Biomedical subjects

Linda S Franck

Publications and source records attributed to Linda S Franck.

At least 19 recordsLinked to original sources

PubMed2006

The quality of parental consent for research with children: a prospective repeated measure self-report survey.

BACKGROUND: Researchers have ethical and legal responsibilities to ensure that individuals give informed consent to participate in research. The few studies of parental consent for paediatric research suggest there may be inadequate competence, information, understanding, or voluntariness for valid consent to occur. OBJECTIVES: To determine parents' level of understanding of the research study requirements and satisfaction with the informed consent process. PARTICIPANTS: English literate parents of children actively involved in research studies. METHODS: A repeated measures self-report survey was conducted to measure parent understanding (actual and perceived) of the study consented for and satisfaction with the informed consent process. Relationships between parents understanding of the research and their satisfaction with the consent process were explored and changes in parent understanding or satisfaction over time were described. RESULTS: Questionnaires from 109 parents were returned, representing 25 different studies. Parents demonstrated a high level of knowledge of information essential for informed consent, such as the purpose, benefits, and participant rights. Nervousness or inability to concentrate, and reading ease of the information sheet were found to relate to parents' knowledge and their perceptions of the adequacy of the consent. Parents overall reported high satisfaction with the consent process. CONCLUSIONS: These findings support and extend previous research on parental consent for research with children. They suggest areas where further research is indicated, including: the value and use of information and consent documents given to parents, the views and concerns of parents for whom English is not their first language, and further exploration of the concerns of the few dissatisfied parents. Current practices of obtaining informed consent for research lack supporting research evidence and may not be ethically justifiable.

Adolescent↗

PubMed2006

Chest drain removal pain and its management: a literature review.

AIMS AND OBJECTIVES: The purpose of this review was to analyse critically the published research on chest drain removal pain and its management. The findings of descriptive and non-pharmacological intervention studies were summarized and studies of analgesic efficacy were critiqued in depth. BACKGROUND: The removal of a chest drain is a painful and frightening experience, particularly for children. However, there is limited research regarding the amount of pain experienced or effectiveness of analgesia for this procedure. RESULTS: Fourteen studies were reviewed, including five descriptive studies; three studies of non-pharmacological interventions; and six randomized controlled trials of morphine, local anaesthetics and Entonox. The search revealed only two paediatric studies. Many of the studies had design limitations or were poorly reported. The majority of studies indicated that patients experienced moderate to severe pain during chest drain removal, even when morphine or local anaesthetics were given. CONCLUSIONS: Morphine alone does not provide satisfactory analgesia for chest drain removal pain. Non-steroidal anti-inflammatory drugs, local anaesthetics and inhalation agents may have a role to play in providing more effective analgesia for this procedure. RELEVANCE TO CLINICAL PRACTICE: Analgesic protocols for the management of painful procedures such as chest drain removal are unsatisfactory and practice in this area should be revised. More research is needed to determine the efficacy of drugs other than morphine, particularly Entonox and to investigate multi-modal techniques of management further.

Adult↗

PubMed2005

A critical review of the health-related quality of life of children and adolescents after liver transplantation.

We critically examined research on health-related quality of life (HRQL) in children and adolescents after liver transplantation. The specific aims were to identify research studies on HRQL after liver transplantation, to critique the methodological quality of the studies, to estimate overall HRQL after transplant, and to make recommendations for future research. Databases searched included Medline, Cumulative Index to Nursing and the Allied Health Literature, PsycINFO, EMBASE, Allied and Complementary Medicine, Institute for Scientific Information Web of Science, and Applied Social Sciences Index and Abstracts. Searches also were made on related Web sites and proceedings of transplantation and associated conferences. Eligible studies involved children between birth and 18 years of age who received isolated orthotopic, auxiliary, or living related liver transplantation. HRQL was assessed through 2 or more of the domains of physical health, psychological functioning, social functioning, family functioning, or general well-being. Eligible studies were abstracted, assessed for methodological quality, and synthesized using the sign test to provide an indication of the effect of liver transplantation on each HRQL domain. The synthesis of findings suggested an improvement in HRQL in comparison with pretransplant status; there was a trend toward a worse HRQL in comparison with the healthy population and better than those with other chronic illnesses. In conclusion, liver transplantation in childhood has a negative impact on some aspects of HRQL. However, this finding is tentative because of the small number of studies and variable study quality found.

