxis (OR = 4.9, OR = 9.2). Parent-related factors included pretreatment anxiety of the parent (r = 0.271, r = 0.287), accommodation (OR = 5.5), not eating (OR = 1.2, OR = 1.3), and bad smell (OR = 1.2), which were described amongst parents' as factors that trigger CINV.

CONCLUSIONS

The occurrence of CINV is significantly affected by child-, treatment-, and parent-related risk factors.

PRACTICE IMPLICATIONS

Pediatric nurses should create an environment for children and their parents to reduce their anxiety and provide basic knowledge and skills about the management of CINV.

The pediatric provider communication skills assessment scale

PROBLEM

Building rapport and trust between healthcare professional and patient/parents would improve satisfaction of patient/parents. The purpose of this study was to develop "The Pediatric Provider Communication Skills Assessment Scale" in this study.

METHODS

A trial form, with linguistic and psychometric validation and consisting of 44 statements, was administered to a sample of 325 individuals. Data were collected between January 20 and October 22, 2021. The validity of the scale was concluded after examining its construct validity and internal validity. "Exploratory factor analysis" was used for determining construct validity, and "comparison of lower-upper groups" for internal validity. "Cronbach's α reliability coefficient" and "split half test consistency coefficient" were calculated for testing the reliability of the scale.

FINDINGS

The Pediatric Provider Communication Skills Assessment Scale that we developed consists of one dimension and 20 items, and the variance it can explain was calculated as 62.3%. The Cronbach α reliability coefficient of the scale was calculated as 0.90, indicating high reliability.

CONCLUSIONS

According to the findings, "The Pediatric Provider Communication Skills Assessment Scale" is a scale with features that can measure in a valid and reliable way, with high variance and a low number of items. The study aims to develop the "The Pediatric Provider Communication Skills Assessment Scale," and present it to the literature as a validated and reliable new objective measurement tool. This study will enable us to understand more about the complex communication processes involved in pediatric care and how these may influence care delivery.

Does the immigration affect prenatal attachment levels?

Pregnancy is an important period in which mother-infant attachment begins, includes bio-psychological changes, and has physical and psychological effects on the future life of the fetus. This study aims to evaluate the prenatal attachment levels of Syrian refugee and Turkish mothers in Turkey and to determine the variables that affect these. This cross-sectional study conducted in the obstetric outpatient clinics with 397 pregnant women 197 Syrian and 200 native women. Inclusion criteria were a pregnancy of at least 20 weeks, no communication or mental disorders, no chronic diseases, no diagnosis of high-risk pregnancy, literacy in the pregnant Turkish women, Turkish language proficiency in the pregnant Syrian women, and residence in Turkey for at least three years. Data were collected using a Sociodemographic form and The Prenatal Attachment Inventory (PAI). The data were analyzed by conducting independent t-tests, and hierarchical multiple linear regression analysis. The mean prenatal attachment score of Turkish pregnant women (61.79 ± 8.55) was higher than Syrian women (48.38 ± 10.39) (p < .05). Education level, pre-pregnancy counseling, regular checkup, support from spouses, relatives, and friends, and being a refugee of pregnant women were determined as predictors of prenatal attachment. The results showed that 67 percent of the total variance in the prenatal attachment levels could be explained in model 2 (F = 35.524, R2 variation = .673, p = .001). The low prenatal attachment level of Syrian pregnant women was a result of the detrimental impacts of being a refugee on pregnancy. The integration of transcultural knowledge, culture-specific perspectives, and cross-cultural theories into clinical practices is essential for immigrant women.

Nursing students' views on trauma-informed pediatric nursing care and family-centered care

PURPOSE

We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care.

METHODS

This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the "Student Information Form," "Family-Centered Care Attitude Scale," and "trauma-informed care (TIC) Provider Survey."

RESULTS

Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score.

CONCLUSIONS

Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients.

PRACTICE IMPLICATIONS

Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients.

Development and psychometric analysis of a Pediatric Oncology Nurses' Educational Needs Scale

BACKGROUND/OBJECTIVES

It is important to determine the educational needs of pediatric oncology nurses in order to maximize and implement nursing care interventions. Therefore, this study aims to develop a valid and reliable measurement tool to determine pediatric oncology nurses' educational needs and examine its psychometric properties.

