A randomised trial of early palliative care for maternal stress in infants prenatally diagnosed with single-ventricle heart disease

AbstractChildren with single-ventricle disease experience high mortality and complex care. In other life-limiting childhood illnesses, paediatric palliative care may mitigate maternal stress. We hypothesised that early palliative care in the single-ventricle population may have the same benefit for mothers. In this pilot randomised trial of early palliative care, mothers of infants with prenatal single-ventricle diagnoses completed surveys measuring depression, anxiety, coping, and quality of life at a prenatal visit and neonatal discharge. Infants were randomised to receive early palliative care – structured evaluation, psychosocial/spiritual, and communication support before surgery – or standard care. Among 56 eligible mothers, 40 enrolled and completed baseline surveys; 38 neonates were randomised, 18 early palliative care and 20 standard care; and 34 postnatal surveys were completed. Baseline Beck Depression Inventory-II and State-Trait Anxiety Index scores exceeded normal pregnant sample scores (mean 13.76±8.46 versus 7.0±5.0 and 46.34±12.59 versus 29.8±6.35, respectively; p=0.0001); there were no significant differences between study groups. The early palliative care group had a decrease in prenatal to postnatal State-Trait Anxiety Index scores (−7.6 versus 0.3 in standard care, p=0.02), higher postnatal Brief Cope Inventory positive reframing scores (p=0.03), and a positive change in PedsQL Family Impact Module communication and family relationships scores (effect size 0.46 and 0.41, respectively). In conclusion, these data show that mothers of infants with single-ventricle disease experience significant depression and anxiety prenatally. Early palliative care resulted in decreased maternal anxiety, improved maternal positive reframing, and improved communication and family relationships.</jats:p

A cross-cultural examination of the impact of social, organisational and individual factors on educational technology acceptance between British and Lebanese university students

This paper examines the social, organisational and individual factors that may affect students' acceptance of e-learning systems in higher education in a cross-cultural context. A questionnaire was developed based on an extended technology acceptance model (TAM). A total sample of 1173 university students from two private universities in Lebanon and one university in England participated in this study. After performing the satisfactory reliability and validity checks, the hypothesised model was estimated using structural equation modeling. The findings of this study revealed that perceived usefulness (PU), perceived ease of use (PEOU), social norms (SNs), perceived quality of work life (QWL), computer self-efficacy (SE) and facilitating conditions (FC) are significant determinants of behavioural intentions (BIs) and usage of e-learning system for the Lebanese and British students. QWL, the newly added variable, was found the most important construct in explaining the causal process in the model for both samples. Differences were found between Lebanese and British students with regard to PEOU, SN, QWL, FC, SE and actual usage; however, no differences were detected in terms of PU and BI. Overall, the proposed model achieves acceptable fit and explains for 69% of the British sample and 57% of the Lebanese sample of its variance which is higher than that of the original TAM. Our findings suggest that individual, social and organisational factors are important to consider in explaining students' BI and usage of e-learning environments

An empirical study on behavioural intention to reuse e-learning systems in rural China

The learner’s acceptance of e-learning systems has received extensive attention in prior studies, but how their experience of using e-learning systems impacts on their behavioural intention to reuse those systems has attracted limited research. As the applications of e-learning are still gaining momentum in developing countries, such as China, it is necessary to examine the relationships between e-learners’ experience and perceptions and their behavioural intention to reuse, because it is argued that system reuse is an important indicator of the system’s success. Therefore, a better understanding of the multiple factors affecting the e-learner’s intention to reuse could help e-learning system researchers and providers to develop more effective and acceptable e-learning systems. Underpinned by the information system success model, technology acceptance model and self-efficacy theory, a theoretical framework was developed to investigate the learner’s behavioural intention to reuse e-learning systems. A total of 280 e-learners were surveyed to validate the measurements and proposed research model. The results demonstrated that e-learning service quality, course quality, perceived usefulness, perceived ease of use and self-efficacy had direct effects on users’ behavioural intention to reuse. System functionality and system response have an indirect effect, but system interactivity had no significant effect. Furthermore, self-efficacy affected perceived ease of use that positively influenced perceived usefulness

Survey of diagnostic and typing capacity for Clostridium difficile infection in Europe, 2011 and 2014

