Search

The proposed systematic review aims to synthesize the experiences of nurses working in any shifts during pregnancy.Nurses are among the most burdened health care workers and are at risk of diseases of the circulatory system due to prolonged standing. Among pregnant nurses, this could reduce blood circulation and blood flow to the uterus and placenta. Contributing factors include long working hours and frequent heavy lifting, which may induce uterine contractions and premature birth; irregular shifts, which exacerbates fatigue; and high levels of psychosocial stress. There is no qualitative evidence as to what nurses are experiencing while working shifts when pregnant. This review will evaluate and integrate the current available findings related to the experience of shift-working nurses who are pregnant.This review will include qualitative studies focusing on the experience of shift work among pregnant nurses. No language or date limits will be applied. All types of pregnancy among nurses will be included.The databases to be searched will include CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), and Igaku Chuo Zasshi (the Japan Medical Abstracts Society). Sources of gray literature will include MedNar and DANS, as well as the websites of the American Nurses Association and the Japanese Nursing Association. Study selection, critical appraisal, data extraction, and data synthesis will be performed independently by 2 reviewers. The synthesized findings will be graded according to the ConQual approach for establishing confidence in findings.PROSPERO CRD42022309674.

The objective of this review is to synthesize the experiences of patients with metachromatic leukodystrophy (MLD), adrenoleukodystrophy (ALD), and Krabbe disease and the experiences of their family members.MLD, ALD, and Krabbe disease are rare disorders that are classified as lysosomal storage or peroxisomal disorders, with similar presentations as leukodystrophy. As these diseases cause cognitive and neurological decline due to the progression of leukodystrophy associated with demyelination, they have significant impact on the lives of patients and their families. It is important to identify the impact and challenges of these diseases on patients' lives and on their families, as well as to synthesize qualitative studies regarding their experiences.We will consider studies including patients with MLD, ALD, or Krabbe disease and their family members. These experiences will include the challenges, dissatisfactions, and frustrations with symptoms and treatments; complications of hematopoietic stem cell transplantation; and the increased caregiver burden with disease progression. This is important since the impacts of disease progression are experienced in a variety of settings beyond the hospital, such as in the community and at home.The search strategy will follow JBI methodology and be conducted in 3 steps: an initial limited search, a comprehensive database search, and a reference search of the included articles. MEDLINE, CINAHL Plus, PsycINFO, and Scopus will be searched with no restriction on language and publication dates. The study selection, critical appraisal, data extraction, and data synthesis will be performed per JBI guidelines for systematic reviews of qualitative research. Final syntheses will be assessed using the ConQual approach.PROSPERO CRD42022318805.

Purpose This study aimed to identify factors associated with discharge difficulties for pediatric patients in Japan in order to develop pediatric discharge screening tools. Design and methods This study employed the Delphi method by setting consensus level to 80%. A total of 131 acute hospitals were randomly selected by computer from among 261 hospitals. Five nurses with experience in discharge planning for children from each hospital were recruited for this study resulting in 655 participants enrolled. Results We received 160 responses from participants who expressed consent to participate in the first edition questionnaire, and 112 responses with the second questionnaire. The study identified three factor categories associated with discharge difficulties: patient factors (22 items), family factors (32), and societal factors (12). Among these, 4 patient factors including “Unstable child with congenital disease”, 15 family factors including “Abuse or possibility of abuse”, “Carer with difficulties in bringing up the child due to a tendency towards depression”, and “Carer with a poor opinion of home care”, and 5 societal factors including “No alternative pediatric hospitals for transfers” reached consensus showing them to be considered important for the participants. Implications The findings suggest that the factors associated with discharge difficulties for Japanese pediatric patients may be useful when used for the screening, in providing discharge planning at an early stage. These factors would provide useful ideas when developing discharge screening tools that will enable nurses to provide discharge planning for pediatric patients at the early stages of hospitalization.