DESIGN/METHODS

This methodological study was conducted with 215 pediatric oncology nurses in Turkey between December 2021 and July 2022. Data were collected with the "Nurse Information Form" and "Pediatric Oncology Nurses' Educational Needs Scale." IBM SPSS 21.0 and IBM AMOS 25.0 software programs were used for data analysis, and descriptive statistics were used to analyze numeric variables. Exploration and confirmatory factor analyses were performed to determine the scale's factorial structure.

RESULTS

The factorial analysis was used to test the structural validity of the scale. A five-factor structure consisting of 42 items was developed. The Cronbach's alpha coefficient for "Illness" was .978, "Chemotherapy and Side Effect" was .978, "Another Therapy and Side Effect" was .974, "Palliative Care" was .967, "Supportive Care" was .985, and the total score was .990. Fit indices resulting from the study were χ² /SD: 3.961, root mean square error of approximation (RMSEA): 0.072, goodness-of-fit index (GFI): 0.95, comparative-of-fit index (CFI): 0.96, and normed fit index (NFI): 0.95.

CONCLUSION

The Pediatric Oncology Nurses' Educational Needs Scale is a valid and reliable scale for pediatric oncology nurses to determine their educational needs.

"All in One: Fear, Happiness, Faith" A Qualitative Study on Experiences and Needs of Turkish Mothers of Infants with Congenital Heart Disease

Having an infant with congenital heart disease (CHD) may cause difficulties and changes in mothers' life. This study was aim to explore the experiences and needs of Turkish mothers of infants with CHD. The study was carried out with the descriptive phenomenological method from qualitative research. The study sample included 18 mothers having infants in the age range of 0 to 2 years with CHD. The data were collected using a sociodemographic data form and a semi-structured interview form. The data obtained from the interviews were evaluated using the content and thematic analysis methods. Four main themes and sub-themes emerged from the qualitative data. "Effect of getting a diagnosis" with two sub-themes (emotional changes and a protective mother-infant relationship), "All emotions in one" with two sub-themes (fearing of death and torn between fear and hope), "Influences on a mother's life" with three sub-themes (forgetting herself, getting away from siblings' lives and relations with spouse), and stressors with three sub-themes (loss of control, physical care and unfulfilled needs). The results of the study provide insight into how Turkish mothers subjectively experience life after CHD. Mothers expected healthcare professionals to support and understand their experiences and needs. Healthcare professionals need to create an environment for mothers to cope with emotional difficulties, gain knowledge and care skills, and adapt to their lives.

Integrating Family-Centered Care to Child Health and Diseases Nursing Course via Distance Education

The aim of this study was to determine the impact of an online Child Health and Diseases Nursing course emphasizing family-centered care upon the perceptions of nursing students toward family-centered care. A one-group pretest-posttest model was used in this study. The research participants consisted of 88 students studying at X University, Faculty of Health Sciences, Department of Nursing. While 67.1% of the students stated that there were obstacles in implementing family-centered care, 73.9% stated that there were no facilitating elements in implementing of family-centered care. A statistically significant difference was found between the mean scores of the students' posttest family-centered care attitude and parents' attitude at the end of the training. This study provides insights into family-centered care, which could be used in crafting policies and interventions in nursing education in Turkey. Such insights could foster positive perceptions of family-centered care among student nurses.

Validity and reliability of the Family Empowerment Scale for parents of children with cleft lip and/or palate

BACKGROUND

Empowerment is recognized as a crucial concept in strengthening the position of parents in healthcare services. This study aimed to evaluate the validity and reliability of the Turkish Family Empowerment Scale (FES).

METHODS

This methodological study was conducted between January and March 2021, with 348 family members actively caring for their children in the age group of 0-18 years with cleft lip and/or palate (CL/P). The English FES was translated into Turkish using back translation and modified so that it is generic and convenient for all families. The construct validity, internal validity, internal consistency, and split-half test reliability and responsiveness of the Turkish FES were examined.

RESULTS

The original FES structure with three factors (family, health services provided to the child and community participation) and 34 items was verified in Turkish culture. This obtained structure can explain 66% of the variance of the relevant concept. Scores of parents ranged between 34 and 170 points. Increasing scores indicated a positive significance regarding family empowerment. The Cronbach's α reliability coefficient of the scale was calculated as 0.976.

CONCLUSION

The study findings and the goodness-of-fit values indicated that the FES and its Turkish version are a valid and reliable measurement instrument to be used in Turkish culture.

Predictors of parenting stress in parents of children with cancer

PURPOSE

In the present study, we investigated the parenting stress experienced by parents of children with cancer and the influencing factors.

