Quality of life in caregivers of children with asthma: Validity and reliability of the IFABI-R questionnaire.

BACKGROUND: Parents'/caregivers' quality of life is an important aspect to consider when handling paediatric asthma, but there is a paucity of valid and reliable instruments to measure it. The Family Impact of Childhood Bronchial Asthma (IFABI-R) is a recently developed questionnaire to facilitate the assessment of asthma-related parents'/caregivers' quality of life. This study researches the psychometric properties of IFABI-R. METHODS: Parents/main caregivers of 462 children between 4 and 14 years of age with active asthma were included in the sample. IFABI-R was administered on two different occasions and a number of other variables related to the parents'/caregivers' quality of life were measured: child's asthma control, family functioning, and parents'/caregivers' perception of asthma symptoms in the child. IFABI-R evaluative and discriminative properties were analysed, and the minimal important change in the IFABI-R score was identified. RESULTS: IFABI-R showed high internal consistency (Cronbach's alpha=0.941), cross-sectional construct validity (correlation with the degree of child's asthma control, family functioning and parent/caregiver perception of the child's asthma symptoms), longitudinal construct validity (correlation of changes in the IFABI-R with changes in asthma control and changes in the perception of symptoms), sensitivity to change and test-retest reliability. An absolute change of 0.3 units in IFABI-R related to a minimal significant change in the parents'/caregivers' quality of life. CONCLUSIONS: IFABI-R is a reliable and valid instrument to study the quality of life of parents/caregivers of children with asthma.

Sub-two-cycle pulses by soliton self-compression in highly nonlinear photonic crystal fibers.

We demonstrate the direct generation of sub-two-cycle pulses by soliton self-compression of femtosecond pulses from a Ti:sapphire laser at 85 MHz using a 4.85-mm-long highly nonlinear photonic crystal fiber. Sub-nanojoule, 41 fs input pulses were compressed down to 4.6 fs without additional phase compensation schemes. To our knowledge, these are the shortest pulses obtained by soliton-effect compression of a laser oscillator. Efficient, near-dispersionless collimation of the fiber output was achieved with a simple lens and an octave-spanning double-chirped mirror pair. The full electric field of the compressed pulses was retrieved with a genetic algorithm applied to spectral and interferometric autocorrelation measurements, and the results are well described by numerical simulations.

Pediatric implications in bioterrorism part II: postexposure diagnosis and treatment.

Bioterrorism is an old tactic used in warfare. The use of fatal diseases or man-made poisons to subdue others has not been limited to wartime. Trauma personnel should be aware of commonly used agents, the signs and symptoms of their exposure, and recommended treatment. Children can be victims of terrorists' acts and need special attention because of their unique response to exposure, varying dosages of medications, and lack of active immunity.

The effects of core and peripheral warming methods on temperature and physiologic variables in injured children.

INTRODUCTION: Injured children are at risk for thermoregulatory compromise, where temperature maintenance mechanisms are overwhelmed by severe injury, environmental exposure, and resuscitation measures. Adequate thermoregulation can be maintained, and heat loss can be prevented, by core (administration of warmed intravenous fluid) and peripheral (application of convective air warming) methods. It is not known which warming method is better to maintain thermoregulation and prevent heat loss in injured children during their trauma resuscitations. The purpose of this feasibility study was to compare the effects of core and peripheral warming measures on body temperature and physiologic changes in a small sample of injured children during their initial emergency department (ED) treatment. METHODS: A prospective, randomized experimental design was used. Eight injured children aged 3 to 14 years (mean = 6.87, SD = 3.44 ) treated in the ED of Children's Hospital of Pittsburgh were enrolled. Physiologic responses (eg, heart rate, blood pressure, respiratory rate, arterial oxygen saturation, core, peripheral temperatures) and level of consciousness were continuously measured and recorded every 5 minutes to detect early thermoregulatory compromise and to determine the child's response to warming. Data were collected throughout the resuscitation period, including transport to CT scan, the inpatient nursing unit, intensive care unit, operating room or discharge to home. Core warming was accomplished with the Hotline Fluid Warmer (Sims Level 1, Inc., Rockland, MA), and peripheral warming was accomplished with the Snuggle Warm Convective Warming System (Sins Level 1, Inc., Rockland, MA). Data were analyzed using descriptive and inferential statistics. RESULTS: There were no statistically significant differences between the two groups on age (t = -0.485, P = 0.645); weight (t = -0.005, P = 0.996); amount of prehospital intravenous (IV) fluid (t = 0314, P = 0.766); temperature on ED arrival (t = 0.287, P = 0.784); total amount of infused IV fluid (t = -0.21, P = 0.8); and length of time from ED admission to hospital admission (t = -0.613, P = 0.56). There were no statistically significant differences between the two groups on RTS (t = -0.516, P = 0.633). When comparing the mean differences in temperature upon hospital admission, no statistically significant differences were found (t = -1.572, P = 0.167). There were no statistically significant differences between the two groups in tympanic [F(15) = 0.71, P = 0.44] and skin [F(15) = 0.06, P = 0.81] temperature measurements over time. CONCLUSION: Core and peripheral warming methods appeared to e effective in preventing heat loss in this stable patient population. A reasonable next step would be to continue this trial in a larger sample of patients who are at greater risk for heat loss and subsequent hypothermia and to use a control group.

