BackgroundBronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis.Aim of the studyTo unravel main reasons of pediatricians in prescribing drugs to infants with bronchiolitis, and to possibly correlate therapeutic choices to the severity of clinical presentation. Also possible influence of socially deprived condition on therapeutic choices is analyzed.MethodsPatients admitted to Pediatric Division of 2 main Hospitals of Naples because of bronchiolitis in winter season 2008-2009 were prospectively analyzed. An RDAI (Respiratory Distress Assessment Instrument) score was assessed at different times from admission. Enrolment criteria were: age 1-12 months; 1st lower respiratory infection with cough and rhinitis with/without fever, wheezing, crackles, tachypnea, use of accessory muscles, and/or nasal flaring, low oxygen saturation, cyanosis. Social deprivation status was assessed by evaluating school graduation level of the origin area of the patients. A specific questionnaire was submitted to clinicians to unravel reasons of their therapeutic behavior.ResultsEighty-four children were enrolled in the study. Mean age was 3.5 months. Forty-four per cent of patients presented with increased respiratory rate, 70.2% with chest retractions, and 7.1% with low SaO2. Mean starting RDAI score was 8. Lung consolidation was found in 3.5% on chest roentgenogram. Data analysis also unraveled that 64.2% matched clinical admission criteria. Social deprivation status analysis revealed that 72.6% of patients were from areas "at social risk". Evaluation of length of stay vs. social deprivation status evidenced no difference between "at social risk" and "not at social risk" patients. Following therapeutic interventions were prescribed: nasal suction (64.2%), oxygen administration (7.1%), antibiotics (50%), corticosteroids (85.7%), bronchodilators (91.6%). Statistically significant association was not found for any used drug with neither RDAI score nor social deprivation status. The reasons of hospital pediatricians to prescribe drugs were mainly the perception of clinical severity of the disease, the clinical findings at chest examination, and the detection of some improvement after drug administration.ConclusionsWe strongly confirm the large use of drugs in bronchiolitis management by hospital pediatricians. Main reason of this wrong practice appears to be the fact that pediatricians recognize bronchiolitis as a severe condition, with consequent anxiety in curing so acutely ill children without drugs, and that sometimes they feel forced to prescribe drugs because of personal reassurance or parental pressure. We also found that social "at risk" condition represents a main reason for hospitalization, not correlated to clinical severity of the disease neither to drug prescription. Eventually, we suggest a "step-by-step" strategy to rich a more evidence based approach...
Background The nursing shortage is of worldwide concern, with nursing student retention acknowledged as a priority. As a fundamental step towards exploring factors that can guide the implementation of strategic approaches to retain undergraduate nursing students and prevent their attrition, the aim of this study is to examine the motivation for choosing nursing studies of first-year nursing students within the theoretical framework of self-determination theory. Methods We conducted a study at the Medical School of the University of Palermo. A total of 133 first-year nursing students completed a two-part questionnaire: a measure of socio-demographic aspects and an open question about their motivation for choosing nursing studies. Students’ responses were analysed using thematic analysis. Dimensional analysis was performed in order to verify an organization along one dimension, in agreement with the differentiation of the autonomous and controlled types of motivation of self-determination theory. A person-centred approach was utilised to define motivational profiles able to characterize clusters of students according to both quality and quantity of motivation. Results A set of 18 categories was developed. The factor analysis has shown that nursing students’ motivations can be organized along one dimension, in alignment with the differentiation of the autonomous and controlled forms of motivation of self-determination theory. Through adoption of a person-centred approach, four motivational profiles were identified: a) students with good quality motivation profile (high autonomous and low controlled); b) students with poor quality motivation profile (low autonomous and high controlled); c) students with low quantity motivation profile (low autonomous and low controlled); d) students with low quantity and poor quality motivation profile (i.e. prevalence of controlled motivation). Conclusions Importance of this research includes the possibility to interpret nursing students’ reasons within the theoretical framework of self-determination theory, a well-grounded model able to offer useful information to academic nursing schools, in order to promote effective strategies to foster and support student motivation.
Mobile technologies are becoming ubiquitous in education, yet the wider implications of this phenomenon are not well understood. The paper discusses how mobile lifelong learning (mLLL) may be defined, and the challenges of forging a suitable definition in an evershifting technological and socio-economic landscape. mLLL appears as a ubiquitous concept that puts together mobile learning, essentially an ensemble of didactic practices based on the use of mobile technologies, and lifelong learning, a general vision of education in the knowledge society. Starting from the results of an EU-funded project, MOTILL, the paper situates mLLL within the more complex framework of the network society. This illuminates the difficulties in formulating a comprehensive definition, but also the relevance of this concept in the future of learning. We conclude that the future of mLLL can be understood only as a 360 degree vision that is able to take into account a range of pedagogical, managerial, political and ethical issues.
The interaction of high-frequency asymptotic waves in general relativistic magnetohydrodynamics will be investigated. It shall be proved that an order-one magnetosonic wave generates a gravitational wave of order three (theorem 1), and an order-two gravitational wave generates a magnetosonic wave of the same order (theorem 2). If the fluid satisfies the limit state equation , then a magnetosonic and a gravitational wave of same phase and of the same order can coexist and interact, each one acting as a source for the other (theorem 3).
BackgroundThe most recent computing technologies can promote the application of evidence-based practice (EBP) in the field of applied behaviour analysis (ABA).ObjectiveThe study describes how the use of technology can simplify the application of EBPs in ABA.MethodsThe Web Health Application for ADHD Monitoring (WHAAM) application demonstrates this in the following two case studies. We are monitoring dysfunctional behaviours, collecting behavioural data, performing systematic direct observations, creating both visual baseline and intervention charts and evaluating the planned interventions using the TAU-U statistical index.ResultsSignificant positive changes of children’s problem behaviours are observed and recorded. Both the duration of the previously identified behaviour ‘to get out of bed in time’ (r = −0.79, TAU-U = −0.58, p < 0.05) and the frequency of the behaviour ‘interrupting others’ (r = −0.96, TAU-U = −0.82, p < 0.01) decreased.ConclusionsThe WHAAM application is an effective tool to support functional behaviour assessments and it is an example of how technology can support practitioners by facilitating the application of EBPs and increasing the communication among clinical, educational and family environments.
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