METHOD

This was a cross-sectional and descriptive correlational study that consisted of parents of 136 children in the age group of 0-18 years who were followed up for cancer in the outpatient clinics and services of a university hospital in Turkey. Parenting Stress Index, Burden Interview, Multidimensional Scale of Perceived Social Support, Marital Life Satisfaction Scale, and Ways of Coping Questionnaire were used to collect the data.

RESULTS

No statistically significant difference was found between the parenting stress mean scores and gender of the parents of children with cancer (t = -0.350; P = 0.727). The results of the present study showed that the economic status (t = -4.16; P = 0.000), parents' physical (t = 3.606; P = 0.000) and mental health status after the child is diagnosed (t = 5.647; P = 0.000), accompanying mental health problems of the child (t = 2.567; P = 0.011), and diagnosis of children at a young age (t = -2.776; P = 0.006) increased the parenting stress of the parents.

CONCLUSIONS

Nursing interventions can reduce parental stress by providing sufficient care and support during the disease process.

"Unexpected event": Having an infants with cleft lip and/or palate

This study aimed to determine the difficulties that the mothers of infants with a cleft lip and/or palate (CL/P) go through, the problems they encounter in this process, and how they perceive the support of healthcare professionals, families, and friends. The study used a phenomenological approach from qualitative research methods. The study sample included 18 mothers of 0 to 3-month-old infants with CL/P. The data were collected using socio-demographic information form and semi-structured interview form. The data obtained from the interviews were evaluated using content and thematic analysis approaches. On the basis of the interviews conducted with mothers of infants with CL/P, the following themes emerged: (a) "unexpected event: having an infant with CL/P," (b) "using social media," (c) "stigma," and (d) "uncertainty of long-term treatment." In this study, it was determined that mothers experienced shock, confusion, sadness, and disappointment in this process; therefore, they used social media to seek support from the families as well as conducted research on the disease that involved a lot of uncertainty due to long-term treatments. The present study can help healthcare professionals, who play a role in the care and treatment of infants with CL/P, to understand and know what mothers need in the preoperative period.

The effect of sociodemographic characteristics of adolescents on E-Health literacy

Background

As a result of having easy access to the internet and mobile devices, a great part of the population uses the internet in order to search for information related to health; therefore, health literacy on the internet has gained importance.

Methods

The study was conducted in three schools from different socioeconomic levels (low, middle, high) affiliated with the Provincial Directorate of Education in the capital city of Turkey, Ankara city. The sample of the study consisted of a total of 1082 adolescents in the age group of 14 and 18 years, who were studying in the 9th, 10th, 11th, and 12th grades in the selected schools. The data were collected using a data collection form consisting of questions related to the adolescents and the sociodemographic characteristics of their parents, as well as E-Health Literacy Scale in Adolescents. The predictors of e-health literacy in adolescents were analyzed through linear regression.

Results

It was found that the e-health literacy mean score of the adolescents was 26.9±7.6 in the study. There was a correlation between e-health literacy and the increase in the age of the adolescent, monthly income of the family, the status of having a computer for the child, the status of reading subjects related to health on the internet, and the status of reading subjects related to their own health on the internet among characteristics of adolescents. In the study, the e-health mean scores of adolescents having high socioeconomic levels were found to be statistically higher (F = 2.153, p &lt; 0.000).

Conclusions

The results revealed the importance of improving the e-health literacy skills of male adolescents, having low socioeconomic levels and using less internet, in order to have access to online health information effectively.

Key messages

Training programs suitable for the developmental period of the adolescents should be organized in the school to increase the e-health literacy of adolescents. The adolescents in high socioeconomic status have higher electronic health literacy than the adolescent in low and middle socioeconomic status.

The Use of Social Media Among Parents of Infants with Cleft Lip and/or Palate

PURPOSE

To determine the purpose of the parents of infants with cleft lip and/or palate (CL/P) for using Facebook, how they share for the audience and what kind of information they search for.

DESIGN AND METHODS

The results of the study were analyzed using qualitative and quantitative methodologies. Data were collected for one major social media platform (Facebook) from public accounts dedicated to CL/P. The former involved thematic and word count analysis for online posts on the Facebook platform, while the latter employed descriptive statistics.

RESULTS

Facebook has a total of 8 group accounts and 7695 users in Turkey. Among the 702 posts analyzed, "requesting information" was found to be the most commonly encountered theme (55.4%). This study, it was determined that especially parents of infants with CL/P need information about surgery. The "announcement" was mentioned in only 3.3% of all posts. Our text analysis of 17.134 words mentioned in posts revealed that the most common word was surgery (6.6%).