This study aimed to clarify mothers' perceptions about psychosocial issues and solutions in preschool-age foodallergic children (FA children) who need to carry adrenaline auto-injector (Epipen®). Semi-structured interviews were conducted with eight mothers of FA children, which were analyzed qualitatively and descriptively. The problems perceived by mothers were: situations that only FA children have to deal with; lack of experience with food; negative feelings about the allergy-inducing food; immaturity of judgment about allergies; and difficulty in transitioning to the stage of separation from parents. The mothers' proposed solutions were: setting scenes to foster food experiences that are led by the FA child; adjusting the environment for shared experiences with other children; empathy for the feelings of FA children; preparing allergen-free elimination diet menus when going out; responding to a dietary therapy that considers the feelings of FA children; education to improve FA children’s self-care ability for allergies; and working to be understood by adults involved with FA children outside the home regarding food allergies., 母親が認識した携帯用アドレナリン自己注射薬を所持する重症食物アレルギー児の幼児期における心理社会的問題と母親が実施した対応策を明らかにすることを目的に、FA 児の母親8 名に半構成面接を行い、質的記述的に分析した。母親は、FA 児の幼児期の心理社会的問題として、【FA 児だけが我慢しなければならない状況】【食を通した体験の不足】【原因食物に対するネガティブな感情】【アレルギーに関する判断の未熟さ】【親元から離れる段階への移行が困難な状況】を認識していた。それらの問題に対して、【食への主体性を育める場面の設定】【他児と体験が共有できる環境の調整】【FA 児の気持ちへの共感】【外出時にアレルギー対応食を食べさせる準備】【FA 児の気持ちに配慮した食事療法への対応】【アレルギーに対するセルフケア能力の向上を目指した教育】【家庭外でFA 児に関わる大人に理解を得るための働きかけ】を有効な対応策として実施していた。

The purpose of this study is to ascertain nursing practices that can be responsible for reassuring parents of children with severe motor and intellectual disabilities (SMID) during short-term hospitalization. Semi- structured interviews with 12 parents were conducted. The results determined the following vehicles for reassurance in nursing practices:“ compassionate care,”“ care that meets parents’ expectations,”“ consideration toward parents,” and“ management of information and goods.” The reassurance in short-term hospitalization to parents of children with SMID who are highly dependent on home medical care was connected to “care that meets parents' expectations,” and polite “compassionate care” nursing practices, which protect the lives of such children. In addition, this study discerned that there is often little time to provide“ consideration to parents”; therefore, it was determined that nursing practices and the“ management of information and goods” could provide reassurance leading to smooth check-ins and check-outs during hospitalizations. Based on the nursing practices clarified in this study, it is necessary to support short-term hospitalizations as opportunities in which parents are not only providing their own care for children with SMID but also accepting care from experienced nurses. Through the interactions with nurses, it is vital to facilitate growing social in the relationships between children and their hardworking parents., 過去に重症心身障がい児（以下、重症児）の短期入所を利用した経験のある主たる養育者12 名を対象に、重症児の短期入所における養育者の安心に繋がる看護支援について明らかにすることを目的に質的記述的研究を行った。その結果､重症児の養育者の安心に繋がる看護支援は､【愛護的なケア】、【養育者の期待に応じたケア】、【養育者への配慮】、【情報と物品の管理】が抽出された。 在宅で医療依存度の高い重症児をケアする養育者の短期入所の安心は､わが子の生命を守る【養育者の期待に応じたケア】と丁寧な【愛護的なケア】の看護支援から繋がっていた。また養育者の時間的な余裕のなさを理解した【養育者への配慮】とスムーズな入退所に繋がる【情報と物品の管理】が安心できる看護支援であった。 今回明らかになった看護支援を主軸に、短期入所を重症児が、看護師からのケアを受け入れ社会性を拡げる機会とする看護支援が必要である。

小児科外来の診療場面において、スムーズに診療や看護を進めるための看護師の判断や工夫について明らかにするために、A 大学病院の小児科外来に勤務する看護師の5 名を対象に参加観察とインタビューを実施した。フィールドノートとインタビューの逐語録から、内容分析により分析した。小児科外来の看護師が診療や看護をスムーズにするために実施していた判断や工夫は28コード、4 カテゴリー『時間を短縮するための判断・工夫』『安全に診療をするための判断・工夫』『関係性を築くための判断・工夫』『待ち時間に対する不満を軽減させるための判断・工夫』から構成されていた。小児科外来の看護師は、外来での経験が積み重ねられ、限られたマンパワーと労力で効率よくスムーズに診療や看護を進めていることが考えられた。

