1,2-Oxazine N-Oxide Derivatives from 1-Hetera-4-Cyclohexanone Enamines and Nitroolefins. Ring-chain Tautomerism

1,2-Oxazine N-oxide condensed heterocycles have been prepared from (E)-1-phenyl-2-nitropropene and enamines derived from 1-methyl-4-piperidone, 4H-tetrahydro-pyran-4-one and 4H- tetrahydro-thiapyran-4-one. They are more stable than the analogous systems derived from cyclohexanone enamines and just like them they are in equilibrium with their open-chain isomers

1,2-Oxazine N-Oxide Derivatives from 1-Hetera-4-Cyclohexanone Enamines and Nitroolefins. Ring-chain Tautomerism

1,2-Oxazine N-oxide condensed heterocycles have been prepared from (E)-1-phenyl-2-nitropropene and enamines derived from 1-methyl-4-piperidone, 4H-tetrahydro-pyran-4-one and 4H- tetrahydro-thiapyran-4-one. They are more stable than the analogous systems derived from cyclohexanone enamines and just like them they are in equilibrium with their open-chain isomers

Formare all'engagement: esperienze di formazione all'engagement nel corso di Laurea in Infermieristica dell'Università di Trieste

Introduction: The article describes how in ASUGI nursing students are made aware, since their first year bachelor degree, about the importance of actively engaging the person in the health-care process and of measuring the level of engagement with validated instruments (with particular reference to the PHE-S®). Methods: During the clinical internship, with the help of the internship tutors, students can experiment and use this tool. At the end of the third year, they try to systematize what they have learnt in the practical traineeship by connecting their practical experience with theoretical concepts learnt and critically analysing their clinical experiences. Results and Discussion: This didactic experience has led to the preparation and defence of a good number of degree theses focused on the value of measuring and promoting the engagement of people along their healthcar

Un percorso co-costruito di implementazione di pratiche di coinvolgimento attivo in un contesto di cure integrate: l'esperienza di ricerca partecipativa con l'ASUGI di Trieste

Introduction: In this article we can find the report of the main phases of the collaboration between ASUGI and the Università Cattolica del Sacro Cuore of Milan from 2015 to today. Methods: During these years, a path of activation and implementation of engagement practices within ASUGI has been developed, from basic training on the tools for monitoring and supporting engagement to the selection of a group of operators involved in a participatory path as "trainers to trainers", up to the grafting of engagement practices within the individual patient education paths in the different sectors of ASUGI. Results and Conclusions: This contribution is an exemplifying scenario that can be useful for other health structures that want to undertake a similar path

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

Introduction: Growing evidence recognizes that patients who are motivated to take an active role in their care can experience a range of health benefits and reduced healthcare costs. Nurses play a critical role in the effort to make patients fully engaged in their disease management. Trainings devoted to increase nurses' skills and knowledge to assess and promote patient engagement are today a medical education priority. To address this goal, we developed a program of nurse education training in patient engagement strategies (NET-PES). This paper presents pilot feasibility study and preliminary participants outcomes for NET-PES. Methods: This is a pilot feasibility study of a 2-session program on patient engagement designed to improve professional nurses' ability to engage chronic patients in their medical journey; the training mainly focused on passing patient engagement assessment skills to clinicians as a crucial mean to improve care experience. A pre-post pilot evaluation of NET-PES included 46 nurses working with chronic conditions. A course specific competence test has been developed and validated to measure patient engagement skills. The design included self-report questionnaire completed before and after the training for evaluation purposes. Participants met in a large group for didactic presentations and then they were split into small groups in which they used role-play and case discussion to reflect upon the value of patient engagement measurement in relation to difficult cases from own practice. Results: Forty-six nurses participated in the training program. The satisfaction questionnaire showed that the program met the educational objectives and was considered to be useful and relevant by the participants. Results demonstrated changes on clinicians' attitudes and skills in promoting engagement. Moreover, practitioners demonstrated increases on confidence regarding their ability to support their patients' engagement in the care process. Conclusions: Learning programs teaching nurses about patient engagement strategies and assessment measures in clinical practice are key in supporting the realization of patient engagement in healthcare. Training nurses in this area is feasible and accepted and might have an impact on their ability to engage patients in the chronic care journey. Due to the limitation of the research design, further research is needed to assess the effectiveness of such a program and to verify if the benefits envisaged in this pilot are maintained on a long-term perspective and to test results by employing a randomized control study design

CHE-S® as a tool to predict the Caregiver's ability to actively manage disability of stroke patients admitted to the ward of the complex rehabilitation structure of ASUGI

Introduction: This article affirms that measuring the Caregiver's emotional experience and engagement, especially as the condition of the person assisted changes, is useful for assessing the sustainability of the care plan. Methods: With this pilot study, aimed at detecting the level of Caregiver engagement, by using the Caregiving Engagement Scale (CHE-S®), for people suffering from chronic and/or fragile pathologies, it was decided to verify the relationship between engagement levels and other variables such as: socio-demographic characteristics of the Caregiver; duration and frequency person; clinical characteristics of the assisted person. Results and Conclusions: In the future, the results of this research will allow to define new working practices to support those who take on the responsibility and burden of caring for a sick, fragile, disabled family member

Mapping Protein Structure Changes with Cysteine Labeling Kinetics by Mass Spectrometry

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide "system" inertia-really difficult to be overcome-and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of "fertilizing a patient engagement ecosystem": an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient "disengagement" is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper

On the design of the gate seals of the new Panama canal locks

The paper describes the research that led to the detailed mechanical design of the J-shaped seals, which are currently mounted on the gates of the locks of the new Panama Canal. The research purpose was to provide a reliable and long lasting operation of the passive seal activation-deactivation mechanism, as well as a perfect watertight. In particular, the authors identified the operation principle of the seal, selected the suitable materials and designed the critical parts of the seal. The design was performed by means of simple analytical procedures whose accuracy has been confirmed by non linear stress\u2013strain analysis, carried out on a very detailed finite element model

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