CONCLUSIONS

The current study provides a comprehensive reference to the role of social media in CL/P.

PRACTICE IMPLICATIONS

In the near future, analysis of patients' and public knowledge and perception of surgery will be an important next step in building greater awareness of its role in the management of CL/P.

Parenting Stress in Turkish Mothers of Infants With Cleft Lip and/or Palate

Objective:

To explore parenting stress and factors affecting the mothers of infants with cleft lip and/or palate (CL/P) in Turkey.

Design and Participants:

The study compared mothers of infants born with CL/P (n = 90) with mothers of healthy infants (n = 90). Mothers completed the data collection form, the Parenting Stress Index-Short Form, and the Multidimensional Scale of Perceived Social Support.

Results:

Mothers of infants born with CL/P had higher mean parenting stress scores than the control mothers. A significant negative relationship was found between social support and parenting stress for mothers of infants born with CL/P but was not related for control mothers. Among mothers with an infant with CL/P, the mean parenting stress scores were higher for mothers preoperatively than mothers responding postoperatively. Among mothers with an infant with a cleft, higher stress was found for diagnosis after birth, not breastfeeding, feeding difficulties, lack of fathers’ support, perceived difficult infant temperament, blame, anger, and concern for the future.

Conclusion:

Parenting stress was higher and social support was lower for mothers of infants with a cleft. Treatment teams can design interventions aimed at factors related to stress, such as addressing feeding issues, teaching coping skills, and linking to social support.

Maternal Pain Management at Home in Children with Cancer: A Turkish Sample

PURPOSE

The purpose of the present study was to examine maternal pain management in children with cancer and the associated factors.

DESIGN AND METHODS

The present work is a descriptive and cross-sectional study. Data for the study were obtained from mothers of children in the age group of 0 to 18 years undergoing treatment for solid tumors in Pediatric Oncology Service and Outpatient Clinics (n = 112). We used a questionnaire on parental pain management practices at home, the knowledge about pain and analgesic drugs, Spielberger State-Trait Anxiety Inventory (STAI), and Pain Catastrophizing Scale (PCS) to collect the data.

RESULTS

Several mothers taking part in the study reported various misconceptions about the assessment of children's pain, analgesic drugs, and usage of limited non-pharmacological methods for managing pain in children with cancer. No significant relationships were found between mothers' pain management practices, knowledge of pain assessment and analgesic drugs, and mothers' and children's sociodemographic characteristics or mothers' pain catastrophizing and anxiety about their own pain.

CONCLUSIONS

The findings of the study revealed that the majority of mothers of children with cancer had misconceptions regarding knowledge of pain assessment and analgesic drugs; these misconceptions potentially lead to manage children's pain associated with cancer ineffectively. Findings indicate mothers' information and support needs for children's cancer pain management in the home settings.

PRACTICE IMPLICATIONS

A further understanding of barriers to parental pain management in children with cancer in the home setting will contribute immensely in developing appropriate management practices.

The effects of amniotic fluid and foetal cord blood cotinine concentrations on pregnancy complications and the anthropometric measurements of newborns

Our objective was determining the effects of amniotic fluid (AF) and fetal cord blood (FCB) cotinine concentrations on pregnancy complications and the anthropometric measurements in the newborns whose mothers underwent amniocentesis. This study was conducted as a case-control study, in Turkey. A total of 250 pregnant women with amniocentesis indication were recruited into the study and the cotinine levels in the AF and FCB were determined. A smoking habit did not statistically affect the incidence of pregnancy complications (p>.05). The birth weights of the newborns were negatively correlated with the AF cotinine levels. The incidences of low birth weight, low Apgar scores and RDS were positively correlated with higher levels of cotinine in AF and FCB. It is important for healthcare staff to provide training and consultancy services for the health improvement of pregnant women and the prevention of smoking during pregnancy. Impact statement What is already known on this subject? The pre-pregnancy smoking habit usually continues during the pregnancy. A significant negative correlation was present between the foetal cord blood cotinine levels and the birth weight. What do the results of this study add? The anthropometric measurements of the newborns born from mothers with high AF cotinine levels were lower than newborns born from mothers with low amniotic fluid cotinine levels. Respiratory Distress syndrome is more often determined in newborns born from mothers with high AF cotinine levels. What are the implications of these findings for clinical practice and/or further research? Future studies should be performed to investigate the effects of cigarette smoking on the health problems, the growth characteristics and the neurological development of newborns and infants within the first year of life.