Objective The objective of this review was to investigate the experiences of patients with lysosomal storage disorders who are receiving enzyme-replacement therapy and the experiences of their family members. Introduction Lysosomal storage disorders are rare diseases caused by mutations in the genes that encode proteins required for lysosomal function. The age of onset of these disorders varies from infancy to adulthood, depending on the specific disease and type. Enzyme-replacement therapy is the standard treatment for some lysosomal storage disorders. However, patients' adherence to this treatment is affected not only by the resultant changes (or lack thereof) in their symptoms, but also by the scheduling of the frequent hospital visits necessary to receive this treatment. No previous qualitative systematic review has examined the experiences of these patients and their families. Inclusion criteria Qualitative studies on the experiences of patients with lysosomal storage disorders who were receiving enzyme-replacement therapy and/or the experiences of family members of these patients were included. These experiences could include satisfaction/dissatisfaction with diagnosis, difficulties, and expectations regarding continuing treatment, advantages/disadvantages concerning school and work life, and the psychological burden on and support provided by families. This review considered studies in all settings because relevant experiences may occur outside medical institutions. Methods MEDLINE, CINAHL Plus, APA PsycINFO, Scopus, and Igaku Chuo Zasshi were searched for articles published between January 1991 and May 13, 2021. No language restrictions were applied. The study selection, critical appraisal, data extraction, and data synthesis were performed in accordance with the guidelines for systematic reviews of qualitative evidence outlined in the JBI Manual for Evidence Synthesis. Results Seven studies were included in this review, from which 37 findings with narrative illustrations were extracted; of these, 33 were assessed as unequivocal and four as credible. These findings were integrated into 10 categories and three synthesized findings. The first synthesized finding was encouraging awareness of the minor changes in physical symptoms caused by the treatment, which contains categories such as physical change caused by treatment. The second was supporting acceptance of the disease and coping with associated psychological challenges, which contains categories such as concerns regarding the future. The third was customization of treatment plans to minimize restrictions on the patient's and their family's lives, which contains categories such as restrictions on patients' lives. According to the ConQual criteria, all three synthesized findings had low confidence levels. Conclusion Evidence obtained through the synthesized findings produced in this review identified the primary experiences of both patients with lysosomal storage disorders who are receiving enzyme-replacement therapy and their family members. These experiences concerned challenges regarding physical, psychological, and social health. When supporting patients with lysosomal storage disorders and their families, it is necessary to consider not only the symptoms and treatments but also the mental and social aspects. Systematic review registration number PROSPERO CRD42019147751.

BACKGROUND Parents of children with cleft lip and/or palate (CL/P) have concerns including guilt and worry. Differences in concerns by cleft type is, however, under-researched. AIM To compare differences in perceived concerns among parents of children with CL/P by cleft type, adjusting for children's gender and age. DESIGN Cross-sectional study conducted in an outpatient centre, assessing psychological status of 171 parents of children aged

The objective of this systematic review was to identify, evaluate and synthesize evidence of the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and younger.Needle-related procedures (NRPs) are common medical procedures associated with pain. Children, in particular, experience unpredictable and severe pain in response to NRPs. The gate control theory is commonly used to countermeasure this pain. Based on this theory, various types of vibratory stimulation have been used to reduce pain in several clinical studies.Participants were 0- to 18-year-old children who underwent NRPs for any condition. The intervention included any type of vibratory stimulation during the NRPs. The main outcome was pain measured on any pain scale, including both self-rated and observer-rated pain scales. The secondary outcomes were anxiety, the duration of the procedure and the success rate. All studies were randomized controlled trials (RCTs) or quasi-randomized trials published in English.The search strategy aimed to identify both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE and CINAHL was undertaken, followed by a search for unpublished studies. Nine databases were used for the search in October 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion. Quantitative data were extracted from papers included in the review using a standardized data extraction tool. Where possible, quantitative data were pooled in the statistical meta-analysis. All results were subject to double data entry. Effect sizes were expressed as risk ratios (for categorical data) and weighted mean differences (for continuous data), and their 95% confidence intervals were calculated for analysis.Twenty-one RCTs involving 1727 children were identified. Blinding of the participants and those delivering the treatment was not achieved in all studies, introducing a potential risk of bias. Overall, the vibratory stimulation was significantly effective in reducing NRP pain in children as shown by measurement of self-rated pain outcomes (standardized mean difference [SMD]: -0.55, 95% confidence interval [CI]: -0.92 to -0.18) and observer-rated pain outcomes (SMD: -0.47, 95% CI: -0.76 to -0.18). Among secondary outcomes, the effect on the child's anxiety (SMD: -1.03, 95% CI: -1.85 to -0.20) was significant.Vibratory stimulation was effective in reducing NRP pain in children; however, blinding was not possible in the trials. Moreover, heterogeneity was high. Therefore, the confidence in the evidence is low. Personal preference should be a priority when using vibratory stimulation in the clinical setting.