Adolescent↗

PubMed2005

Measuring neonatal intensive care unit-related parental stress.

AIMS: This paper reports a study: (1) to determine the validity and reliability of the Parent Stressor Scale:Neonatal Intensive Care Unit (PSS:NICU) for use with United Kingdom (UK) parents; (2) compare UK scores with those from a contemporary reference sample from the United States (US), (3) to identify the sources of greatest NICU-related stressors for parents and (4) to identify demographic or situational factors influencing NICU-related parental stress. BACKGROUND: Evaluation of the adequacy of nursing care and psychosocial support services for parents of ill infants in the NICU requires valid and reliable measures of parental stress. The PSS:NICU is a well-validated scale developed in the US to measure NICU-related parental stress. However, it has not been tested in the UK. METHODS: Consecutive samples of parents (n = 257) of infants in nine UK NICUs and two reference US units completed the PSS:NICU and the Spielberger State-Trait Anxiety Scale approximately 1 week after admission. Psychometric properties of the PSS:NICU, including internal consistency reliability and construct, concurrent and predictive validity, were evaluated. RESULTS: PSS:NICU scores were similar in the UK and US samples and high internal consistency reliability was found for all metrics (e.g. Overall Stress: 0.94 for both samples). A three-factor principal components solution accounted for 66% of the variance in the scores, with the items grouped into the three a priori scales specified in the PSS:NICU (Infant Behaviour and Appearance, Parental Role Alterations, and Sights and Sounds). Stress Occurrence and Overall Stress were moderately correlated with State Anxiety in both samples (r = 0.46-0.61, P < 0.001). Thirty-one per cent of the variance in Stress Occurrence in the UK sample was explained by State Anxiety, infant severity of illness score, parent gender, and less frequent visitation. CONCLUSIONS: The PSS:NICU demonstrated appropriate psychometrics in a large sample of parents from diverse NICUs in the UK. These findings support its wider use in research and clinical practice to identify parental distress and evaluate the effectiveness of nursing care and psychosocial support services for parents.

Adult↗

PubMed2005

Giving parents written information about children's anesthesia: are setting and timing important?

BACKGROUND: Research indicates that parents wish to receive more information and are anxious about anesthesia prior to their child's surgery. METHODS: A pilot randomized controlled trial was conducted to ascertain if parents who received a general anesthesia information leaflet by post 1 week following their presurgical assessment clinic visit (n = 19) had greater knowledge, reduced anxiety, or greater satisfaction with anesthetic information on the day of surgery than parents who received the leaflet at the clinic visit (n = 21). RESULTS: Parents had important knowledge deficits on the day of surgery, despite receiving the leaflet in addition to standard verbal communication. Parents who were given the leaflet at the presurgical assessment clinic had a modest 10% increase in knowledge compared with parents who received the leaflet by post. However, parents who received the leaflet within 2 weeks for their child's surgery also had 10% greater knowledge, regardless of the method of delivery. There were no differences in parental anxiety or satisfaction with the information related to method or timing of delivery. Parents appreciated receiving written information and a slight majority of parents (56%) preferred to receive the information at the presurgical assessment clinic visit. CONCLUSIONS: Parents have unmet information needs related to children's anesthetic care. Written information may improve parent knowledge and enhance satisfaction, but the setting and timing of information delivery are also important to consider.

Adult↗

PubMed2005

Liver transplantation in children: part 1--peri-operative issues.

This two-part review provides a comprehensive summary of clinical and research literature on paediatric liver transplantation. Part 1 outlines the peri-operative issues of liver transplantation, covers a brief history, discusses the indications and methods of transplantation and outlines the physical complications which can occur either as a result of the surgery or the subsequent immunosuppressive therapy required to maintain graft integrity. Post-liver transplantation care may require prolonged admission in hospital due to the complications that can occur during surgery and as a result of immunosuppression. This can have a further impact on the emotional status of the child and family. Health care professionals in all settings require greater knowledge about paediatric liver transplantation, its associated complications and long-term health implications.

Adolescent↗

PubMed2005

Liver transplantation in children: part 2--long-term issues.

This two-part review provides a comprehensive summary of clinical and research literature on paediatric liver transplantation. Part 2 focuses on the long-term physical consequences and psychological impact of transplantation and critically examines neurobehavioural, sexual development, psychosocial function and overall impact on children's quality of life. This review highlights the implications for clinical practice in specialist and local services and suggests areas where research is required to improve the lives of children after liver transplantation.

