Parental administration of inhaled short-acting beta agonists in the pediatric emergency department: a survey of family perspectives.

BACKGROUND: The management of children with an asthma exacerbation includes timely systemic corticosteroids and frequent short-acting beta-agonist therapy. In selected patients, inhaled short-acting beta-agonist administration by parents may promote comfort, constitute an educational opportunity for the family, and safely reduce provider workload. Our objective was to evaluate parental satisfaction and perceived safety of this new approach. METHOD: This was a cross-sectional study, conducted in a tertiary pediatric ED. We investigated patient and parent perspectives on a newly implemented parental short-acting beta-agonist administration program. A convenience sample of families participating in this program was approached for study enrolment. The primary outcome was the proportion of parents and children who were satisfied with the program. We also evaluated the program's safety and impact on asthma education as reported by parents. RESULTS: From February 2019 to March 2020, 72 of 74 (97%) families approached for enrolment participated in the survey. A vast majority (95%) of parents appreciated the program and 93% would participate again. Among children > 7 years, 86% preferred receiving inhaled short-acting beta-agonist by their parents rather than by a healthcare provider. Nearly all parents (96%) found the program to be "safe" or "very safe". Some participants reported improvements in their inhaler administration technique (25%) and ability to recognize their child's respiratory distress (25%). CONCLUSION: A novel parental short-acting beta-agonist administration program in the pediatric ED was widely appreciated by participating families. Parents perceived it as being safe, educational, and contributing to their child's comfort.

RéSUMé: CONTEXTE: La prise en charge des enfants présentant une exacerbation d'asthme comprend des corticostéroïdes systémiques et un traitement avec des doses fréquentes de bêta-agonistes à courte durée d'action. Chez certains patients, l'administration de bêta-agonistes à courte durée d'action en inhalation par les parents pourrait favoriser le confort, représenter une opportunité éducative pour la famille et réduire en toute sécurité la charge de travail des professionnels de la santé. Notre objectif était d'évaluer la satisfaction parentale et la sécurité perçue d'une telle nouvelle approche. MéTHODE: Cette étude transversale a été menée dans un service d'urgence pédiatrique tertiaire. Nous avons étudié les points de vue des patients et des parents impliqués dans un programme d'administration parentale de bêta-agonistes à courte durée d'action récemment déployé. Un échantillonnage de convenance de familles participant à ce programme a été invité à participer à l'étude. L'issue primaire était la proportion de parents et d'enfants satisfaits par ce programme. La sécurité du programme et son impact sur l'éducation sur l'asthme, tels que rapportés par les parents, ont aussi été évalués. RéSULTATS: De février 2019 à mars 2020, 72 des 74 familles (97 %) approchées ont participé à l'étude. Une grande majorité (95 %) des parents ont apprécié le programme et 93 % y participeraient à nouveau. Parmi les enfants de plus de 7 ans, 86 % ont préféré recevoir le bêta-agoniste à courte durée d'action par voie inhalée par leurs parents plutôt que par un professionnel de la santé. Presque tous les parents (96 %) ont trouvé le programme « sécuritaire¼ ou « très sécuritaire¼. Certains participants ont signalé des améliorations dans leur technique d'administration d'inhalateur (25 %) et dans leur capacité à reconnaître la détresse respiratoire chez leur enfant (25 %). CONCLUSION: Un nouveau programme d'administration de bêta-agonistes à courte durée d'action par les parents  dans un département d'urgence pédiatrique a été largement apprécié par les familles participantes. Les parents percevaient ce programme comme sécuritaire, éducatif et contribuant au confort de leur enfant.

Does the Finger-to-Nose Test measure upper limb coordination in chronic stroke?

BACKGROUND: We aimed to kinematically validate that the time to perform the Finger-to-Nose Test (FNT) assesses coordination by determining its construct, convergent and discriminant validity. METHODS: Experimental, criterion standard study. Both clinical and experimental evaluations were done at a research facility in a rehabilitation hospital. Forty individuals (20 individuals with chronic stroke and 20 healthy, age- and gender-matched individuals) participated.. Both groups performed two blocks of 10 to-and-fro pointing movements (non-dominant/affected arm) between a sagittal target and the nose (ReachIn, ReachOut) at a self-paced speed. Time to perform the test was the main outcome. Kinematics (Optotrak, 100Hz) and clinical impairment/activity levels were evaluated. Spatiotemporal coordination was assessed with slope (IJC) and cross-correlation (LAG) between elbow and shoulder movements. RESULTS: Compared to controls, individuals with stroke (Fugl-Meyer Assessment, FMA-UE: 51.9 ± 13.2; Box & Blocks, BBT: 72.1 ± 26.9%) made more curved endpoint trajectories using less shoulder horizontal-abduction. For construct validity, shoulder range (ß = 0.127), LAG (ß = 0.855) and IJC (ß = -0.191) explained 82% of FNT-time variance for ReachIn and LAG (ß = 0.971) explained 94% for ReachOut in patients with stroke. In contrast, only LAG explained 62% (ß = 0.790) and 79% (ß = 0.889) of variance for ReachIn and ReachOut respectively in controls. For convergent validity, FNT-time correlated with FMA-UE (r = -0.67, p < 0.01), FMA-Arm (r = -0.60, p = 0.005), biceps spasticity (r = 0.39, p < 0.05) and BBT (r = -0.56, p < 0.01). A cut-off time of 10.6 s discriminated between mild and moderate-to-severe impairment (discriminant validity). Each additional second represented 42% odds increase of greater impairment. CONCLUSIONS: For this version of the FNT, the time to perform the test showed construct, convergent and discriminant validity to measure UL coordination in stroke.