小児科外来の看護師が認識する「保護者の小児科外来に対する満足度」に対する関連要因について明らかにするため、調査票を用いた横断研究を実施した。小児が入院する病棟のある総合病院451 施設に調査を依頼し調査票は136 施設より回答があった（回収率30.2％）。看護師が認識する保護者の満足度の平均は、100 点満点のうち57.8 点であった。看護師が認識する保護者の満足度を従属変数とした重回帰分析では、医師と看護師の人間関係、待ち時間、医師の子どもや保護者への対応、小児科経験の浅い看護師の教育、複数の検査がある場合は結果がでるまでの時間が長い検査から実施することの5 項目が有意な関連要因であった。保護者の満足度を高めるために、待ち時間への配慮や看護師への教育などの対策を講じることの有効性が示唆された。

Objective The objective of the review is to investigate the experiences of patients with lysosomal storage disorders treated with enzyme replacement therapy and the experiences of their families. Introduction Lysosomal storage disorders are rare diseases caused by mutations in genes encoding proteins required for lysosomal function. The onset of lysosomal storage disorders vary from infancy to adulthood, depending on the specific disease and disease type. Enzyme replacement therapy is the standard treatment for some lysosomal storage disorders. The adherence to the treatment by patients and their families is affected not only by the symptoms but also by the scheduling of hospital visits. No qualitative systematic review on this topic has examined the experiences of patients and their families. Inclusion criteria Qualitative studies dealing with the experiences of patients with lysosomal storage disorders receiving enzyme replacement therapy and their families will be included. These may include experiences related to satisfaction or dissatisfaction with being diagnosed, difficulties and expectations continuing treatment, the advantages or disadvantages related to school and work life, and the psychological burden and supports on families. This review will consider studies in all settings because relevant experiences of patients and their families may occur outside medical institutions. Methods MEDLINE, CINAHL Plus, APA PsycINFO, Scopus, and Igaku Chuo Zasshi databases will be examined from 1991 to the present. Studies published in any language will be included. The study selection, critical appraisal, data extraction, and data synthesis will be performed in accordance with the guidelines for systematic reviews of qualitative evidence in the JBI Manual for Evidence Synthesis. Systematic review registration number PROSPERO CRD42019147751.

Background Although vaccine injections are important, children experience pain and discomfort upon their administration. BUZZY®, a vibratory stimulation tool with an ice pack, was reported to be an effective tool for reducing the pain caused to children during injection administration; its mechanisms were explained by gate control theory. However, the evidence is inadequate because of insufficient methodology in previous reports. Therefore, we aimed to assess whether the application of vibration would significantly reduce children’s pain during vaccine injections. Methods A single-blind randomized controlled trial recruiting children aged ≤6 years who were receiving vaccine injections was conducted between August and December 2019. If the children’s parents consented to their participation, BUZZY® was attached to the child’s arm prior to vaccination. BUZZY® was switched on before injection in the intervention group but not in the control group. The vaccination procedure was recorded, and researchers and parents assessed each child’s pain using validated pain scales. Researchers conducted their assessment using video data to ensure blinding. Parents were administered a questionnaire after the children’s vaccination. Data were analyzed using the t-test or chi-square test. Results We analyzed 118 children (intervention group = 62, control = 56). No between-group difference was observed according to the researchers’ assessment (mean score = 6.98 and 7.63, respectively; p = 0.25); however, a significant difference was found based on the parents’ assessment (mean score = 7.39 versus 8.46; p = 0.02). Most responses received to open-ended questions were positive comments for this study. Conclusions We revealed that the effect of vibration is not significant in reducing vaccine injection pain among children. Further studies are needed to examine the other components of BUZZY®, which include its cooling effect, and the effect of BUZZY® itself in terms of whether children will undergo vaccination without resistance and have reduced trauma related to vaccination.

The objective of this systematic review is to identify, evaluate and synthesize evidence on the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and under.The review will address the following question: Is vibratory stimulation effective in reducing needle-related procedural pain in children aged 18 years and under, in comparison with no stimulation for needle-related procedures?

小学校低学年の口唇裂・口蓋裂児の母親が認識している児の学校での疾患に関連した否定的な体験とそれに対する母親の思いを明らかにすることを目的に、小学校低学年の口唇裂・口蓋裂児の母親13名に半構造化面接調査を行い、内容分析法にて分析した。母親は口唇裂・口蓋裂児の否定的な体験として【容姿や行動の違いへの指摘に自分で対応できた】【容姿の違いへの指摘や病気の暴露に苦痛を感じていた】と認識していた。その体験に対して母親は【疾患に関連したからかいは起こるものだ】【疾患に関連したからかいによる子どもの苦痛をわかってあげたい】【子どもが自分でからかいに対応できるようになって欲しい】【子どもに自分の疾患を前向きに捉えて欲しい】【教師はからかいに適切に対応して欲しい】と思っていることが明らかになった。医療者は親子と共にからかいへの対処方法を考えると同時に、教師の疾患への理解を深めるよう支援していく必要がある。

看護師を対象とするデルファイ法を用いた国内文献の研究手順の実態について明らかにすることを目的とした。2017 年6 月に医学中央雑誌web 版にて、キーワードを「デルファイ」として検索した結果、看護師を対象とするデルファイ法を用いた研究論文は29 件が該当した。これらの文献を分析した結果、専門家集団の経験則から得られる価値観や評価、予測の指標について意見を集約して合意形成をすることを目的とした研究が多くみられた。デルファイ法のラウンド数は概ね3、4 回、同意率は80％が多かった。最終段階の参加者数は50 〜60 名程度確保できれば十分であるが、11 〜20 名の文献も少なからずみられた。このことから、参加者の質を高めた場合では20 名程度でも許容されるのではないかという示唆を得た。参加者の脱落率とラウンド数および項目数との間に有意な相関はなかったことから、ラウンド数や質問項目数が回収率に与える影響は少ないことが示された。

REVIEW QUESTION The objective of this systematic review is to identify, evaluate and synthesize evidence of effectiveness on ultrasound-guided peripheral intravenous cannulation in pediatric patients aged under three years.Specially, the review question is: In pediatric patients aged under three years, what is the effect of ultrasound-guided peripheral intravenous cannulation on the first attempt and on the overall success rate, time to cannulation and number of attempts for successful cannulation compared with the traditional blind approach?

本研究は、小児用転倒・転落リスクアセスメントツールC-FRAT（Child Falls Risk Assessment Tool）第3 版の評価者間信頼性を、カッパ係数を算出して明らかにすることを目的とした。参加者は、A 病院の小児病棟で勤務する看護師のうち、同意を得た13 名であった。サークルベッドを使用する小児用の転倒・転落リスクアセスメントツールC-FRAT第3 版を使用した。アセスメント項目とリスク判定結果について、2 名の評価者間信頼性の指標として、一致度を示す「カッパ係数」を算出した。参加者がアセスメントを行った回数は計108 回であった（のべ54 組）。各アセスメント項目のカッパ係数は0.414 ～ 1.000 であり、リスク判定結果のカッパ係数は0.852 であった。リスク判定のもととなる15 項目のアセスメント項目のうち、一致度が中等度のものは5 項目であったが、最終的なリスク判定結果の一致度は非常に高く、十分な評価者間信頼性が示された。

Parents experience uncertainty when their children become sick. The study aimed to develop a Parents’ Uncertainty regarding their Child with Acute Illness Scale (PUCAS) and to clarify differences in PUCAS scores between groups that were divided according to participants’ demographic characteristics. PUCAS was developed based on interviews, literature review, and a pilot study. We obtained valid responses from 235 parents with children hospitalized due to an acute childhood illness. Exploratory factor analysis narrowed the number of items to 25, divided into the following 5 subscales: unpredictability of the course of the illness, ambiguity about the severity of the illness, ambiguous appropriateness of management, discrepancy of judgement with health care professionals, and lack of information about the causes of the illness. There was satisfactory construct validity and criterion-related validity. Cronbach’s alpha was 0.92 for the overall scale. Participants who used ambulances, those who were not given any reliable diagnosis for their children, and fathers scored significantly higher on the PUCAS. PUCAS has high validity and reliability in measuring uncertainty of parents who have children with acute childhood illness and could be a useful screening tool for parents with high uncertainty in a clinical setting.

Mothers often express intense stress and uncertainty when their children develop acute childhood illnesses and it is important for healthcare professionals to consider maternal uncertainty when providing support for mothers. This study aimed to examine maternal uncertainty about children’s hospitalization due to acute childhood illnesses. We recruited 15 Japanese mothers of children aged 1 - 12 months who had been hospitalized for the first time due to acute childhood illnesses, and conducted unstructured interviews with the participants at the time of discharge. Content analysis was used to examine uncertainty in their expression of their psychological state. Mothers’ uncertainty was classified into five categories: ambiguity about the severity of the illness, unpredictability of the course of the illness, discrepancy of the judgement with healthcare professionals, lack of information about the causes of the illness, and ambiguous appropriateness of management. The former three categories were reported as uncertainty of mothers of children with chronic diseases, while the latter two categories were particularly characteristic of mothers of children with acute childhood illnesses. It is, therefore, important to explore the causes of children’s illnesses and help mothers build confidence in their ability to manage their children’s illness before discharge.

To examine characteristics of parents of children with acute, albeit mild, illnesses who used ambulance transport unnecessarily.A cross-sectional study.From 2016 - 2017, we recruited parents who visited the emergency room of a Japanese paediatric hospital and whose children were discharged without hospitalization. Participants whose children arrived by ambulance were classified as using ambulance services unnecessarily. Participants answered a questionnaire consisting of parents' characteristics, including health literacy scales and the Parents' Uncertainty regarding their Children with Acute Illness Scale. We conducted a receiver operating characteristic analysis to convert the Parents' Uncertainty regarding their Children with Acute Illness Scale results to binary scores. We analysed questionnaire responses using logistic regression analysis.Analysed data were from 171 participants. The cut-off score was 59 for the Parents' Uncertainty regarding their Children with Acute Illness Scale. Results of the logistic regression indicated that parents who did not use resources to obtain information regarding their child's illness, had low health literacy, were observing presenting symptoms for the first time in their child, or had high uncertainty, were significantly more likely to unnecessarily use ambulances.Publicizing available resources regarding child health information, social healthcare activities to raise parents' health literacy and providing explanations in accordance with parents' uncertainty, especially when confronting new symptoms in their child, might reduce unnecessary ambulance use.Of patients transported to hospitals by ambulance, the rate of paediatric parents with mild conditions has been found to be high. The study findings could contribute to the appropriateness of using ambulances and have implications for policymakers and healthcare providers, particularly in the Japanese paediatric emergency system. In particular, parental uncertainty, one of four significant characteristics, could be resolved in clinical settings. Generalization for global health services requires further research.目的: 调查不必要地使用救护车运送患急性病(尽管很轻微)儿童患者的父母的特性。 设计: 一项横断面研究。 方法: 在2016年到2017年间,招募了曾在日本一家儿科医院急诊室就诊的父母,并且他们的孩子没有住院就离开了医院。实验参与者的孩子由救护车护送至医院,但被列为不必要地使用救护车服务。参与者完成了一份由父母特征组成的问卷,其中包括健康素养量表以及父母对孩子是否换急性病的不确定性量表。我们进行了受试者操作特征分析,将父母对孩子是否患有急性病的不确定性量表转化为二进制分数。我们使用逻辑回归分析来分析问卷。 结果: 分析数据来自171位受试者。父母对孩子是否患有急性病的不确定性的分数分界点为59分。逻辑回归的结果表明,那些对于孩子的疾病没有动用资源,并且健康素养较低的父母,或不确定性较高的父母,明显更倾向于在孩子首次出现一些症状时不必要地使用救护车。 结论: 公开有关儿童健康信息、社会医疗活动以提高父母健康素养,并根据父母的不确定性提供说明,尤其是在他们孩子出现新的症状时,这样可能会减少不必要地使用救护车的情况出现。 影响: 通过救护车运送至医院的病人中,病情较轻的儿童患者家长比例较高。此项研究的结果可能有助于适当使用救护车,并对政策制定者、医务人员产生一定影响,尤其是日本的儿科急救系统。作为四个重要特征之一,尤其是父母的不确定可以在临床环境中解决。全球卫生服务的普遍化需要进一步的研究。.

本研究は、口唇裂・口蓋裂（以後CLP とする）児の専門医療機関での経験豊かな看護師11名のCLP 児の母親に対す る看護援助の内容と援助する上で感じている問題を明らかにすることを目的とした。看護援助は、【専門医療機関内での看護援助の実際】と【出向での看護の実際】に、援助する上での問題は【看護実践 の基盤】と【専門医療機関での問題意識と対応】のコアカテゴリーが抽出できた。本論文では、主に【専門医療機関内 での看護援助の実際】除くコアカテゴリーの内容を述べた。看護師は、専門医療機関内での看護援助とともに、地域に出向く看護援助の母親に与える効果や意義を認識している。 病院内外の看護援助を実施する際には、看護師内面と職場の特色を基にするとともに、援助する上でシステムや連携の問題を認識していることが明らかになった。

Immediately after cleft lip repair, breastfeeding and bottle-feeding are generally restricted to avoid placing tension on the surgical incision. However, no consensus about feeding methods after cleft lip repair has been reached. The objective of this systematic review was to examine the impact of breastfeeding and/or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants., We searched PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Mednar from October to November 2017. Two reviewers independently assessed eligibility for inclusion and checked critical appraisal of the study quality., Three randomized controlled trials and two cohort studies involving 342 infants were included in this review. Two cases of surgical wound dehiscence occurred in the control group of alternative feeding. In three of five studies, surgical wound dehiscence did not occur in either the intervention or control group within the first week postoperatively., This review showed no increased risk of surgical wound dehiscence in infants with breastfeeding and/or bottle-feeding after cleft lip repair compared with infants with alternative feeding methods. It may not be necessary to restrict breastfeeding and/or bottle-feeding immediately after cleft lip repair.