Child↗

PubMed2004

Informing parents about anaesthesia for children's surgery: a critical literature review.

This review critically analysed the published research literature on providing information about children's anaesthesia to parents. An extensive search of the biomedical literature yielded 11 studies: 6 descriptive and 5 intervention studies. Standardised instruments for measuring parental knowledge, need for information and anxiety about children's anaesthetic care showed preliminary validity and reliability. The intervention studies tested different methods of providing information, including verbal, video or written modalities and showed some improvements in knowledge, anxiety and satisfaction. Parents want detailed information about the specifics of anaesthetic procedures, risks, and personnel roles and this information should be incorporated into the routine pre-surgical anaesthesia assessment clinic visits. Until further research determines the most effective methods, mode of delivery should be based on feasibility so that parents consistently receive more information. Audits of parental satisfaction with information should be performed and used to continuously improve the content and delivery of information.

Ambulatory Surgical Procedures↗

PubMed2004

Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients.

The purposes of this prospective repeated measures study were to: (a) describe the occurrence of withdrawal symptoms with the use of a standardised protocol to slowly taper opioids and benzodiazepines; and (b) to test the predictive validity of an opioid and benzodiazepine withdrawal assessment scoring tool in critically ill infants and young children after prolonged opioid and benzodiazepine therapy. Fifteen children (6 weeks-28 months of age) with complex congenital heart disease and/or respiratory failure who received opioids and benzodiazepines for 4 days or greater were evaluated for withdrawal symptoms using a standardized assessment tool. Thirteen children showed moderate to severe withdrawal symptoms a median 3 days after commencement of tapering. Symptom intensity was not related to prior opioid or benzodiazepine exposure, extracorporeal membrane oxygenation (ECMO) therapy or length of tapering. Children who received fentanyl in addition to morphine more often exhibited signs of withdrawal. This study demonstrated that significant withdrawal symptoms occur in critically ill children even with the use of a standardised assessment tool and tapering management protocol. The predictive validity and utility of the Opioid and Benzodiazepine Withdrawal Score (OBWS) was adequate for clinical use, but areas for further improvement of the tool were identified. Problems with the clinical withdrawal prevention and management guidelines were also identified. More research is needed to establish the optimal methods for prevention and management of iatrogenic opioid and benzodiazepine withdrawal in paediatric critical care.

Analgesics, Opioid↗

PubMed2004

The symptom experience of hospitalised Chinese children and adolescents and relationship to pre-hospital factors and behaviour problems.

PURPOSE: To describe the symptom experience of hospitalised Chinese children and adolescents and examine the relationship of symptoms to pre-hospital factors and child behaviour. METHODS: Data were collected at two hospital sites in Hong Kong (HK) and at five hospitals in the Chinese Mainland (CM). A total of 307 hospitalised children and adolescents (ages 2-18) and their primary caregiver (e.g., mother, father or grandparent) participated in the study. Children and adolescents completed an age-appropriate symptom diary on one evening and subsequent morning early in their hospital stay. Parents completed the diary for the children less than 6 years of age. Parents also completed an age-appropriate Chinese version of the Child Behaviour Checklist. RESULTS: Over 50% of the children and adolescents reported some degree of pain, 75% of them reported evening tiredness, and 21% reported gastrointestinal symptoms. The intensity of symptoms varied by age and region and symptoms often co-occurred. Greater symptom burden was predicted by previous surgery, higher level of worst pain prior to hospitalisation, parent report of child behaviour problems, and co-occurrence of other symptoms. CONCLUSIONS: Hospitalised Chinese children manifest symptoms of pain, tiredness, and gastrointestinal distress that vary based on pre-hospital factors and are associated with child behaviour problems. Further research is needed to identify causes and treatments for children's symptoms.

Adolescent↗

PubMed2004

Parents' perceptions of their infant's pain experience in the NICU.

Despite numerous advances in the recognition, assessment, and management of pain in neonates over the past two decades, there has been limited improvement in the knowledge base regarding parental responses to their infant's pain. This study examined parents' views of their experiences observing and coping with their infant's pain in the neonatal intensive care unit (NICU). Twelve participants were recruited using purposive sampling from two groups: (a) parents who had infants currently receiving care in the NICU (n=6); and (b) parents whose infants had been discharged from the NICU and were enrolled in the outpatient follow-up clinic at each hospital (n=6). An exploratory, semi-structured format was used to interview parents individually (n=5) or in focus groups (n=7) regarding their infant's clinical course, infant pain experiences, and the parenting experience during and after the NICU stay. Thematic content analysis was used to develop conceptual categories. Two broad themes were identified: (a) infant pain as a source of parental distress and (b) relief of parental distress due to infant's pain.