Predictors of caregiver burden in mothers of children with leukemia and cerebral palsy

OBJECTIVE

Caring for a sick child can lead to considerable burden in the caregiver. Comparative studies of burden in mothers of children with different types of disorders are rare.

METHODS

We assessed levels of and risk factors for burden in mothers of children with leukemia (n: 70) or with cerebral palsy (CP) (n: 69). Subjects were recruited from two hospitals in Ankara.

RESULTS

Levels of burden or depression were not different between groups. Burden was predicted by the presence of depression in the mother and severity of illness in both groups. In the leukemia group, mothers reported higher burden if the child was male or younger; no such relationship was observed in the CP group.

CONCLUSION

Our results show that type of illness has an effect on levels of burden. Mothers of children with leukemia should receive more attention, especially if their child is male or younger, to take preventive measures against burden.

School-age children's perception of the hospital experience

In order to determine the perception of hospital experiences among school-age children's (6-12 years), a descriptive and cross-sectional study was performed in 130 children hospitalized in a pediatric hospital with different diagnoses. Data were collected using a pediatric information form, questionnaire form, scale for attitudes towards hospital and healthcare personnel, and sources of anxiety generating thoughts scale (SAGTS). Children's expectations of the nurses were to be well treated (62%), to perform painless procedures (20%), to play games together (12%), to be capable of their job (10%), and to be cheerful (10%). Children's expectation of the hospital facilities was the availability of playgrounds and toys (19.2%), large and single rooms (15.4%), rooms with private bathroom (9.2%), and rooms with a television and Internet access (7.7%). A statistically significant, negative, and moderate linear relationship was found between the scale for attitudes towards hospital and healthcare personnel and SAGTS ( p < 0.05, r: -0.296). The present study was performed to define the children's hospital experiences, keeping in mind that the best opinion on this matter is the child's own opinion. The foundation of this understanding depends on admitting that the children can express their own opinions about the care they receive.

Nurses perceptions of barriers to implementing family-centered care in a pediatric setting: A qualitative study

PURPOSE

This was a qualitative study conducted to explore the views of nurses regarding the practice of family-centered care (FCC).

DESIGN AND METHODS

Eighteen nurses working in different units of a children's hospital in Turkey were included in the study. In-depth interviews were conducted with the nurses to obtain detailed information about their perspectives on FCC activities.

RESULTS

Two main themes emerged from the data, each with subthemes. The first theme pertained to the nurses' opinions on FCC, and the second theme included their views on parents' participation during nursing rounds.

PRACTICE IMPLICATIONS

This study indicated that nurses had positive views of FCC activities and that they recognized the need for the family's continuing presence in the child's life, which were important findings. However, they stated that families' cultural characteristics were an obstacle. Therefore, to better implement this model, nurses should not only understand the model conceptually but also understand the rights, roles, and responsibilities of parents. To practice FCC appropriately, nurses need to have sufficient resources, appropriate education, and support from their managers.

Evaluation of Peripheral Intravenous Catheter-Induced Local Complications in Pediatrics

AIM

This study was conducted to evaluate the local complications in children who had a peripheral intravenous catheter.

BACKGROUND

Currently, the insertion of peripheral intravenous catheters occurs in most children that are hospitalized. However, the development of some complications associated with the insertion of these catheters are unavoidable. A significant aspect of nursing care is to ensure the safety of the placement and management of peripheral intravenous catheters in children.

DESIGN

The prospective cohort study design was used in the study, and the data of the study were collected between February 3, 2015 and May 17, 2015 by using the "Patient and Disease-Related Data Collection Form" and the "Peripheral Intravenous Catheterization Observation Form".

METHODS

The population of the study consisted of 100 children (201 catheters) who received inpatient treatment from the internal medicine and surgery services of a children's hospital.

RESULTS

A total of 201 catheter placements were observed, and 100 (49.7%) of them developed complications. It was determined that infiltration ranked first among the complications at 72.0% (n=72), followed by mechanical complications at 22.0% (n=22) and phlebitis at 6.0% (n=6). While the complications developed mostly in children under the age of 3 years (67.7%), complications developed least commonly among children aged ≥10 (33.3%). All phlebitis cases were confirmed in children whose catheter site could not be secured.

CONCLUSIONS

The rate of complications was predicted for the catheterization site, and the security of the catheter determined the rate of complications. Children's gender, body mass index, hemoglobin values, and reason for hospitalization were not significant predictors of complications.