Playground injuries in children: a review and Pennsylvania Trauma Center experience.

ISSUES AND PURPOSE: To describe patient demographics, injury characteristics, and circumstances of playground injuries in children admitted to Pennsylvania trauma centers and to identify injury prevention strategies. DESIGN AND METHODS: Retrospective, descriptive study of 234 children ages 1 to 18 years sustaining playground-related injuries and whose hospital data were entered into the Pennsylvania Trauma Outcome Study. RESULTS: Most of the injuries occurred between April and September (77%), and noon to 6 P.M. (69%). Falls from playground equipment constituted the highest proportion of incidents (73%). Of 421 injuries (M = 1.8/patient), most were upper extremity (n = 117) and head (n = 110) injuries. PRACTICE IMPLICATIONS: Nurses can advocate for playground safety by teaching children to play safely and recommending age-appropriate equipment and protective surfacing.

Pediatric implications in bioterrorism part I: physiologic and psychosocial differences.

Children are physically and psychologically different from adults and require care modified to meet their needs. In the event of a bioterrorism attack, the child's stage of development can help or hinder his or her response to bioterrorist material. This Part 1 of a series of articles addresses the differences found in children and how health care providers can alter interventions to avoid causing further harm.

Evidence-based practice for pin site care in injured children.

External fixation is an accepted treatment modality for pelvic and long-bone fractures in children following a traumatic injury. One aspect of nursing care in children receiving external fixation is pin site care to prevent pin tract infection. A review of the nursing and medical literature reveals common clinical guidelines for pin site care, such as observing for infection, cleaning the sites, removing crusts, and applying dressings. There is no evidence-based practice for the care of pin sites in children or adults receiving external fixation devices for pelvic or long bone fractures to prevent infection. While the nursing literature describes pin site care techniques, the surgical literature describes the prevalence of pin tract infection. Neither set of literature consistently addresses the protocols for and outcomes in pin site care. Experimental research is needed to create evidence-based practice guidelines for pin site care to prevent pin tract infection.

Treatment of trauma-associated hypothermia in children: evidence-based practice.

BACKGROUND: Hypothermia is a serious immediate consequence of traumatic injury in children. Although numerous studies have addressed the treatment of hypothermia in adults after trauma or surgery, few have examined this issue in injured children. OBJECTIVES: To evaluate the research literature on when and how to treat hypothermia during emergency care of children with trauma and to apply these findings to clinical nursing practice. METHODS: Electronic literature searches conducted periodically for 3 years yielded more than 50 publications on hypothermia and its treatment in trauma and surgical patients. Publications were grouped by cause of hypothermia and by warming methods. Single case reports and publications related to submersion injuries were excluded. RESULTS: Three clinical trials of patients with head injuries included adolescents aged 15 years and older. One study compared peripheral and core warming methods used during operative management of infants and young children. Only one study evaluated core warming in children with trauma. DISCUSSION: The treatments examined in the few research-based studies on the treatment of hypothermia during emergency care of children with trauma were given low recommendations. Although the warming methods were successful in selected surgical and adult patients, the methods cannot be recommended for treating children with trauma because of the lack of evidence-based findings. CONCLUSIONS: Caution should be used when extrapolating published data on the treatment of hypothermia in injured adults to injured children. Ongoing clinical trials should evaluate in children with trauma those warming methods that have been used successfully in surgical patients.

Dog bites in children treated in a pediatric emergency department.

ISSUES AND PURPOSE: Unintentional injury is the leading cause of death and disability among children. This study sought to describe the characteristics of dog bite injuries to aid in promoting healthy environments for children. DESIGN AND METHODS: This descriptive, retrospective study of one hospital's 1997 emergency department records detailed dog bite injuries to children and adolescents and resultant emergency treatment (N = 204). RESULTS: Children < or = 5 years of age accounted for 49% of the injuries. The biting dog's owner was generally a parent or neighbor. Only 2 children received rabies prophylaxis. PRACTICE IMPLICATIONS: Parents and children need information about safe interactions with dogs, including community leash laws and quarantine guidelines. Nurses should know the procedures for reporting dog bite injuries to local health authorities. Interested nurses can find many opportunities to assist with community safety campaigns.

Improving holographic data storage by use of an optimized phase mask.

A method for improving the spectral distribution and for reducing the reconstruction error in optical holographic data storage is proposed. By use of an optimized phase mask in the input plane, the uniformity of the spectral distribution is optimized and the reconstruction error minimized. The phase mask is designed by use of amplitude-phase retrieval algorithms. Simulation results show the merits of the proposed method.

Dog bites in children admitted to Pennsylvania trauma centers.

Dog bites are a major public health problem in the pediatric population, requiring emergency treatment for wound repair and possible hospitalization in a trauma center. Data from the Pennsylvania Trauma Outcome Study were analyzed, and the records of 183 pediatric dog bite patients from 1990 to 1995 were evaluated. Dog bites were found to constitute a very small proportion of the total pediatric admissions to Pennsylvania trauma centers; however, the findings were similar to other reported studies.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in emergency department record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product, Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Life events and injury in children: implications for schools.

Life events have been identified as a characteristic associated with injury in children and adolescents. Life events include moving to a new home or school and the death or hospitalization of a family member. The purpose of this study was to verify this relationship between life events and injuries in school-age children aged 6-11 years. A case-control design compared life events among 76 injured and 77 well school-age children. The school-age children with injuries were evaluated in a pediatric trauma unit and the well school-age children were evaluated in both a pediatric clinic and a private pediatrician's office. The parents of all the subjects completed the Life Event Scale-Children and a demographic data sheet. Severity of injury was measured with the Pediatric Trauma Score. There were no differences in the number or types of life events between the injured and well school-age children. There was no relationship between severity of injury and life events. However, children whose parents were not currently married, who came from non-Caucasian families, and who had lower socioeconomic status had higher life Event Scale-Children scores than children whose parents were currently married, were from Caucasian families, and had higher socioeconomic status. School nurses need to be aware of the influence of life events on the lives of their students. While this study did not find a statistically significant relationship between injury and life events, being alert to the family characteristics of children who experience high numbers and many types of life events may assist the school nurse in understanding and providing care for these students.

Pediatric sledding injuries in Pennsylvania.

OBJECTIVE: To describe the frequency, characteristics, and circumstances of pediatric sledding-associated injuries and to assess the validity of published risk factors and prevention measures for these injuries. METHODS: A retrospective, descriptive study of patients admitted to the 25 accredited trauma centers in Pennsylvania. RESULTS: Two hundred twenty-six patients were admitted for sledding-related injuries. Sixty-nine percent were male. The mean ICU LOS was 1.2 days (SD = 3), and the mean hospital LOS was 7 days (SD = 7.2). Ninety-eight percent were discharged alive. Forty-seven percent of the ISS scores were classified as moderate (ISS 7-15). There was almost no correlation between age and ISS (r = 0.06), but there was moderate correlation between ISS and length of ICU stay (r = 0.47). Hitting trees and stationary objects (n = 121) was the most common circumstance of injury. Patients struck by moving vehicles (n = 16) had the highest proportion of head (30%) and chest (15%) injuries, the highest mortality rate (33%), the highest median ISS score (20) and the highest mean ICU LOS (6.4 days) compared to patients who hit stationary objects or fell. CONCLUSIONS: Among children admitted to Pennsylvania trauma centers, most sledding injuries were of a mild and moderate severity and required an average of a week's hospitalization. Most children were injured from collision with stationary objects, supporting the precaution against sledding in areas with obstacles. The high mortality rate from motor vehicle/sled collisions justifies the prohibition against sledding in areas with moving vehicles.