Adaptation, Psychological↗

PubMed2004

Quality assurance for clinical research: challenges in implementing research governance in UK hospitals.

The oversight of clinical research in the UK is currently in a state of flux. Discusses the quality assurance problems that have arisen in the management of research and the protection of the rights of human participants. Contrasts clinical governance and regulatory approaches to research quality assurance and performs a critical analysis of the Department of Health (England) Research Governance Framework (RGF) to see where it falls within the continuum. Highlights the implications for UK hospitals engaged in clinical research through the presentation of a case study in implementing the RGF. Concludes by suggesting the priority areas that need to be addressed and invites further debate regarding the merits of a clinical governance or regulatory approach to research quality assurance.

Biomedical Research↗

PubMed2004

Ensuring quality information for patients: development and preliminary validation of a new instrument to improve the quality of written health care information.

BACKGROUND: Despite the recent focus on improving the quality of patient information, there is no rigorous method of assessing quality of written patient information that is applicable to all information types and that prescribes the action that is required following evaluation. OBJECTIVE: The aims of this project were to develop a practical measure of the presentation quality for all types of written health care information and to provide preliminary validity and reliability of the measure in a paediatric setting. METHODS: The Ensuring Quality Information for Patients (EQIP) tool was developed through a process of item generation, testing for concurrent validity, inter-rater reliability and utility. Patient information managers and health care professionals tested EQIP in three annual audits of health care leaflets produced by a children's hospital. RESULTS: The final tool comprised 20 items. Kendall's tau B rank correlation between EQIP and DISCERN was 0.56 (P = 0.001). There was strong agreement between intuitive rating and the EQIP score (Kendall's tau B = 0.78, P = 0.009). Internal consistency using Cronbach's alpha was 0.80. There was good agreement between pairs of raters (mean kappa = 0.60; SD = 0.18) with no differences based on types of leaflets. Audits showed significant improvement in the number of leaflets achieving a higher quality EQIP rating over a 3-year period. CONCLUSIONS: EQIP demonstrated good preliminary validity, reliability and utility when used by patient information managers and healthcare professionals for a wide variety of written health care information. EQIP uniquely identifies actions to be taken as a result of the quality assessment. Use of EQIP improved the quality of written health care information in a children's hospital. Wider evaluation of EQIP with written information for other populations and settings is recommended.

Humans↗

PubMed2003

Are there opportunities to decrease nosocomial infection by choice of analgesic regimen? Evidence for immunity and pain interactions.

BACKGROUND: Interactions suggest that anesthetic and analgesic strategies could be used to modulate immune function and reduce nosocomial infection in critically ill pediatric patients. However, this theory has yet to be adequately tested. OBJECTIVE: To present the evidence for interactions between nociceptive and immune pathways. DATA SOURCES: The MEDLINE database and hand searches of the English-language biomedical literature for the 1985-2003 period. DATA SYNTHESIS: Substantial evidence exists for numerous bidirectional relationships between nociceptive and immune pathways. Some studies suggest that surgical pain and stress may alter immune function in adults. Limited evidence indicates that anesthetic and analgesic immunomodulation may boost immune function to prevent nosocomial infection. However, unique aspects of immune function maturation and neurodevelopment must be considered. CONCLUSION: Research is urgently needed to determine if the interactions between nociceptive and immune function pathways in critically ill infants and children are similar to those in adults and if host defenses can be enhanced by optimal anesthetic and analgesic strategies.

Analgesia↗

PubMed2003

Parent visiting and participation in infant caregiving activities in a neonatal unit.