RELEVANCE TO CLINICAL PRACTICE

In light of the study's results, infiltration is more commonly observed in lower extremities and other areas, it is suggested that these areas should be avoided for peripheral intravenous catheterization. More effective interventions are recommended for determination of the catheter site. This article is protected by copyright. All rights reserved.

Does the visibility of a congenital anomaly affect maternal-infant attachment levels?

PURPOSE

To determine whether congenital anomaly visibility affects maternal-infant attachment levels.

DESIGN AND METHODS

The study population consisted of mothers who had infants with cleft lip/palate or congenital heart anomalies who were receiving treatment in a university hospital. The data were collected using the Structured Questionnaire Form and the Maternal Attachment Inventory.

RESULTS

Statistically significant differences in maternal-infant attachment levels were observed between infants with cleft lips/palates and healthy infants and between infants with congenital heart anomalies and healthy infants.

PRACTICE IMPLICATIONS

It is important to apply appropriate nursing interventions for these mothers during the postpartum period.

Administration of oral medication by parents at home

AIMS AND OBJECTIVE

The objective of this study was to determine parents' experiences and problems with administering medication to their children at home.

BACKGROUND

Parents' experiences and access to information for the treatment of their children's illnesses at home is necessary for their children's safety.

DESIGN

A descriptive cross-sectional study.

METHODS

Four hundred parents from children's hospital outpatient clinics were included. A questionnaire was used to determine parents' experiences and problems with administering medication to their children at home. Descriptive statistical analyses were performed using the spss software package (version 22.00).

RESULTS

Antipyretics (59%) and antibiotics (25%) were the most commonly used medicines by parents without prescription. Nearly half of the parents stated that they gave liquid medicine with a household spoon. It was found that 54% of the parents whose children refused to take tablets or liquid medicine mixed these medications into foods. Treatment was delayed in 20·7% of the children who refused to take tablets and in 29·1% of the children who refused to take liquid medicine. As a result of the project, a form and device were developed as a solution to the problems experienced by parents while administering oral medication in the home environment.

CONCLUSION

The results of the study showed that a significant percentage of the parents did not use the correct equipment to administer medications, used non-prescription medicines, did not administer medications at correct intervals and mixed medication into foods.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals, especially nurses, should continually evaluate medication administration by parents at home and the readmission rate in the emergency department to further improve children's health.

Difficulties experienced during preparation and administration of oral drugs

AIM

It was aimed to determine the difficulties experienced by pediatric nurses working in the wards of a university hospital during preparation and administration of drugs and to determine solution recommendations.

MATERIAL AND METHODS

One hundred and eight nurses who accepted to participate in the study constituted the sample of the study. Open-ended questions were asked in order to obtain detailed information about the attitudes and views of the participants and face to face interview was used. The problems experienced during preparation and administration of drugs were collected using the data collection form prepared by the investigators. Institution approval, ethics committee approval (HEK12/193) and written informed consent from the nurses who wished to participate in the study were obtained to conduct the study. The data obtained were expressed as figures and percentages.

RESULTS

The most commonly reported problems in preparation of drugs included incomplete dissolution of tablets or non-homogeneous distribution in fluids (54.6%) and difficulty in breaking tablets in appropriate doses (45.3%). The most commonly reported problem experienced during administration of drugs was rejection of drugs which tasted bad by babies/children or spitting out the drug (75.9%). In our study, the nurses also mentioned the problems related with drug administration equipment. These problems included fear of injectors (25.9%), escape of the drugs into the respiratory way (15.7%) and lack of appropriate equipment for administering the drugs (7.4%).

CONCLUSIONS

In our study, it was found that all nurses experienced difficulty in preparing and administering drugs. The problems experienced by the nurses and solution recommendations for these problems were reported to the hospital administration.

Individual and familial factors associated with metabolic control in children with type 1 diabetes

BACKGROUND

The aim of this study was to determine the individual and familial factors associated with metabolic control in children with type 1 diabetes (T1DM).

METHODS

The study was performed in 93 children with T1DM between the ages of 3 and 19 years. Children and their families completed questionnaires on sociodemographics and data associated with diabetes. Medical information from the charts was also recorded.

RESULTS

Older age, longer diabetes duration and higher hospitalization rate for acute complications were positively associated with poor metabolic control. Good school performance, regular hospital visits, young maternal age, high paternal education level and fewer numbers of siblings were found to be negatively associated with poor metabolic control.

CONCLUSIONS

Multiple individual and family-level factors are associated with metabolic control. These data may aid in identification of diabetic children and adolescents who have a higher risk of poor metabolic control.

