The BEHAVE application as a tool to monitor inclusive interventions for subjects with neurodevelopmental disorders.

In the last few years, many educational and therapeutic interventions for young people with neurodevelopmental disorders are based on systematic monitoring of the outcomes. These interventions are typically conducted using single-case experimental designs, (SCEDs) a set of methods aimed at testing the effect of an intervention on a single subject or a small number of subjects. In SCEDs, an effective process of decision-making needs accurate, precise, and reliable data but also that caregivers and health professionals can gather information with minimal effort. The use of Information Communication Technologies in SCEDs can support the process of data collection and analysis, facilitating the collection of accurate and reliable data, providing reports accessible also by non-experts, and promoting interactions and sharing among clinicians, educators, and caregivers. The present paper introduces the BEHAVE application, a web-based highly customizable application, designed to implement SCEDs, supporting both data collection and automatic analysis of the datasets. Moreover, the paper will describe two case studies of kindergarten children with neurodevelopmental disorders, highlighting how the BEHAVE application supported the entire process, from data collection in multiple contexts to decision-making based on the analysis provided by the system. In particular, the paper describes the case studies of Carlo and Dario, two children with severe language and communication impairments, and the inclusive education interventions carried out to maximize their participation in a typical home and school setting increasing their mand repertoire. Results revealed an increase in the mand repertoire in both children who become able to generalize the outcomes to multiple life contexts. The active participation of the caregivers played a crucial role in the ability of children to use the learned skills in settings different from the ones they were learned in.

The relationship between empathy and altruistic motivations in nursing studies: a multi-method study.

BACKGROUND: The efficient management of relational competences in healthcare professionals is crucial to ensuring that a patient's treatment and care process is conducted positively. Empathy is a major component of the relational skills expected of health professionals. Knowledge of undergraduate healthcare students' empathic abilities is important for educators in designing specific and efficient educational programmes aimed at supporting or enhancing such competences. In this study, we measured first-year undergraduate nursing students' attitudes towards professional empathy in clinical encounters. The students' motivations for entering nursing education were also evaluated. This study takes a multi-method approach based on the use of qualitative and quantitative tools to examine the association between students' positive attitudes towards the value of empathy in health professionals and their prosocial and altruistic motivations in choosing to engage in nursing studies. METHODS: A multi-method study was performed with 77 first-year nursing students. The Jefferson Scale of Empathy (JSE) - Health Professions Student Version was administered. Students' motivations for choosing nursing studies were detected through an open question and thematically analysed. Using explorative factor analysis and principal component analysis, a dimensional reduction was conducted to identify subjects with prosocial and altruistic motivations. Finally, linear models were tested to examine specific associations between motivation and empathy. RESULTS: Seven distinct themes distinguishing internal and external motivational factors were identified through a thematic analysis of students' answers regarding their decision to enter a nursing degree course. Female students gained higher scores on the empathy scale than male ones. When students' age was considered, this difference was only observed for younger students, with young females' total scores being higher than young males'. High empathy scores were positively associated with altruistic motivational factors. A negative correlation was found between external motivational factors and the scores of the Compassionate Care subscale of the JSE. CONCLUSIONS: Knowing the level of nursing students' empathy and their motivational factors for entering nursing studies is important for educators to implement training paths that enhance students' relational attitudes and skills and promote the positive motivational aspects that are central to this profession.

Self-reported motivation for choosing nursing studies: a self-determination theory perspective.

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.

The WHAAM Application: a Tool to Support the Evidence-Based Practice in the Functional Behaviour Assessment.

BACKGROUND: The most recent computing technologies can promote the application of evidence-based practice (EBP) in the field of Applied Behavior Analysis (ABA). OBJECTIVE: The study describes how the use of technology can simplify the application of evidence-based practices in applied behaviour analysis. METHODS: The WHAAM application demonstrates this in the following two case studies. We are monitoring dysfunctional behaviours, collecting behavioural data, performing systematic direct observations, creating a visual baseline and intervention charts and evaluating the planned interventions using the TAU-U statistical index. RESULTS: Significant positive changes of children's problem behaviours are observed and recorded. Both the duration of the identified behaviour "to get out of bed in time" (r = -.79, TAU-U = -.58, p < .05) and the frequency of the behaviour "interrupting others" (r= -.96, TAU-U = -.82, p < .01) decreased. CONCLUSION: the 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 evidence-based practices and increasing the communication among clinical, educational and family environments.

Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?

BACKGROUND: Bronchiolitis 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 STUDY: To 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. METHODS: Patients 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. Enrollment 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. RESULTS: Eighty-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. CONCLUSIONS: We 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 to bronchiolitis therapy, by adopting specific and shared resident guidelines.