Aims and objectives To identify the factors that predict maternal state anxiety when mothers and their sick children visit the outpatient unit of a paediatric hospital. Background While previous studies have focused on predictors of anxiety in mothers with ill children, the existing literature is limited in study design, research timing, respondent characteristics, sample size and data analysis. Design A cross-sectional design with self-administered questionnaires. Methods Mothers were recruited from the outpatient unit of a Japanese paediatric hospital (N = 1077). Participants' state anxiety scores were collected using the Japanese version of Spielberger's State-Trait Anxiety Inventory. The independent variables were the mothers' and sick children's background information. Results Participants were 1077 mothers; 990 provided valid responses. Mothers' mean state anxiety score was 49·72. Significant predictors of maternal anxiety were mothers' childrearing anxiety, child age, the sick child having a fever, sick child having siblings, having a person providing childrearing support, the mother's first visit to the hospital, out-of-hours visit and severity of the child's illness. The overall model explained 21·6% of the variance (multiple regression analysis). Conclusions As various factors predicted maternal anxiety, identifying methods to address these factors may reduce maternal state anxiety. Relevance to clinical practice There is potential for improved understanding of the predictors of maternal state anxiety to aid in the development of materials that would best measure anxiety. The present findings may also suggest some means of providing appropriate information and support to anxious mothers. Our findings cannot demonstrate causation, however, and teaching methods and supportive practices were not investigated; therefore, a qualitative study on the concrete content of maternal anxiety and an intervention study to create support services for anxious mothers is required. In addition, prospective or longitudinal studies are also important for investigating causation.

Summary Objectives We examined whether aromatherapy involving inhalation of yuzu (Citrus ichangensis × Citrus reticulata) oil was effective in decreasing mothers' anxiety for her sick child receiving an infusion at a paediatric clinic. Design Controlled clinical trial. Setting Mothers of sick children who arrived at the hospital were asked to complete an anonymous questionnaire. After a doctor examined the child and confirmed the necessity for infusion, the mothers who agreed to participate in our study were allocated to an aromatherapy or a control group. Interventions A diffuser was filled with yuzu oil before the subjects entered the aromatherapy room. The mother was shown how to use the aromatherapy diffuser while the child was receiving an infusion in the same room. Fifteen minutes after entering the room, the mothers were asked to complete an another questionnaire. Main outcome measures We measured the mother's anxiety with the state anxiety score from the State-Trait Anxiety Inventory. Results There were 60 subjects in the aromatherapy group and 61 in the control group. Both groups were well balanced in terms of demographic characteristics. Using analysis of variance, we demonstrated a significant difference in two-factor interactions between the control and aromatherapy groups. Maternal state anxiety was significantly lower in the aromatherapy than in the control group. Conclusions Inhalation of yuzu oil was shown to decrease maternal anxiety for a sick child. A multicentre randomized controlled trial or double-blind study is necessary to obtain objective evidence of this benefit of aromatherapy.

AIM The present study explored the differences in emotional difficulties and resilience between fathers and mothers of a child with a cleft lip and palate. METHODS Married couples were recruited who were accompanying their child with a cleft lip and palate (

