Implementation of a nursing oral health care protocol in a university teaching hospital:A cluster-randomized stepped-wedge design

Introduction: Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. Methods: We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0–100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. Results: At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. Conclusion: Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.</p

Does Life Satisfaction Mediate the Association between Socioeconomic Status and Excessive Internet Use?

Excessive Internet use is becoming a rapidly increasing problem in today's society. Our aim was to assess the association between socioeconomic status (SES) of the family and excessive Internet use (EIU), and whether life satisfaction mediates this association. We analyzed data from a representative sample of 2844 Slovak adolescents (mean age 14.34, 50.5% boys) from the 2014 Health Behavior in School aged Children (HBSC) study, based on self-report questionnaires. We assessed the association of SES, measured by several indicators, such as perceived family wealth, parental education, and (un)employment, and adolescent EIU using linear regression, adding life satisfaction as a mediator. Adolescents whose father was unemployed and whose perceived family wealth was low tended to score higher on EIU. Neither gender nor age affected this relationship. Life satisfaction mediated a part of the association between SES and EIU in the case of low perceived family wealth and father's (un)employment. Adolescents with a low SES are more likely to become excessive Internet users, and life satisfaction mediates this association. Prevention of EIU among adolescents should be targeted at those with low SES, with life satisfaction being the topic to address

Adolescents exposed to discrimination:are they more prone to excessive internet use?

BACKGROUND: The Internet may serve as a suitable environment for discriminated adolescents as they may consider the online space as the place where they have possibility to build social ties they are missing in their offline life or manage their self-presentation. Therefore, our aim was to explore the association between different types of discrimination by peers (because of gender, physical appearance, culture/skin color/language, unfavorable family situation) and excessive Internet use (EIU), and whether gender moderates this association. METHODS: We used data from a representative sample of 6,462 Slovak adolescents (mean age: 13.00, 49.6% boys) from the HBSC study conducted in 2018. Data were collected through online self-reported questionnaires. We assessed the association between various types of discrimination by peers and EIU using linear regression, and the role of gender as potential moderator. RESULTS: Discrimination because of physical appearance was most prevalent (18.0%). Adolescents exposed to discrimination by peers reported higher levels of EIU. We found an interaction of gender on the association of discrimination because unfavorable family situation with EIU. Boys who experienced this type of discrimination were at higher risk of EIU compared to girls. CONCLUSION: Discriminated adolescents are more likely to use the Internet excessively, with some associations being stronger for boys than for girls. Prevention strategies focused on raising adolescent awareness of the risks and benefits of the Internet should target discriminated adolescents, especially boys, as they seem to be the vulnerable group

Adherence to all steps of a pain management protocol in intensive care patients after cardiac surgery is hard to achieve

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Exploration of the effects of an innovative mentalization-based training on patient-centered communication skills of pharmacy staff:A video-observation study

OBJECTIVE: To explore whether a mentalization-based communication training for pharmacy staff impacts their ability to elicit and recognize patients' implicit and explicit medication related needs and concerns.METHODS: A single-arm intervention pilot study was conducted, in which pre-post video-recordings of pharmacy counter-conversations on dispensed-medication (N = 50 and N = 34, respectively; pharmacy staff: N = 22) were coded. Outcome measures included: detecting needs and concerns, and implicitly and explicitly eliciting and recognizing them. Descriptive statistics and a multi-level logistic regression were conducted. Excerpts of videos with needs or concerns were analyzed thematically on mentalizing attitude aspects.RESULTS: Indications show that patients more often express their concerns in an explicit way post-measurement, just as pharmacy staffs' explicit recognition and elicitation of needs and concerns. This was not seen for patients' needs. No statistically significant differences were found for determinants for detecting needs or concerns (i.e., measurement-, professional-type, or interaction). Differences in mentalizing attitude were observed between pre-post-measurements, e.g., more attention for patients.CONCLUSION: This mentalizing training shows the potential of mentalizing to improve pharmacy staff members' explicit elicitation and recognition of patients' medication-related needs and concerns.PRACTICE IMPLICATIONS: The training seems promising for improving patient-oriented communication skills in pharmacy staff. Future studies should confirm this result.</p

Empowering young adults on the autistic spectrum:Reframing assistive technology through design

Increasingly, assistive technologies are designed to ‘empower’ people with cognitive and social challenges. But what does it mean to say technology empowers? In a four-year participatory Research-through-Design project we addressed this question. Eleven autistic young adults participated in designing MyDayLight: an IoT system supporting self-management of domestic activities. Contextual inquiry, co-design, design reflection, prototype deployment and embodied interaction theory were woven together in an iterative reflective process. This allowed us to critically address certain background assumptions that typically underly common understanding of assistive technologies. We present three reframings of our evolving concept of ‘empowering technology’: 1) From ‘planned reminder’ to ‘situated attention grabber’ 2) From ‘supporting action’ to ‘scaffolding developing your own supportive environment’ 4) From ‘assistive product’, to ‘co-design tool in a larger transformational process’. Instead of supporting ‘self-sufficiency’, MyDayLight expresses a developmental-experiential interpretation of empowerment. It helps users experiment with reconfiguring their own environment, reflect on their experiences and gradually develop more grip on life. The design artifacts enabled young adults on the spectrum and their care-givers to share, question- and reframe implicitly held understandings and to imagine and explore new ways for assistive technology to play an empowering role in a person’s life-world

Explaining the polarized macrophage pool during murine allergic lung inflammation

IntroductionDifferentially polarized macrophages, especially YM1+ and MHCII+ macrophages, play an important role in asthma development. The origin of these polarized macrophages has not been elucidated yet. We therefore aimed to investigate how proliferation, monocyte recruitment, and/or switching of polarization states contribute to this specific pool of polarized interstitial and alveolar macrophages during development of house dust mite (HDM)-induced allergic lung inflammation in mice.MethodsMale and female mice were first treated intranasally with PKH26 to label lung-resident macrophages and were then exposed to either HDM or phosphate-buffered saline (PBS) for two weeks. Different myeloid immune cell types were quantified in lung tissue and blood using flow cytometry.ResultsWe found that macrophage polarization only starts up in the second week of HDM exposures. Before this happened, unpolarized alveolar and interstitial macrophages transiently increased in HDM-exposed mice. This transient increase was mostly local proliferation of alveolar macrophages, while interstitial macrophages also contained unlabeled macrophages suggesting monocyte contribution. After two weeks of exposures, the number of interstitial and alveolar macrophages was similar between HDM and PBS-exposed mice, but the distribution of polarization states was remarkably different. HDM-exposed mice selectively developed YM1+ alveolar macrophages and MHCII-hi interstitial macrophages while nonpolarized macrophages were lost compared to PBS-exposed mice. DiscussionIn this HDM model we have shown that development of a polarized macrophage pool during allergic inflammation is first dependent on proliferation of nonpolarized tissue-resident macrophages with some help of infiltrating unlabeled cells, presumably circulating monocytes. These nonpolarized macrophages then acquire their polarized phenotype by upregulating YM1 on alveolar macrophages and MHCII on interstitial macrophages. This novel information will help us to better understand the role of macrophages in asthma and designing therapeutic strategies targeting macrophage functions.</p

Patient-provider communication about medication use at the community pharmacy counter

Objective: The objectives of this study were to, first, describe the information exchanged between pharmacy staff and patients about prescribed medication at the community pharmacy counter, and second, to investigate to what extent this met professional medication counselling guidelines. Methods: Pharmaceutical encounters were videotaped in four community pharmacies in the Netherlands. Patients were included if they collected a prescription for their own use. An observation protocol, including the MEDICODE checklist, was used to analyse the video recordings. A distinction was made between first and repeat prescriptions. Key findings: One hundred fifty-three encounters were videotaped. When dispensing first prescriptions, pharmacy staff provided most information on instructions how to use the medication (83.3%), form of the medication (71.4%) and treatment duration (42.9%). Topics for repeat prescriptions (such as the effects of the medication and the incidence of observed adverse effects) were rarely discussed. Pharmacy staff rarely encouraged patients to ask questions. Conclusions: Pharmacy staff members provided little medication-related information at the counter, especially for repeat prescriptions, did not encourage active patient participation, and thereby did not adhere to the guidelines of their professional organisation. Further research is needed to understand the reasons for this

The basic reproduction quotient (Q0) as a potential spatial predictor of the seasonality of ovine haemonchosis

Haemonchus contortus is a gastrointestinal nematode parasite of small ruminants, which feeds on blood and causes significant disease and production loss in sheep and goats, especially in warmer parts of the world. The life cycle includes free-living immature stages, which are subject to climatic influences on development, survival and availability, and this species therefore exhibits spatio-temporal heterogeneity in its infection pressure based on the prevailing climate. Models that better explain this heterogeneity could predict future epidemiological changes. The basic reproduction quotient (Q0) was used as a simple process-based model to predict climate-driven changes in the potential transmission of H. contortus across widely different geo-climatic zones, and showed good agreement with the observed frequency of this species in the gastrointestinal nematode fauna of sheep (r = 0.81, P <0.01). Averaged monthly Q0 output was further used within a geographical information system (GIS) to produce preliminary haemonchosis risk maps for the United Kingdom (UK) over a four-year historical span and under future climate change scenarios. Prolonged transmission seasons throughout the UK are predicted, especially in the south although with restricted transmission in peak summer due to rainfall limitation. Additional predictive ability might be achieved if information such as host density and distribution, grazing pattern and edaphic conditions were included as risk layers in the GIS-based risk map. However, validation of such risk maps presents a significant challenge, with georeferenced observed data of sufficient spatial and temporal resolution rarely available and difficult to obtain