[Pediatric nurse views regarding parental presence during a child's painful procedures]

OBJECTIVES

Family- centered care is one of the basic principles of pediatric nursing and allows pediatric patients to have parental support during invasive procedures. But health care professionals often hesitate regarding parental presence during pediatric invasive procedure. The aim of this descriptive study is to determine the views of nurses regarding parental presence invasive procedures in children.

METHODS

This study was conducted between the dates 15th March and 15th July 2009 in a university hospital in Ankara which permitted parental stay. A total of 43 (57%) nurses accepted our invitation to participate in this research. A demographic data form with open and closed ended interview questionnaires was used in the study.

RESULTS

The majority of nurses reported that parents should not be present with the child during the painful procedure. The disadvantages of parental presence during a painful procedure commonly expressed by the nurses were increased anxiety in the child (77.1%), increased health professional anxiety (60.0%), and a detrimental effect of parental presence on the success of the procedure (60.0%). The nurses' recommendations to make the painful procedures less traumatic for both children and their parents are explaining the procedure to the children and parents (83.7%), use of local anesthesia or sedation before the procedure (37.2%), and performing painful procedures with specialized teams (20.9%).

CONCLUSION

The nurses in the study population tended to prefer parents not to be present during painfull procedures. The findings of the study indicate the need for development of written polices and guidelines on the practice of painfull procedures. Recommendations for future research are presented.

Fas ligand (FasL, Apo-1L/CD95L) expression and clinical outcome in papillary microcarcinoma and papillary thyroid carcinomas with diameter smaller than 1.5 centimeters

CONTEXT

The presence and the importance of FasL (FasL, APO-1L/CD95L) in papillary microcarcinoma lesions which are smaller than 1.5 cm of the thyroid is unclear.

OBJECTIVE

It was aimed to investigate FasL expression in papillary microcarcinoma (PMC) of the thyroid.

DESIGN

FasL immunoreactivity was evaluated in PMC lesions. Paraffin sections of thyroid specimens obtained from 59 papillary thyroid carcinoma consecutive patients were stained using antibody to FasL. Fas ligand expression and the relation and comparison with clinical and pathological findings in PMC were determined.

RESULTS

There were 39 females (66.1%) and 20 males (33.9%) aged 23-74 years (51.9±11.8 yrs), and 20 patients with tumor size ≤5 mm, 24 patients with 6-10 mm and 15 patients with 10-15 mm. The mean of the intensity and the percentage of FasL immunoreactivity were significantly higher in lesions of PMC than peripheral thyroid tissue (29.5±37.9% and 1.42±1.25 vs. 2.1±5.4% and 0.46±0.95, respectively; p<0.001). Fas ligand immunoreaction were not different according to tumor size, the presence of tumor capsule and tumor invasion, invasion of thyroid capsule, peripheral tissue and vascular structures and multicentricity (p>0.05). However, FasL positivity, staining and intensity were high in patients above 45 years, in oncocytic and tall cell variants, in TNM stage pT4A (p<0.05).

CONCLUSIONS

This study showed that FasL expression (positivity, staining and intensity) was high and increased in PMC of the thyroid tissue, and above 45 years, in tall cell and oncocytic variants, and in advanced tumor.

Clinical characteristics and genetic screening of an extended family with MEN2A

MEN-2A is characterized by medullary thyroid carcinoma (MTC) with pheochromocytoma and sometimes parathyroid adenoma. In affected members of the family, the risk of MTC is about 100%. Biochemical screening allows tumors to be detected early but even at this stage treatment is not always curative. Missense mutations in exon 10 and 11 of the RET proto-oncogene are associated with MEN-2A. Early detection of this mutation by DNA analysis allows the identification of the carriers of the gene. We performed genetic screening in 88 members of an extended family with MEN-2A and found 18 members positive for RET mutation (Cys634Gly). Only three of these 18 RET positive cases had a previous diagnosis of medullary cancer and/or pheochromocytoma. Up to now, 12 of the RET positive cases have undergone thyroidectomy. There was extended disease with cervical lymph node metastasis in 6 of them, bilateral medullary microcancer in 3 and c-cell hyperplasia in the remaining 3. Three of the 18 RET positive patients had also pheochromocytoma. Primary hyperparathyroidism was present in only one patient. The mean age of diagnosis of medullary cancer was between 25-50 yr and mean age of death was between 35-95 yr in affected members of the family. The family had many other affected members in other cities in Turkey and in other countries throughout the world from Australia to the Netherlands. So this family is perhaps one of the most extended families with MEN-2A.

Sunlight exposure and vitamin D deficiency in Turkish women

Vitamin D is an essential steroid involved in bone metabolism, cell growth, differentiation, and regulation of the minerals in the body. The main sources of this vital vitamin are adequate diet and photosynthesis in the skin. The aim of this study was to investigate the efficiency of vitamin D synthesis in 48 premenopausal women (14-44 years) in relation to three different types of dressing in summer. Women in the first group (Group I) dressed in a style which exposed the usual areas of the skin to sunlight; women in the second group (Group II wore traditional clothing with the skin of the hands and face uncovered, while the third group (Group III) dressed in traditional Islamic style, covering the whole body including hands and face. Serum 25OHD levels of Group I, Group II, and Group III were 56+/-41.3 nmol/l, 31.9+/-24.4 nmol/l, 9+/-5.7 nmol/l, respectively (Group I vs Group III, p<0.001; Group II vs Group III, p<0,03; Group I vs Group II, p>0.05). Vitamin D levels were low in 44 percent of the Group I and 60% of the Group II, which suggested that sun exposure of skin areas of hands and face may partially provide vitamin D synthesis, but may not be enough to eliminate vitamin D deficiency. All the patients in group III had vitamin D levels below normal. This study emphasizes the necessity of vitamin D fortification of food even in a sunny country where some people may not be exposed to sunlight because of inappropriate clothing or an indoor-life.

Anaplastic thyroid cancer with transient thyrotoxicosis: case report and literature review

A 55-year-old woman with anaplastic thyroid carcinoma presented with hyperthyroidism and neck swelling, hoarseness, and cervical lymphadenopathy. On physical examination, she was found to be clinically hyperthyroid with an enlarged, nontender multinodular goitre. Her serum thyroid hormone levels confirmed hyperthyroidism and technetium-99m pertechnetate scan failed to visualize the thyroid gland. Open biopsy showed an invasion of the thyroid gland by anaplastic thyroid carcinoma. The thyrotoxic phase lasted 60 days with predominantly increased thyroxine level and triiodothyronine/thyroxine (T3/T4) ratio decreased below 15. The thyrotoxic period was followed by subclinical hyperthyroidism and hypothyroidism which continued until she died of lung metastasis.

Thallium-201, technetium-99m-tetrofosmin and iodine-131 in detecting differentiated thyroid carcinoma metastases

The purpose of this study was to asses the detectability of differentiated thyroid carcinoma (DTC) metastases by 99mTc-tetrofosmin and to compare the results of 99mTc-tetrofosmin with 131I and 201Tl. The reliability of 201Tl and 99mTc-tetrofosmin scanning during suppression therapy also has been studied.

METHODS

A prospective study was performed on 41 patients (30 females, 11 males) with DTC (30 papillary, 11 follicular) who had undergone total thyroidectomy and received an average dose of 117 mCi (4329 MBq) of radioiodine for ablation of postsurgical residual thyroid tissue. All patients (n = 41) had 201Tl, 99mTc-tetrofosmin or 131I whole-body imaging after discontinuation of thyroid hormone replacement (thyroxine-off group). Eight of 14 patients with distant metastases also were imaged when they were on thyroxine therapy both with 201Tl and 99mTc-tetrofosmin (thyroxine on-and-off group). Radiologic studies (chest radiography, CT and MRI), serum thyroglobulin assays and histopathologic examinations were performed to clarify the presence of metastases with positive uptake on any of three radionuclide studies.

RESULTS

In 26 of 41 patients all three scans were negative. These patients also clinically didn't show any evidence of metastases. Fourteen patients were considered to have distant metastases on the basis of clinical, radiologic and histopathologic findings. The sensitivities of 201Tl, 99mTc-tetrofosmin and 131I in diagnosing distant metastases were comparable (0.85, 0.85 and 0.78, respectively). Iodine-131 was much more sensitive than 201Tl and 99mTc-tetrofosmin for demonstrating residual thyroid tissue after surgery (1.00, 0.33 and 0.33, respectively). The only false-positive case involved radioiodine uptake in a tuberculoma. Thyroxine-on images of 8 patients with distant metastases showed no difference from their thyroxine-off images regarding the site, number and uptake of metastases.

CONCLUSION

Technetium-99m-tetrofosmin and 201Tl imaging are highly sensitive for detecting differentiated thyroid carcinoma metastases and do not require prior withdrawal of thyroid hormone suppressive therapy.