Assessment of Knowledge and Healthcare Related Practices of Caregivers Regarding Home Management of Children with Nephrotic Syndrome

Introduction: Nephrotic Syndrome (NS) is the commonest chronic glomerular disorder characterized by heavy proteinuria, hypoproteinaemia, oedema and hyperlipidaemia. Parental motivation and involvement are essential for home management of a child with NS. This study was conducted to assess caregivers' knowledge and healthcare related practices regarding home management of children with NS. Methods: A descriptive cross-sectional study was conducted among caregivers (n=94) attending the Paediatric Nephrology Clinic (PNC) at the Teaching Hospital Karapitiya, Sri Lanka. Data were collected through an interviewer-administered questionnaire. Data were analyzed using SPSS version 20. Results: The majority of the respondents (71.3%) were mothers. The majority of children with NS in the study sample were boys (70.2%), and their mean age was 7.6±3 years. About 40.4% of children had onset of disease at the age of 2-3 years. The majority of participants (53.2%) had scored more than 75 marks for knowledge. The practice score of the majority (66.0%) was between 50-100. The mean knowledge score was significantly higher in the participants who have managed their child with NS for 6-8 years (p=0.006) and for 9-11 years (p=0.019), compared to the participants who have managed their child with NS for 3-5 years. The mean knowledge score was significantly higher in the participants with the family history with NS in compared to the participants without family history of NS (p=0.001). A statistically significant association was found between mean practice score and the number of living children in the family (p=0.009). Mean practice score of the participants who had more than four living children was significantly higher than the participants who had two living children in their family (p=0.002). However, a significant negative correlation was observed between knowledge on NS and healthcare related practices of the participants (r= -0.240, n=94, p=0.020, 2-tailed). Conclusions: The overall knowledge and practices of parents/caregivers regarding home management of children with NS attending to the PNC, Teaching Hospital Karapitiya, Sri Lanka, was adequate and satisfactory. Keywords: Home management, Paediatric, Nephrotic Syndrome, Knowledge, Practice

An observational cohort study comparing ibuprofen and oxycodone in children with fractures

Objective To compare the effectiveness and safety of prescribing ibuprofen and oxycodone for at-home management of children’s fracture pain. Methods A prospective observational cohort was conducted at the Stollery Children’s Hospital pediatric emergency department (June 2010-July 2014). Children aged 4–16 years with an isolated fracture discharged home with advice to use either ibuprofen or oxycodone were recruited. Results A cohort of 329 children (n = 217 ibuprofen, n = 112 oxycodone) were included. Mean age was 11.1 years (SD 3.5); 68% (223/329) were male. Fracture distribution included 80.5% (264/329) upper limb with 34.3% (113/329) requiring fracture reduction. The mean reduction in Faces Pain Score-Revised score (maximum pain–post-treatment pain) for Day 1 was 3.6 (SD 1.9) (ibuprofen) and 3.8 (SD 2.1) (oxycodone) (p = 0.50); Day 2 was 3.6 (SD 1.8) (ibuprofen) and 3.7 (SD 1.6) (oxycodone) (p = 0.56); Day 3 was 3.7 (SD 1.7) (ibuprofen) and 3.3 (SD 1.7) (oxycodone) (p = 0.24). Children prescribed ibuprofen (51.2%, 109/213) experienced less adverse events compared to those prescribed oxycodone (70.5% 79/112) on Day 1 (p = 0.001). Children prescribed ibuprofen (71.8%, 150/209) had their function (eat, play, school, sleep) affected less than those prescribed oxycodone (83.0%, 93/112) (p = 0.03) on Day 1. Conclusion Children prescribed ibuprofen or oxycodone experienced similar analgesic effectiveness for at-home fracture pain. Oxycodone prescribing was associated with more adverse events and negatively impacted function. Oxycodone use does not appear to confer any benefit over ibuprofen for pain relief and has a negative adverse effect profile. Ibuprofen appears to be a safe option for fracture-related pain.

Evaluation of the “safe multidisciplinary app-assisted remote patient-self-testing (SMART) model” for warfarin home management during the COVID-19 pandemic: study protocol of a multi-center randomized controlled trial

Background Warfarin treatment requires frequent monitoring of INR (international normalized ratio) to adjust dosage in a therapeutic range. In China, patients living in small towns usually go to tertiary hospitals to get warfarin monitoring and dosing, resulting in low frequencies of follow-ups and high incidence of complications. Influenced by the COVID-19 pandemic, patients on warfarin have further reduced their visits to healthcare institutions. While patient self-testing (PST) via using a point-of-care testing device for INR measuring at home has been widely used in developed countries and demonstrated improved clinical outcomes compared to usual care in clinics, it is rarely applied in developing countries, including China. This proposed study will develop and assess the “Safe Multidisciplinary App-assisted Remote patient-self-Testing (SMART) model” for warfarin home management in China during the COVID-19 pandemic. Methods This is a multi-center randomized controlled trial. We will carry out the study in three county hospitals, three small tertiary hospitals and three large tertiary hospitals with anticoagulation clinics in Hunan province of China. Eligible patients will be randomly assigned to the SMART model group (n = 360) or the control group (usual care clinic group, n = 360; anticoagulation clinic group, n = 120). Patients in the SMART model group do PST at home once every two to 4 weeks. Controls receive usual care in the clinics. All the patients will be followed up through outpatient clinics, phone call or online interviews at the 3rd, 6th, 9th and 12th month. The percentage of time in therapeutic range (TTR), incidence of warfarin associated major bleeding and thromboembolic events and costs will be compared between the SMART model group and control groups. Discussion Patients in the SMART model group would show improved TTR, lower incidence of complications and better quality of life compared to the control groups. Our design, implementation and usage of the SMART model will provide experience and evidence in developing a novel model for chronic disease management to solve the problem of healthcare service maldistribution, an issue particularly obvious in developing countries during the COVID-19 pandemic. Trial registration ChiCTR, ChiCTR 2000038984. Registered 11 October, 2020.

Home management

Children with ADHD are very challenging to bring up. No plan of management can ever be successful if it is not based on a comprehensive assessment of the child’s particular strengths and difficulties. Look upon the child with ADHD as someone whose behaviour and learning inadequacies are due to a hidden disability that are not of his, or his parents’, making. This chapter explores home management of ADHD, including steps in management—i.e. understanding the condition, explaining the condition to the child, parents’ needs, the needs of siblings, improving the child’s self-esteem, the parents’ role as a teacher, and working with a school.