ABSTRACT
BACKGROUND: To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the perspectives of nurses regarding CMVS is lacking. To this end, we applied a theoretical approach for behaviour change derived from the Behaviour Change Wheel (BCW). AIM: To provide insight in the capability, opportunity and motivation of nurses working with CMVS, in order to inform future implementation efforts. METHODS: A qualitative study was conducted, including twelve nurses of a surgical ward in a tertiary teaching hospital with previous experience of working with CMVS. Semi-structured interviews were audiotaped, transcribed verbatim, and analysed using thematic analysis. The results were mapped onto the Capability, Opportunity, Motivation - Behaviour (COM-B) model of the BCW. RESULTS: Five key themes emerged. The theme 'Learning and coaching on the job' linked to Capability. Nurses favoured learning about CVSM by dealing with it in daily practice. Receiving bedside guidance and coaching was perceived as important. The theme 'interpretation of vital sign trends' also linked to Capability. Nurses mentioned the novelty of monitoring vital sign trends of patients on wards. The theme 'Management of alarms' linked to Opportunity. Nurses perceived the (false) alarms generated by the system as excessive resulting in feelings of irritation and uncertainty. The theme 'Integration and compatibility with clinical workflow' linked to Opportunity. CVSM was experienced as helpful and easy to use, although integration in mobile devices and the EMR was highly favoured and the management of clinical workflows would need improvement. The theme 'Added value for nursing care' linked to Motivation. All nurses recognized the potential added value of CVSM for postoperative care. CONCLUSION: Our findings suggest all parts of the COM-B model should be considered when implementing CVSM on general wards. When the themes in Capability and Opportunity are not properly addressed by selecting interventions and policy categories, this may negatively influence the Motivation and may compromise successful implementation.
ABSTRACT
Patients with Primary Ciliary Dyskinesia (PCD) suffer from recurrent upper and lower airway infections due to defects in the cilia present on the respiratory epithelium. Since chronic inflammatory conditions can cause changes in innate immune responses, we investigated whether monocytes isolated from the peripheral blood of pediatric PCD patients respond differently to inflammatory stimuli, compared to monocytes from healthy children and adults. The receptor for C5a (C5aR) was upregulated in PCD, whereas expression levels of the leukocyte chemoattractant receptors CCR1, CCR2, CCR5, BLT1 and FPR1 on PCD monocytes were similar to those on monocytes from healthy individuals. Also in vitro migration of PCD monocytes towards the ligands of those receptors (CCL2, fMLP, C5a and LTB4) was normal. Compared to healthy children, PCD patients had a higher percentage of the non-classic monocyte subset (CD14+CD16++) in circulation. Finally, PCD monocytes produced higher levels of pro-inflammatory cytokines (IL-1ß and TNF-α) and chemokines (CCL3, CCL5, CCL18 and CCL22) in response to LPS, peptidoglycan and/or dsRNA stimulation. These data suggest that monocytes might exacerbate inflammatory reactions in PCD patients and might maintain a positive feedback-loop feeding the inflammatory process.
Subject(s)
Ciliary Motility Disorders/metabolism , Cytokines/metabolism , Monocytes/metabolism , Adolescent , Adult , Case-Control Studies , Child , Child, Preschool , Ciliary Motility Disorders/pathology , Female , Humans , Inflammation/metabolism , Inflammation/pathology , L-Selectin/metabolism , Lewis X Antigen/metabolism , Male , Monocytes/pathology , Phagocytosis , Receptor, Anaphylatoxin C5a/metabolism , Young AdultABSTRACT
This paper presents definition and characteristics of appearance, psychological consequences, risk factors, differential diagnosis, and management of stuttering in children. Stuttering requires early recognition and management in order to prevent the consequences of secondary psychological disturbances. Management associating speech and behavioral therapies must be entrusted to expert specialists.
Subject(s)
Stuttering/psychology , Stuttering/therapy , Child , Diagnosis, Differential , Family , Humans , Language Therapy , Mental Disorders/prevention & control , Risk Factors , Stuttering/diagnosisABSTRACT
Acquired childhood aphasia is rare but has important conceptual implications for developmental neuropsychology. The last 15 years have seen major changes in their clinical description, which have led to the awareness that the syndromes in acquired childhood aphasia are more similar to the syndromes in adult aphasia than previously thought. This article briefly discusses the definition and differential diagnosis of acquired childhood aphasia from the point of view of the child neurologist and adds new perspectives afforded by neurolinguistic examinations. It reviews the main causes and syndromes of acquired childhood aphasia. Prognosis is less favorable than usually supposed, in terms of both language sequellae and academic failure. Finally, suggestions regarding the basis for aphasic children's nonverbal deficiencies are presented.
Subject(s)
Aphasia/psychology , Adult , Aphasia/diagnosis , Aphasia/etiology , Aphasia/therapy , Child , HumansABSTRACT
A brief review is given of the contribution of neuropsychological diagnostic methods and neurolinguistic diagnostic investigations. Through the analysis of errors, neurolinguistic examinations today make it possible to isolate in dyslexic populations at least three groups with clear-cut characteristics, requiring a distinct remedial approach. Neuropsychological investigations, and in particular their cross-matching with radiological neuro-imaging methods, serve to evidence the specificity of the cerebral organization of dyslexics.
Subject(s)
Dyslexia/psychology , Central Nervous System Diseases/complications , Child , Dyslexia/diagnosis , Dyslexia/etiology , Dyslexia, Acquired/etiology , Female , Humans , Linguistics , Male , NeuropsychologyABSTRACT
We report the case of a ten-year-old boy, who, after herpes simplex encephalitis, presented a sensory aphasia having much in common with Wernicke's aphasia in adults. The genesis of neologisms appeared very similar to the mechanisms described by Buckingham and Kertesz (1974, Brain and Language, 1, 43-61). The findings are discussed in the light of theories of hemispheric specialization and of age-related semiologies.
Subject(s)
Aphasia, Wernicke/diagnosis , Aphasia/diagnosis , Brain Damage, Chronic/diagnosis , Child , Dominance, Cerebral , Encephalitis/complications , Herpes Simplex/complications , Humans , Male , Semantics , Speech Production MeasurementABSTRACT
Eleven unselected cases of aphasia in children seen over a three-year period in a neuropaediatric centre are reported. Contrary to current reports in the literature, the children disclosed a semiology similar to that of adults, particularly for frequency and distribution of 'positive signs' such as paraphasias. The reasons for this discrepancy are discussed and an hypothesis of early intrahemispheric specialization is proposed.
