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Austad B, Nilsen AH, Thorstensen WM, Helvik AS. Postoperative care for children after ventilation tube surgery: A qualitative study of parents' experiences over time in Norway. Am J Otolaryngol 2024; 45:104457. [PMID: 39154491 DOI: 10.1016/j.amjoto.2024.104457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/30/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To explore the parents' experience of postoperative care during the first two years after ventilation tube (VT) surgery in a setting where the check-ups were conducted either by otolaryngologists or their regular general practitioner (GP). METHODS 55 individual interviews of parents at up to three different time points (<1, 6, and 24 months) after their child received VT-surgery, analyzed with reflexive thematic analysis. RESULTS 1. Parents' trust in the healthcare system and responsibility for booking check-ups. Nearly all parents seemed to maintain trust in the healthcare system and felt safeguarded regardless of where they had their check-ups. Still, they would prefer otolaryngologist-led care if they could choose from the top shelf. They took responsibility for seeking healthcare when needed and experienced that their GP referred their child if necessary. 2. As time goes by, parental worries are reduced. Most experienced that their child stayed healthy after surgery, and their demand for postoperative check-ups decreased. For the children who faced ongoing issues, most parents experienced that their child's challenges had been handled professionally, and they became less worried. Some parents attribute other diagnoses to their child's behavior or speech delays, refining their understanding of their child's condition. 3. The desire for closure. Parents sought reassurance about their child's recovery and desired professional evaluation for closure. While some advocated for audiometry, others trusted their own assessments about hearing. The transition to school marked a pivotal time, prompting concerns about social inclusion. CONCLUSION Overall, the parents experienced that their child was safeguarded irrespective of whether postoperative care was provided by otolaryngologists or GPs. Still, many preferred check-ups by an otolaryngologist. The parental worries and focus on the VTs were reduced as time went by after surgery, but even so many wanted a 'closure' to be sure that the hearing was as good as it could be and the VTs rejected. We advocate for an individualized approach to postoperative care that addresses specific medical needs without imposing unnecessary check-ups.
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Affiliation(s)
- Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491 Trondheim, Norway; Øya Medical Centre, Prinsensgate 1 A, 7013 Trondheim, Norway.
| | - Ann Helen Nilsen
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Postbox 3250, 7006 Trondheim, Norway.
| | - Wenche Moe Thorstensen
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Postbox 3250, 7006 Trondheim, Norway; Department of Neuromedicine and Movement Science, NTNU, Postbox 8900, 7491 Trondheim, Norway.
| | - Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491 Trondheim, Norway.
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Ricci Conesa H, Skröder H, Norton N, Bencina G, Tsoumani E. Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children, after widespread use of PCVs-A systematic literature review of published evidence. PLoS One 2024; 19:e0297098. [PMID: 38564583 PMCID: PMC10986968 DOI: 10.1371/journal.pone.0297098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden. METHODS This systematic review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study. RESULTS In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes. CONCLUSIONS Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.
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Affiliation(s)
| | | | | | - Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Moradi A, Soltani R, Shamsi M, Moradzadeh R. Effects of online social media on improving mothers' behaviors towards preventing their children's otitis media based on the PRECED model: a randomized educational intervention trial. BMC Pediatr 2023; 23:216. [PMID: 37147633 PMCID: PMC10161150 DOI: 10.1186/s12887-023-04016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/16/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Otitis media is one of the most common diseases in children, especially those under 2 years of age. This study aimed to investigate the effect of educational intervention based on the PRECEDE model on mothers' preventive behaviors of middle ear infections in infants. METHODS This study was conducted as an educational randomized controlled trial on 88 mothers with infants referred to health centers in Arak, Iran. Sampling from September 2021 to February 2022 selected trough stratified random sampling who were assigned to two groups of experimental = 44 and control = 44. The data collection tool was a reliable and valid questionnaire that included demographic information, constructs of PRECEDE model regarding otitis media, and preventive behaviors. The experimental group received 4 training sessions (each session 60 min) through WhatsApp social network. Information was collected through an online questionnaire before and 3 months after the educational intervention from both groups. Data analysis was also performed with SPSS version 23. RESULTS Before the educational intervention there was no significant difference between the experimental and control groups in the otitis media preventive behaviors and structures of PRECEDE model (p > 0.05). After the educational intervention, in the experimental group the average score of knowledge from 0.49 to 0.81, attitude from 4.01 to 4.58, enabling factors from 0.72 to 0.85, reinforcing factors from 3.31 to 3.91 and behavior from 3.25 to 3.66 increased significantly (p < 0.001). CONCLUSIONS PRECEDE-based education with controlling, monitoring and follow-up during the program was effective in promoting the preventive behaviors of otitis media. Therefore, due to the side effects of otitis media, especially in vulnerable periods such as childhood, it is recommended that trainings based on this model be carried out in other health care centers and clinics in order to maintain children health. TRIAL REGISTRATION This trial has been registered at the Iranian Registry of Clinical Trials, IRCT20210202050228N1. Prospectively registered at 2021-May-21, (2021/05/21) available at: URL: https://en.irct.ir/trial/54073 .
