A comparison of booster seat use in Canadian provinces with and without legislation.

BACKGROUND: The use of booster seats continues to be low, despite their effectiveness in reducing injury in motor vehicle collisions. Many jurisdictions have introduced legislation requiring the use of booster seats. To date, there have been no Canadian studies evaluating the effectiveness of legislation on booster seat use. OBJECTIVES: To describe restraint use among Canadian children aged 4-8 years, and compare booster seat use between provinces/territories with and without legislation. METHODS: The data were obtained from a National Survey of Child Restraint Use/Misuse conducted between June and August 2006. A roadside observation survey was conducted at 182 sites across Canada. Weighted statistical analyses of differences in proportions were conducted, accounting for sampling stratification and clustering by car effects. RESULTS: The roadside survey estimated that 24.6% of children aged 4-8 were restrained in booster seats in provinces with legislation, compared with 16.6% in provinces without (p<0.001). CONCLUSION: This is the first Canadian national study using direct observation to determine the effect of legislation on booster seat use. Provinces with legislation had higher booster seat use, but overall rates were still disappointingly low. Ongoing surveillance of child safety seat use and evaluation of effective adjuncts to legislation is required in order to see collision-related child deaths and injuries drop in the future.

Safety and efficacy of levobupivacaine for postoperative pain relief after the surgical removal of impacted third molars: a comparison with lignocaine and adrenaline.

In a randomised, double-blind placebo-controlled single-centre study we compared the efficacy and safety of 0.75% levobupivacaine (without vasoconstrictor) with 2% lignocaine (with adrenaline 1:80,000) and with placebo for postoperative pain relief in 93 patients having day surgery under general anaesthesia for the removal of impacted mandibular third molars. Premedication and preoperative analgesics were not prescribed, although a short-acting opioid analgesic agent was allowed if required during the anaesthetic procedure. Patients were asked to keep a diary card for 2 days after discharge from hospital. The primary endpoint was the number of patients who requested analgesia within 2 h of completion of the operation. In total, 16 (53%) of patients given levobupivacaine requested analgesia compared with 22 (71%) given lignocaine and 23 (72%) given placebo. Patients given levobupivacaine had lower maximum visual analogue pain scores (VAS) and took longer to request rescue medication (P=0.045 compared with lignocaine). Fewer patients after levobupivacaine n=20 (7%) than after lignocaine n=7 (23%) or placebo n=5 (16%) experienced adverse events. Levobupivacaine seems to be a suitable alternative local anaesthetic to lignocaine with adrenaline for pain control after oral operations.

Pain control after routine dento-alveolar day surgery: a patient satisfaction survey.

OBJECTIVE: An audit study which examines patient's opinions on the efficiency of two analgesic regimes prescribed to them following dento-alveolar surgery in our Day Unit. DESIGN: Single centre prospective study. SETTING: Oral Surgery Day Case Unit SUBJECTS: One-hundred-and-seventy-four adults undergoing routine dento-alveolar surgery under general anaesthetic were asked to assess their pain control (on a five point scale) 1 hour after surgery, at discharge from hospital and at 24 and 48 hours post-operatively. Post-operatively, patients received ibuprofen 400 mg three times daily for five days or two tablets of paracetamol 500 mg with codeine 30 mg six hourly for 5 days if they were allergic to aspirin or were asthmatics sensitive to aspirin. Patients were not given local anaesthesia intra or post-operatively. RESULTS: Completed records were obtained for 161 (93%) patients. Ibuprofen was apparently adequate in controlling pain for 147 out of 161 patients but on further questioning 42 of these patients took supplemental analgesics and self-prescribed paracetamol or a paracetamol combination. Thirteen patients who were prescribed paracetamol with codeine had adequate pain control and did not take supplemental analgesics. One patient did not require any analgesics post-operatively CONCLUSION: Telephone contact with patients 24 and 48 hours post-surgery provides a valuable assessment of pain control following discharge from a day surgery unit. Ibuprofen offered satisfactory control of pain for 65% (95) of patients who underwent routine dento-alveolar surgery. Discharge prescriptions must be given with verbal and written instructions to ensure that patients take the correct dose and self-prescription is within safe doses.