BACKGROUND: Active parent involvement in caring for their infants in the neonatal care unit is thought to improve parent-infant attachment and to moderate the psychological stress for parents, but few recent studies have examined parent visiting patterns and participation in infant caregiving. The study purposes were to describe the frequency and duration of parent visiting and participation in infant caregiving activities, and to identify parent and infant factors associated with parental participation. METHODS: Parental visiting frequency, duration, and participation in social, cleaning, and feeding activities with their infant (n=110) were recorded on 12 days during a 3-month period in a tertiary neonatal unit. RESULTS: Mothers visited more frequently (85% vs 45% of possible days) and for longer than fathers, and visited less frequently if the infant had other siblings, if the infant was over age 1 month, or if fathers made fewer visits. Fathers visited less frequently if the infant was over age 7 days and more frequently if the mothers visited more frequently. All mothers and most (96%) fathers carried out social activities, such as talking, stroking or holding, during their visits. Over 75 percent of mothers engaged in infant cleaning and feeding activities during visits in contrast with less than 20 percent of fathers. Mothers' participation in infant feeding was best predicted by the duration of their visit and their participation in infant cleaning. Fathers' participation in infant feeding was only related to their participation in infant cleaning. CONCLUSIONS: Significant differences were found in this neonatal unit between mothers' and fathers' visiting patterns and infant caregiving activities. Neonatal unit staff should consider factors that may influence parental visiting and explore strategies to improve parental involvement in caregiving.

Adult↗

PubMed2003

Computer-taught coping techniques for venepuncture: preliminary findings from usability testing with children, parents and staff.

Teaching cognitive and behavioural coping techniques can reduce children's pain and distress during medical procedures. However, these simple techniques are often not taught to children due to lack of staff time, training and teaching aids. We developed a computer-based self-administered programme (CTCT) to teach coping skills to school-aged children in the waiting room prior to venepuncture. All children had topical local anaesthetic and parents were present. Children reported only mild pain and distress from venepuncture and seven children used techniques learned from the CTCT programme. Previous pain coping influenced behavioural distress during venepuncture. Ten children reported that they would use CTCT again. Nine parents stated they would recommend their child use CTCT in future. All staff responded favourably to the use of CTCT for children prior to venepuncture. Our preliminary findings demonstrate that the coping techniques can be taught using a computer game format and that children, parents and staff found the method acceptable.

Adaptation, Psychological↗

PubMed2002

Assessment of sickle cell pain in children and young adults using the adolescent pediatric pain tool.

The objectives of this study were to describe and compare the characteristics of pain experienced by children and young adults with sickle cell disease (SCD) in inpatient and outpatient settings. The Adolescent Pediatric Pain Tool (APPT), a multidimensional self-report pain assessment, was completed by African American children and young adults (mean age 15.39 +/- 4.32) with SCD during a clinic visit (n = 52), day hospital visit (n = 29), or during the first 24 hours of an inpatient stay (n = 72). Multiple linear regression revealed that pain intensity, number of body areas with pain, and the quality of pain were related to age, sex, and care setting. Pain intensity, location, and quality were of greater magnitude than previous reports of early postoperative pain in children. Examining the specific dimensions of pain intensity, location, and quality and the influencing factors of age, sex, and care setting may lead to more effective treatments for SCD pain.

Adolescent↗

PubMed2002

Using quality improvement strategies to enhance pediatric pain assessment.

OBJECTIVE: To evaluate the impact of a quality improvement approach to implementing developmentally appropriate pain assessment guidelines for pediatric inpatients. Patient and staff satisfaction with pain assessment and management, and staff documentation were evaluated one year following the implementation of the revised pain assessment guidelines. DESIGN: Quasi-experimental design. SETTING: The pediatric hematology/oncology unit of a regional children's hospital. Study participants. A convenience sample of 36 children and 68 staff at time 1 (TI) and 49 children and 82 staff at time 2 (T2). INTERVENTIONS: Staff were educated on the use of pediatric pain assessment tools and a standardized pain assessment protocol was put into practice. Children or their primary caregivers were interviewed, using a questionnaire modified from the American Pain Society quality assurance guidelines, regarding their experiences with pain assessment and management on the unit at T1, just prior to the staff education, and one year later at T2. Multidisciplinary unit staff completed a parallel questionnaire at T1 and T2. MAIN OUTCOME MEASURES: Patient and staff satisfaction with pain assessment and management, and chart audit of compliance with pain assessment documentation. RESULTS: Patients, family members, and staff reported increased pain assessment, improved staff responsiveness to patients' pain and greater satisfaction with assessment tools between TI and T2. Increased compliance with the assessment guidelines was confirmed by chart audit. CONCLUSIONS: Improved pain assessment and management practices with resultant increase in patient and staff satisfaction can be achieved and sustained over time using quality improvement strategies.

Adolescent↗