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Affiliation(s)
- Atefeh Moradi
- Student Research Committee, Department of Health Education, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
| | - Raheleh Soltani
- Department of Health Education, Faculty of Health, Arak University of Medical Sciences, Arak, Iran.
| | - Mohsen Shamsi
- Department of Health Education, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
| | - Rahmatallah Moradzadeh
- Department of Epidemiology, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
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Zhou Y, Peng M, Zhou J. Quality of life in children undergoing tonsillectomy: a cross-sectional survey. Ital J Pediatr 2023; 49:52. [PMID: 37143161 PMCID: PMC10161552 DOI: 10.1186/s13052-023-01449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The quality of life in children undergoing tonsillectomy remains unclear. We aimed to analyze the current status and influencing factors of quality of life in children undergoing tonsillectomy, to provide useful insights to clinical postoperative care for children. METHODS Children who underwent tonsillectomy in our hospital from June 1, 2021 to October 31, 2022 were selected. The characteristics of children were collected and Paediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) was used for evaluating the quality of life in children. Pearson correlation, univariate and logistic regression analyses were condcuted to evaluate the influencing factors of quality of life in children undergoing tonsillectomy. RESULTS A total of 118 children undergoing tonsillectomy were included. The total score of PedsQL™ 4.0 in children undergoing tonsillectomy was (70.28 ± 13.15). Pearson correlation analyses indicated that age(r = 0.586), courses of tonsillitis(r = 0.595), parental education level(r = 0.612) and monthly family income(r = 0.608) were associated with the PedsQL™ 4.0 total score in children undergoing tonsillectomy (all P < 0.05). Logistic regression analyses indicated that age ≤ 5y (OR = 2.009,95%CI: 1.826 ~ 2.401), courses of tonsillitis ≥ 3years (OR = 2.167,95%CI: 1.688 ~ 2.547), high school of parental education level (OR = 1.807,95%CI: 1.224 ~ 2.181) and monthly family income ≤ 5000 RMB(OR = 2.624,95%CI:2.092 ~ 3.077) were the independent influencing factors of quality of life in children with undergoing tonsillectomy (all P < 0.05). CONCLUSIONS The quality of life of children after tonsillectomy is not high, and the quality of life of children is affected by many factors. Medical staff should take early targeted nursing countermeasures tageted on those influencing factors to improve the quality of life of children.
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Affiliation(s)
- Ying Zhou
- Department of Nursing, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Mingqi Peng
- Department of Nursing, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
| | - Jing Zhou
- Department of Nursing, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
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Pauli N, Sunnergren O, Florentzson R. High frequency hearing 25 years after transmyringeal ventilation tube treatment. Int J Pediatr Otorhinolaryngol 2023; 167:111509. [PMID: 36907111 DOI: 10.1016/j.ijporl.2023.111509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES The main aim of the study was to compare hearing outcome between a healthy control group and patients treated with transmyringeal ventilation tubes, 25 years after primary surgery. Another aim was to analyse the relation between ventilation tube treatment in childhood and the occurrence of persistent middle ear pathology 25 years later. METHODS In 1996, children treated with transmyringeal ventilation tubes were recruited for a prospective study on the outcome of ventilation tube treatment. In 2006, a healthy control group were recruited and examined together with the original participants (case group). All participants in the 2006 follow-up were eligible for this study. A clinical ear microscopy examination including eardrum pathology grading and high frequency audiometry (10-16 kHz) was carried out. RESULTS A total of 52 participants were available for analysis. Hearing outcome was worse in the treatment group (n = 29) compared to the control group (n = 29), both in regard to standard frequency range hearing, (0.5-4 kHz), and high frequency hearing (HPTA3 10-16 kHz). Almost half the case group (48%) had eardrum retraction to some extent, compared to 10% in the control group. No case of cholesteatoma was found in this study and eardrum perforation was rare (<2%). CONCLUSION In the long term, high frequency hearing (HPTA3 10-16 kHz) was more often affected in the patients with transmyringeal ventilation tube treatment during childhood compared with the healthy controls. Middle ear pathology of greater clinical significance was rare.
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Affiliation(s)
- Nina Pauli
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, Gothenburg, Sweden.
| | - Ola Sunnergren
- Region Jönköping County, Ryhov Hospital, Ear, Nose and Throat Clinic, Jönköping, Sweden
| | - Rut Florentzson
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, Gothenburg, Sweden
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Clinical decision making in paediatric otitis media: A pilot quality improvement study. Int J Pediatr Otorhinolaryngol 2023; 164:111395. [PMID: 36434883 DOI: 10.1016/j.ijporl.2022.111395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to improve local management of paediatric otitis media using the 2022 American-Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) Clinical Practice Guideline for Tympanostomy Tubes in Children. METHODS A SQUIRE 2.0 compliant quality improvement study was carried out within the outpatient department of our otolaryngology tertiary referral centre. Local outpatient management of paediatric otitis media was compared to the AAO-HNS guidelines, specifically focussing on the decision to offer tympanostomy tubes. Following initial audit of practice, an educational session was performed within the otolaryngology department and local practice was subsequently re-evaluated. RESULTS Overall, 88 children were included (46 pre-intervention and 42 post-intervention) with a mean age of 7.6 years (range 1-12 years). Sixty-four (72.7%) children presented with suspected otitis media with effusion. The remainder presented with recurrent or persistent acute otitis media (24/88, 27.3%). Twenty-six children were offered tympanostomy tubes (29.5%). Initial evaluation of practice identified that the decision to offer tympanostomy tubes was guideline appropriate in 76.1% of children (35/46). This significantly improved following an educational session (40/42, 95.2%, p = 0.02). The reasons for non-guideline compliance included: otitis media with effusion <3 months, no evidence of middle ear fluid and patients meeting criteria for tympanostomy tube insertion not being offered. CONCLUSIONS A focussed educational intervention may improve local adherence to guidelines in the management of paediatric otitis media. Continued re-evaluation of local practice is essential in order to ensure children are managed in accordance with the guidelines.
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Daly M, Howe R. Myringotomy and insertion of grommets as day surgery: a case study. ACTA ACUST UNITED AC 2021; 30:142-147. [PMID: 33565937 DOI: 10.12968/bjon.2021.30.3.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This evidence-based case study follows a child from a nursing assessment on the day of his elective surgery at a children's hospital for myringotomy and insertion of grommets under general anaesthesia through to his arrival at the operating room. Potential pre-operative problems are identified and two problems that arose are discussed in detail. The main care provider in this case was a student nurse referred to as 'the nurse', supported by a qualified nurse, referred to as the 'registered nurse', who performed some assessments.
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Affiliation(s)
- Michelle Daly
- Second Year Student Nurse, BSc in Children's and General Nursing, University College Dublin, School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Rachel Howe
- Lecturer/Assistant Professor, University College Dublin, School of Nursing, Midwifery and Health Systems, Dublin, Ireland
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Homøe P, Heidemann CH, Damoiseaux RA, Lailach S, Lieu JEC, Phillips JS, Venekamp RP. Panel 5: Impact of otitis media on quality of life and development. Int J Pediatr Otorhinolaryngol 2020; 130 Suppl 1:109837. [PMID: 31883704 PMCID: PMC7197055 DOI: 10.1016/j.ijporl.2019.109837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To summarize recent advances in knowledge on otitis media (OM) and quality of life (QoL) and development by synthesizing relevant research in this field published between June 1., 2015 until June 1., 2019. DATA SOURCES Systematic searches of PubMed, Embase and the Cochrane Library using predefined database-specific syntaxes. REVIEW METHODS Articles selected were randomized controlled trials and observational studies with an adequate control group estimating treatment effects of OM including acute OM (AOM), recurrent AOM (RAOM), OM with effusion (OME), chronic OM (COM) and chronic suppurative OM (CSOM). Items included were Health Status, Health Status Indicators, Quality of Life, Functional Status, Specific Learning Disorder, Developmental Disabilities, Language Development Disorders, and Problem Behavior. RESULTS The electronic database searches yielded a total of 699 records. After screening titles and abstracts, we identified 34 potentially eligible articles. Of these, 18 were excluded. This left 15 articles suitable for inclusion. CONCLUSIONS Although evidence is accumulating that OM may significantly impair children's QoL and development as well as caregiver's QoL, studies on this topic are relatively scarce and vary substantially in terms of methodological quality and outcome measurement instruments (OMI) used. In this review, studies have used 10 different OMIs capturing a wide range of OM symptoms as well as generic and disease-specific QoL outcomes. OM was associated with negative effects on auditory processing, language and speech development, school readiness, social competence, psychosocial wellbeing, and sleep. We found only four relevant randomized controlled trials, which mostly failed to demonstrate superiority of interventions in terms of QoL improvement and reports on reversibility are lacking. This underpins the urgent need for high quality studies in this field using validated and uniform OMIs. To facilitate interpretation and harmonization of study findings, we suggest and support the development of a core outcome set for the various OM entities that should include the most reliable and meaningful QoL and developmental OMIs.
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Affiliation(s)
- Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital and Department of Clinical Medicine, University of Copenhagen, Denmark.
| | | | - Roger Amj Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Susen Lailach
- Department of Otorhinolaryngology, Head and Neck Surgery, Dresden University, Germany
| | - Judith E C Lieu
- Department of Otolaryngology and Head and Neck Surgery, Washington University, St. Louis, USA
| | - John S Phillips
- Norfolk and Norwich University Hospitals, NHS Foundation Trust, UK
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
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Zhao C, Li J, Yang J, Yang L, Chen P, Dou J, Zhao S. Inhibitor of γ-secretase alleviates middle ear inflammation by regulating Th2 response in OVA-mediated allergic OME in vivo. Immunobiology 2019; 224:765-773. [DOI: 10.1016/j.imbio.2019.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/13/2019] [Accepted: 08/22/2019] [Indexed: 12/31/2022]
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