The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants.Immediately after cleft lip repair in infants, breastfeeding and bottle-feeding are generally restricted. Alternative feeding methods such as spoon-feeding are recommended to avoid placing tension on the surgical wound. However, some studies have reported that alternative feeding methods are a source of stress to the infant and cause them to cry incessantly, resulting in postoperative weight loss. This suggests that these alternative feeding methods may have an unfavorable impact on surgical wound healing. However, a consensus on this topic has not been reached. The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants.Cleft lip and/or palate is a craniofacial anomaly and one of the most common birth defects. The incidence of cleft lip and/or palate differs among races, ethnic groups and geographical areas. The prevalence of cleft lip and/or palate is highest in South American countries (Bolivia: 22.94 per 10,000 live births; Paraguay: 14.90 per 10,000 live births), followed by Asian countries (China: 13.60 per 10,000 live births; Japan: 16.04 per 10,000 live births). The prevalence is lowest in African countries (3.54 per 10,000 live births). The overall worldwide prevalence is 7.9 per 10,000 births.A cleft lip and/or a cleft palate can occur separately, although they are more likely to occur together early in pregnancy. These anomalies can be surgically repaired. Without proper treatment, patients have aesthetic and functional problems, such as feeding disorders, otitis media and speech difficulties.Patients with cleft lip and/or palate usually undergo a combination of surgical procedures, speech therapy and orthodontic treatment from infancy to young adulthood. Comprehensive treatment is provided with thoughtful consideration of the balance between intervention and growth. Cleft lip repair is carried out first in comprehensive treatment regimens. The aim of cleft lip repair is to create contrast between the lip and external nose and provide good muscular continuity across the cleft without any scarring. It is usually performed from three to six months of age. Surgery is delayed until this age to allow for growth of the lip structure and assessment of the patient for the presence of comorbidities. The ability of newborn patients with cleft lip and/or palate to drink milk is important for proper growth and development.For cleft lip and/or palate patients in the newborn developmental stage, feeding can be an area of great concern and anxiety for their parents. One study found that 32% of newborn patients with cleft lip and/or palate had poor feeding skills. Feeding difficulties lead to poor growth and development in early infancy and increase the burden of care. Therefore, it is important for new parents to learn appropriate feeding techniques. Infants with cleft lip can generally drink milk from the breast through various ways of feeding. In contrast, infants with both cleft lip and palate have difficulty sucking the nipple because of weak intraoral negative pressure, and specially designed nipples are generally used. Although such infants suckle with weakened pressure, these nipples enable them to drink milk by lightly pushing them through their lip. However, after cleft lip repair, infants with cleft lip and/or palate are forced to change their feeding methods (even infants who have managed to drink milk before the repair).Breastfeeding and bottle-feeding are generally restricted immediately after cleft lip repair. Alternative feeding methods such as the use of a spoon, cup or syringe are recommended to avoid placing tension on the surgical incision. The use of a very soft nipple of sufficient size is recommended to provide a dripping milk flow, thus avoiding tension on the operative site. Some authors have recommended that patients with cleft lip and/or palate be spoon-fed for a certain period of time after cleft lip repair to avoid tension on the surgical site. However, management of the surgical site after surgical repair of cleft lip and/or palate varies among countries and healthcare centers. Little evidence-based research is available to guide healthcare staff members through the many treatment protocols for cleft lip and/or palate. No consensus about feeding methods after cleft lip repair has been reached.The above mentioned alternative feeding methods might influence the process of surgical wound healing. Minimizing crying has been considered to be the most important factor in avoiding tension on the surgical wound. In one study, however, 21.7% of infants who were given milk by a spoon on the first day after cleft lip repair resisted feeding by crying and/or moving the head laterally, while all infants fed by the nipple that had been used preoperatively accepted feeding without a major observable response. In another study, infants who were breastfed or bottle-fed after the repair were reportedly more relaxed than spoon-fed or syringe-fed infants. Changes in feeding methods seem to stress the infants and cause them to cry, which places tension on the wound.These alternative feeding methods may also have other impacts on surgical wound healing. One study reported that infants took longer to drink milk using alternative feeding methods than when using traditional feeding methods after the surgery. A systematic review suggested that alternative feeding methods were associated with less postoperative weight gain in patients than traditional feeding methods. Postoperative nutritional intake also influences wound healing. A long duration of feeding milk coupled with weight loss after the surgery suggests unnecessary energy consumption associated with the alternative feeding methods. Wound healing may consequently be inhibited or delayed.Wound healing complications after surgery include wound infection, dehiscence and proliferative scarring. Surgical wound dehiscence has been regarded as a typical complication after cleft lip and/or palate repair, followed by pyrexia. In one case series, post-surgical complications were found in 11 of 2100 infants who underwent surgical cleft lip and/or palate repair during a seven-year period. Wound dehiscence results from tissue failure rather than improper suturing technique. Therefore, alternative feeding methods are recommended to avoid placing tension on the surgical wound. However, no strong evidence has been presented to show that breastfeeding or bottle-feeding after cleft lip repair may cause surgical wound dehiscence among infants with cleft lip.Our initial search failed to find any systematic review examining the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair using the Cochrane Library, the JBI Database of Systematic Reviews and Implementation Reports, and other bibliographic databases, including MEDLINE and CINAHL. The proposed systematic review will contribute to the understanding of this topic and identify areas for further research. If breastfeeding or bottle-feeding is recommended immediately after cleft lip repair, the patients will experience less stress and crying, placing less tension on the wound than with alternative feeding methods. Breastfeeding or bottle-feeding will result in more weight gain, facilitating wound healing.