Parental needs following the discharge of a hospitalized child.

Many studies have addressed parents' needs when their child is hospitalized, yet few studies have identified the needs of parents after their child is discharged. An exploratory-descriptive study of families (N = 16) at a large acute care general hospital in Canada examined parents' needs following their child's discharge and parents' perceptions of the effectiveness of a discharge follow-up program. Parents described needs in two areas: (a) the need for detailed information about their child, and (b) the need for support regarding multiple stresses that their families were facing. Parents reported high levels of satisfaction with the discharge follow-up program, and all of the families recommended its continuance.

Relationships between stress, coping resources, and satisfaction with family functioning in families of children with disabilities.

The purpose of the current descriptive correlational study was to examine relations between stress, coping resources, and satisfaction with family functioning in families caring for children with developmental disabilities at home. Fifty families who used the services of a respite care program were surveyed to examine relationships among child characteristics (behavioral problems and handicapping conditions); coping resources including mastery and health, esteem and communication, family hardiness, and social support; and the primary outcome variable of satisfaction with family functioning. Families of children with developmental disabilities experience significant stressors in terms of the severity of their child's handicapping conditions and behaviour problems. However, they reported satisfactory coping resources such as mastery and health, hardiness, and esteem and communication. Although they were lower than normative scores, social support scores for spouses and friends were related to satisfaction with family functioning. Implications for practitioners are discussed.

Ketorolac and diclofenac for postoperative pain relief following oral surgery.

A double-blind clinical study was designed to compare the efficacy and safety of intramuscular and oral ketorolac, a new non-steroidal anti-inflammatory analgesic with that of diclofenac and placebo for patients undergoing removal of impacted mandibular third molar teeth. Results showed that both analgesic preparations were more effective than placebo (p = 0.0029) and that ketorolac provided a similar degree of pain relief to that of diclofenac. It is concluded that ketorolac is important new addition to the available intra-muscular NSAID preparations.

Recovery from intravenous sedation with midazolam--the value of flumazenil.

A total of 40 patients receiving intravenous midazolam for surgical removal of impacted wisdom teeth were randomly assigned to recover either spontaneously or undergo reversal by the benzodiazepine antagonist flumazenil. Whilst initial postoperative recovery to a 'fully awake' state occurred more rapidly in the reversal group, objective psychomotor testing revealed significantly poorer performance postoperatively compared with spontaneously recovering patients; this emphasises the need to retain patients for at least 1 h prior to discharge home.

The challenge of accountability in nursing.

The authors examine the literature on accountability in nursing and analyze the following questions: What is meant by accountability in nursing? To whom are nurses accountable? For what should nurses be held accountable? Finally, the implications of accountability for the nursing profession are explored. In order for nursing to grow and develop as a profession based on sound theoretical foundations, nurses need to examine what it means to be truly accountable. The authors point out that accountability is a complex issue that requires nurses to examine their practice relative to the needs of healthcare consumers, their relationships with other healthcare professional, and the increasingly critical role of nursing in the healthcare system.

The maternal role in the pediatric intensive care unit and hospital ward.

Two issues were examined in this study, (1) the mother's parental role when a child is admitted to a pediatric intensive care unit (PICU) and then transferred to a hospital ward, and (2) the influence of situational factors (e.g., whether procedures were taking place, the presence of others such as family or friends) that could alter mothers' parenting role in the PICU and on the ward. Twelve mothers were observed at the child's bedside and were found to assume six parental roles (namely, Vigilant Parent, Nurturer-Comforter, Medical Parent, Caregiver, Entertainer, Protector). In both settings, the Vigilant Parent and Nurturer-Comforter roles were the most predominant roles. The Medical Parent role was assumed more often during procedures, particularly on the ward. Mothers assumed the Caregiver role more often on the ward than in the PICU. The Entertainer and Protector roles occurred infrequently in both settings. The child's condition and the presence of another person influenced the roles mothers assumed.