Suboptimal laboratory diagnostics for Clostridium difficile infection (CDI) impedes its surveillance and control across Europe. We evaluated changes in local laboratory CDI diagnostics and changes in national diagnostic and typing capacity for CDI during the European C. difficile Infection Surveillance Network (ECDIS-Net) project, through cross-sectional surveys in 33 European countries in 2011 and 2014. In 2011, 126 (61%) of a convenience sample of 206 laboratories in 31 countries completed a survey on local diagnostics. In 2014, 84 (67%) of these 126 laboratories in 26 countries completed a follow-up survey. Among laboratories that participated in both surveys, use of CDI diagnostics deemed ‘optimal’ or ‘acceptable’ increased from 19% to 46% and from 10% to 15%, respectively (p < 0. 001). The survey of national capacity was completed by national coordinators of 31 and 32 countries in 2011 and 2014, respectively. Capacity for any C. difficile typing method increased from 22/31 countries in 2011 to 26/32 countries in 2014; for PCR ribotyping from 20/31 countries to 23/32 countries, and specifically for capillary PCR ribotyping from 7/31 countries to 16/32 countries. While our study indicates improved diagnostic capability and national capacity for capillary PCR ribotyping across European laboratories between 2011 and 2014, increased use of ‘optimal’ diagnostics should be promoted

Moderators in the Adoption of E-Learning: An Investigation of the Role of Gender

Past research has hypothesized and empirically supported a model for learners’ acceptance of e-learning. To further investigate the influence of gender on e-learning acceptance, data were collected from a sample of 259 Taiwanese undergraduates that were relatively balanced between genders. Comparisons of means and multiple-group Structural Equation Modeling (SEM) with LISREL were used to analyze the data. Examining t-test results indicated that differences in construct means between males and females occurred only for some of the model predictors. Specifically, men have more confidence in using the technology, more Internet experience, a higher perception of system interactivity, and higher beliefs of usefulness and ease of use than women. However there is no significant difference in their intentions to use the e-learning system. In addition, multiple-group SEMs revealed that gender moderated some of the relationships between the hypothesized determinants and intentions to use the e-learning system. In particular, women’s adoption intention for distance education purposes is more strongly influenced by system interactivity. Women’s perception of e-learning usefulness is negatively influenced by self-efficacy. Some implications for practical purposes are addressed

a pilot study, 2013

Introduction After recognition of European outbreaks of Clostridium difficile infections (CDIs) associated with the emergence of PCR ribotype 027/NAP1 in 2005, CDI surveillance at country level was encouraged by the European Centre for Disease Prevention and Control (ECDC) [1]. In 2008, an ECDC-supported European CDI survey (ECDIS) identified large intercountry variations in incidence rates and distribution of prevalent PCR ribotypes, with the outbreak-related PCR ribotype 027 being detected in 5% (range: 0–26) of the characterised isolates [2]. The surveillance period was limited to one month and the representation of European hospitals was incomplete; however, this has been the only European (comprising European Union (EU)/European Economic Area (EEA) and EU candidate countries) CDI surveillance study. The authors highlighted the need for national and European surveillance to control CDI. Yet, European countries were found to have limited capacity for diagnostic testing, particularly in terms of standard use of optimal methods and absence of surveillance protocols and a fully validated, standardised and exchangeable typing system for surveillance and/or outbreak investigation. As of 2011, 14 European countries had implemented national CDI surveillance, with various methodologies [3]. National surveillance systems have since reported a decrease in CDI incidence rate and/or prevalence of PCR ribotype 027 in some European countries [4-8]. However, CDI generally remains poorly controlled in Europe [9], and PCR ribotype 027 continues to spread in eastern Europe [10-12] and globally [13]. In 2010, ECDC launched a new project, the European C. difficile Infection Surveillance Network (ECDIS-Net), to enhance surveillance of CDI and laboratory capacity to test for CDI in Europe. The goal of ECDIS- Net was to establish a standardised CDI surveillance protocol suitable for application all over Europe in order to: (i) estimate the incidence rate and total infection rate of CDI (including recurrent CDI cases) in European acute care hospitals; (ii) provide participating hospitals with a standardised tool to measure and compare their own incidence rates with those observed in other participating hospitals; (iii) assess adverse outcomes of CDI such as complications and death; and (iv) describe the epidemiology of CDI concerning antibiotic susceptibility, PCR ribotypes, presence of tcdA, tcdB and binary toxins and detect new emerging types at local, national and European level. The primary objectives of the present study were to: (i) test the pilot protocol for the surveillance of CDI in European acute care hospitals developed by ECDIS-Net (methodology, variables and indicators); (ii) assess the feasibility and workload of collecting the required hospital data, case- based epidemiological and microbiological data; and (iii) evaluate the quality of data collected, whether in the presence or absence of existing national CDI surveillance activities. A secondary aim was to assess the relationship between patient and microbiological characteristics and in-hospital outcome of CDI to confirm the added value of collecting detailed epidemiological and microbiological data on CDI at European level