Study protocol for a randomised controlled trial to determine the effectiveness of a mHealth application as a family supportive tool in paediatric otolaryngology perioperative process (TONAPP)

Background: Otorhinolaryngology (ORL) surgery is common in children, but hospitalisation, surgery, and home care after discharge are stressful experiences for young patients and their family caregivers. Findings from literature highlight a lack of time in hospitals to support ORL surgery children and their caregivers through the perioperative process, along with the risks of caregivers' autonomous web or social media resources investigation. Therefore, this study aims to evaluate the effectiveness of a mobile health application with content to support ORL patients and their caregivers in the perioperative period to reduce caregiver anxiety and child distress compared to standard care. Methods: An open-label, two-arm randomised control trial design is being adopted. The intervention consists of a mobile health application with content to support ORL patients and their caregivers during the perioperative period. One hundred eighty participants will be enrolled and randomly assigned to the experimental group using the mHealth application or the control group. The control group receives standard information and education about the ORL perioperative period from healthcare providers orally or through brochures. The primary outcome is the difference between the intervention and control groups in preoperative caregiver state anxiety. Secondary outcome measures include children's distress before surgery and family preparation for hospitalisation. Discussion: The results of this study will be critical to the implementation of a new and safe model for the management of care and education in paediatrics. This model can achieve positive organisational and health outcomes by supporting continuity of care and empowering citizens to have informed participation and satisfaction in paediatric health promotion and management. Trial registration: Trial identifier: NCT05460689 registry name: ClinicalTrials.gov. Date of registration: July 15, 2022. Last update posted: February 23, 2023

Between Restrictive and Supportive Devices in the Context of Physical Restraints: Findings from a Large Mixed-Method Study Design

Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives’/patients’ requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories ‘Restrictive’ and ‘Supportive’ devices aimed at ‘Preventing risks’ and at ‘Promoting support’, respectively, have emerged. Reasons triggering ‘restrictive devices’ involved patients’ risks, the health professionals’ and/or the relatives’ concerns. In contrast, the ‘supportive’ ones were triggered by patients’ problems/needs. ‘Restrictive’ and ‘Supportive’ devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with ‘restrictive devices’ (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings

Quali alternative alle contenzioni fisiche sono applicate nella pratica quotidiana? Risultati di uno studio multi-metodo multicentrico

Introduction: Physical restraint is still very widespread and debated due to its implications; however, available literature focuses on prevention, neglecting recommendations on possible alternatives. Objective: To explore whether and which alternatives nurses apply before deciding to restrain patients. Method: A two-phase multi-centre multi-method study was performed. In the first, a prevalence survey on restraints was conducted; in the second, a short interview was carried out with the nurses responsible for the care of restrained individuals to identify the alternatives implemented before deciding to restrain. Results: 37 facilities in Friuli-Venezia Giulia region were included, 17 Nursing Homes (NHs), 10 Intermediate Units (IUs) and 10 Medical/Surgical wards. On the index day 1818 (78.2%) patients were present in the NHs, 157 in the IUs (6.8%) and 308 in the hospital wards (13.3%) (= 2283). A total of 28.9% (659/2283) patients were restrained (31.3% in NHs; 26.8% in IUs; 15.6% in hospitals). Only for 81 (12.3%) of them the restraints had been preceded by the application of an alternative (e.g., involving family members, lowering the bed, or using pillows). Discussion: In the physical restrain decision-making process, nurses consider few alternatives, approximately one in every eight restraints, more frequently in IUs, less in NHs and never in hospital wards. Those used are simple, and depend on the context and the resources available

Age and gender influence the cardiorespiratory function and metabolic rate of broiler chicks during normocapnia and hypercapnia

Pulmonary ventilation (V-E), body temperature (Tb), mean arterial pressure (MAP), heart rate (f(H)) and metabolic rate (V-O2) were measured in 10 (d10)- and 21 (d21)-day-old male and female chicks exposed to 7% CO2. Under normocapnia, V-E was higher in d10 chicks than in d21 due to a higher tidal volume; in females a higher respiratory frequency (f(R)) was also observed. The d10 birds presented higher f(H) and V-O2. The d21 females showed the highest CO2 ventilatory response due to increased f(R). MAP did not change during hypercapnia while a hypercapnic bradycardia occurred, except in d21 females. Hypercapnia induced a drop in Tb in all groups and an increase in V-O2 in d21 males. Overall, no gender effect is observed in cardiorespiratoly and metabolic variables in d10 and d21 chicks under normocapnia, the differences in V-E and f(H) between ages may be related to distinct metabolic demands of these phases. The d21 female chicks seem to be more sensitive to hypercapnia. (C) 2014 Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Mujeres con discapacidad: reflexiones sobre el camino de la política pública de salud

Submitted by Luis Guilherme Macena ([email protected]) on 2013-08-16T12:59:59Z No. of bitstreams: 1 MULHERES COM DEFICIÊNCIA- REFLEXÕES SOBRE A TRAJETÓRIA DAS.pdf: 391016 bytes, checksum: d5d9cc065156118181b7a41f4b99f517 (MD5)Made available in DSpace on 2013-08-16T12:59:59Z (GMT). No. of bitstreams: 1 MULHERES COM DEFICIÊNCIA- REFLEXÕES SOBRE A TRAJETÓRIA DAS.pdf: 391016 bytes, checksum: d5d9cc065156118181b7a41f4b99f517 (MD5) Previous issue date: 2013Associação Brasileira de Ensino Superior. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, BrasilInstituto Nacional de Câncer. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, BrasilObjetivo: promover reflexões sobre a trajetória dos programas e políticas direcionados as pessoas com deficiência e as mulheres no Brasil e suas implicações na assistência em saúde da mulher com deficiência. Método: estudo descritivo, de reflexão teórica. Resultados: a Política Nacional de Saúde da Pessoa Portadora de Deficiência traz, como diretriz, a assistência integral à saúde das pessoas. No entanto, o que se percebe é que embora as mulheres com deficiência constituam porcentagem expressiva do total da população brasileira, poucas conseguem ter seus direitos assegurados e garantidos por lei, fundamentados no princípio da igualdade. Conclusão: fragilidades na organização e operacionalização da atenção à saúde das pessoas com deficiência são percebidas, em especial das mulheres com deficiência.Objective: to promote reflection on the history of programs and policies targeted people with disabilities and women in Brazil and its implications for health care of women with disabilities. Method: a descriptive study of theoretical reflection. Results: the National Health Policy of Persons with Disabilities provides, as a guideline, the comprehensive health care of people. However, what we see is that although women with disabilities constitute a significant percentage of the total population, few can have their rights guaranteed and secured by law, based on the principle of equality. Conclusion: weaknesses in the organization and operation of health care for people with disabilities are perceived, especially women with disabilities.Objetivo: promover la reflexión sobre la historia de los programas y políticas dirigidos personas con discapacidad y las mujeres en Brasil y sus consecuencias para la salud de las mujeres con discapacidad. Método: estudio descriptivo de la reflexión teórica. Resultados: la Política Nacional de Salud de las Personas con Discapacidad establece, como norma, la atención de la salud integral de las personas. Sin embargo, lo que vemos es que si bien las mujeres con discapacidad constituyen un porcentaje importante de la población total, pocos pueden tener sus derechos garantizados y asegurados por la ley, con base en el principio de igualdad. Conclusión: las deficiencias en la organización y funcionamiento de la atención sanitaria para las personas con discapacidad se percibe, sobre todo las mujeres con discapacidad

Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery

Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020–May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app’s content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond