The effect of buzzy®, DistrACTION® cards on reducing pediatric pain and fear during blood collection in the rheumatology polyclinic: A randomized controlled trial.

PURPOSE: The aim of this study was to compare the effectiveness of Buzzy® and DistrACTION® Cards in reducing children's pain and fear while taking venous blood samples. METHODS: This research was designed as a randomized controlled experimental study. The study population consisted of children aged 6-12 years admitted to the Pediatric Rheumatology Diseases Polyclinic in a Faculty of Medicine in Germany. The sample of the study consisted of 96 children (Buzzy® = 32, DistrACTION® Cards = 32, control = 32) who met the patient selection criteria and agreed to participate in the study. The data were obtained using a Child and Family Information Form, the Children Fear Scale (CFS), and the Faces Pain Scale-Revised (FPS-R). The data were evaluated using the Pearson chi-square test, Kruskal-Wallis test, One-way ANOVA test with Bonferroni correction, and Fisher-Freeman-Halton. FINDINGS: In the study, the average age of the children was 9.21 ± 2.15 years. The Buzzy® group had the lowest pain and procedural fear scores (self-report = 0.88 ± 1.13, 0.31 ± 0.47; parent report = 0.75 ± 0.98, 0.34 ± 0.48, and researcher report = 0.81 ± 1.00, 0.31 ± 0.54, respectively) than the DC, and control groups. CONCLUSIONS: The Buzzy® method was effective in reducing venipuncture pain and fear in children. PRACTICE IMPLICATIONS: Nurses can use the Buzzy® methods to help reduce venipuncture pain and fear in children. The clinical trial registration number is NCT05560074. (https://clinicaltrials.gov/ct2/show/study/NCT05560074).

Opening up a tailored tutor qualification program for medical students to other healthcare students - a mixed-method study.

BACKGROUND: Peer-led tutorials are widely used in medical education to promote practical skills acquisition and support faculty staff. Typically, student tutors are custom trained for this specific task. We investigated whether opening up an existing medical tutor qualification program to other degree programs is successful in terms of acceptance among students, acquisition of tutor-specific and interprofessional competencies, and which factors contribute to success or failure. METHODS: We developed a two-day tutor qualification program and conducted it annually from 2016 to 2020 with medical and other healthcare students. At the end of each course, we administered a written survey in which the participants rated the following items: their attitudes towards interprofessional learning (using the UWE-IP-D Interprofessional Learning Scale), the interprofessional learning setting, the teaching approach, and their competency acquisition (each on a five-point Likert scale; 1 = strongly agree, 5 = strongly disagree). Furthermore, we assessed participants' qualitative feedback in free-text fields and performed inductive content analyses. RESULTS: The study participation rate was high (response rate 97%; medical students: n = 75; healthcare students: n = 22). Participants stated high levels of competency acquisition (total M = 1.59, individual items' M's ranging from 1.20 to 2.05) and even higher satisfaction with the teaching approach (total M = 1.28, individual items' M's ranging from 1.43 to 1.05). Overall satisfaction with the training was M = 1.22; SD = 0.58. No significant differences in ratings were found between the student groups. The qualitative results showed that students appreciated the interprofessional setting and experienced it as enriching. The most positive feedback was found in didactics/teaching methods on role-plays and group work; most suggestions for improvement were found in the area of structure and organisation on breaks and time management. CONCLUSIONS: Opening up an existing medical tutor qualification program to other student groups can be seen as fruitful to teach not only tutor-related aspects but also interprofessional competencies. The results demonstrate the importance of detailed planning that considers group composition and contextual conditions and provides interactive teaching methods to promote interprofessional experiences. This study offers important information about prerequisites and methodological implementation that could be important for the interprofessional redesign of existing training programs.

Start-up of an aerobic granular sludge system from stored granules: Evaluating the impact of storage period on biomass activity and stability and the effect of temperature on nitrification and phosphorus removal rates.

Aerobic granular sludge (AGS) has been considered a breakthrough within the wastewater treatment sector. However, the long reactor start-up for the formation of granules is challenging and may hinder the spread of this technology. To circumvent this obstacle, inoculation of the reactors with pre-formed granules from existing plants is an interesting approach. In this context, issues related to biomass storage becomes very relevant. In this study, reactivation of aerobic granular biomass after storage was evaluated in a sequencing batch reactor (SBR) designed for achieving simultaneous organic matter, nitrogen and phosphorus removal. Two different scenarios, short (40 days) and long (180 days) storage periods, were assessed, and their influence on the granules physical properties and bioactivity was addressed. The results revealed that the granules stored for a shorter period showed higher resistance to breakage and underwent smooth color changes. On the other hand, the biomass stored for a longer period acquired a dark color and was more susceptible to disruption during reactivation. The granules stored for 6 months become swollen and exhibited an irregular morphology and fluffy structure within the first days of reactivation. Consequently, their settling properties were adversely affected, and some parameters such as the food-to-microorganism ratio had to be adjusted to prevent granules disintegration. Regarding the bioactivity of important microbial functional groups, COD removal was rapidly restored within a few days of SBR operation with the biomass stored for a shorter period. However, it took longer for the biomass stored for 180 days to reach the same performance observed for the granules stored for 40 days. A similar trend is valid for nitrification. In the experiments with sludge stored for a longer time, it took almost twice as long to reach effluent ammonium concentrations lower than 1 mg NH4+-N L-1 compared to the test using biomass stored for 40 days. Phosphate removal was strongly affected by biomass storage, especially after 180 days of inactivity, a condition found to be detrimental for polyphosphate-accumulating organisms. Finally, cycle tests were also conducted to assess substrate conversion rates for comparison between different trials and evaluate the influence of temperature (10-35 °C) on nitrification and phosphate removal rates.

Comparison of construction and demolition waste management between Brazil, European Union and USA.

Construction and demolition waste represents a significant waste flow, both in Brazil and in other countries. According to specific Brazilian legislation, since 2004 construction and demolition waste can no longer be disposed of in open dumps, municipal solid waste landfills, slopes, waterways and environmental protected areas. Construction and demolition waste should preferably be recycled, but just a small amount of it returns to the construction industry production chain in Brazil. This work aims both to present diagnoses of the construction and demolition waste management in Brazil, the European Union and the United States and to compare their results. It is concluded that Brazil presents performance indicators in relation to construction and demolition waste management well below those found for the other analysed countries. Furthermore, differences and similarities are identified and potentials for improvement in the current situation of construction and demolition waste in Brazil are discussed.

Attitudes towards interprofessional collaboration in young healthcare professionals.

Successful interprofessional (IP) collaboration has great potential to improve healthcare delivery. The aim of this study was to evaluate and compare the attitudes towards IP collaboration in young health professionals who had not been exposed to IP learning activities. About one year after graduation from their vocational training, 387 graduates from various healthcare professions [Nurses (nursing and pediatric nursing), Therapists (physical therapy, speech and language therapy), Diagnostic professionals (biomedical science and radiography)], were invited to participate in an online survey. In total, data from 129 graduates were considered for data analyses. The University of Western England Interprofessional Questionnaire was administered to self-assess graduates individual attitude towards IP collaboration and learning using four scales. All health professional groups showed an overall positive attitude in communication and teamwork as well as in IP relationships and expressed a neutral attitude in IP learning and IP interactions. There were no significant differences in the overall scores between the health professional groups. In total, the three health professional groups showed similar attitudes towards IP collaboration and learning, despite their different scope of work. Results may help to design IP learning activities and this may contribute to better communication with and to know more about each other.

TSPO PET with [18F]GE-180 sensitively detects focal neuroinflammation in patients with relapsing-remitting multiple sclerosis.

PURPOSE: Expression of the translocator protein (TSPO) is upregulated in activated macrophages/microglia and is considered to be a marker of neuroinflammation. We investigated the novel TSPO ligand [18F]GE-180 in patients with relapsing-remitting multiple sclerosis (RRMS) to determine the feasibility of [18F]GE-180 PET imaging in RRMS patients and to assess its ability to detect active inflammatory lesions in comparison with the current gold standard, contrast-enhanced magnetic resonance imaging (MRI). METHODS: Nineteen RRMS patients were prospectively included in this study. All patients underwent TSPO genotyping and were classified as high-affinity, medium-affinity or low-affinity binders (HAB/MAB/LAB). PET scans were performed after administration of 189 ± 12 MBq [18F]GE-180, and 60-90 min summation images were used for visual analysis and assessment of standardized uptake values (SUV). The frontal nonaffected cortex served as a pseudoreference region (PRR) for evaluation of SUV ratios (SUVR). PET data were correlated with MRI signal abnormalities, i.e. T2 hyperintensity or contrast enhancement (CE). When available, previous MRI data were used to follow the temporal evolution of individual lesions. RESULTS: Focal lesions were identified as hot spots by visual inspection. Such lesions were detected in 17 of the 19 patients and overall 89 [18F]GE-180-positive lesions were found. TSPO genotyping revealed 11 patients with HAB status, 5 with MAB status and 3 with LAB status. There were no associations between underlying binding status (HAB, MAB and LAB) and the signal intensity in either lesions (SUVR 1.87 ± 0.43, 1.95 ± 0.48 and 1.86 ± 0.80, respectively; p = 0.280) or the PRR (SUV 0.36 ± 0.03, 0.40 ± 0.06 and 0.37 ± 0.03, respectively; p = 0.990). Of the 89 [18F]GE-180-positive lesions, 70 showed CE on MRI, while the remainder presented as T2 lesions without CE. SUVR were significantly higher in lesions with CE than in those without (2.00 ± 0.53 vs. 1.60 ± 0.15; p = 0.001). Notably, of 19 [18F]GE-180-positive lesions without CE, 8 previously showed CE, indicating that [18F]GE-180 imaging may be able to detect lesional activity that is sustained beyond the blood-brain barrier breakdown. CONCLUSION: [18F]GE-180 PET can detect areas of focal macrophage/microglia activation in patients with RRMS in lesions with and without CE on MRI. Therefore, [18F]GE-180 PET imaging is a sensitive and quantitative approach to the detection of active MS lesions. It may provide information beyond contrast-enhanced MRI and is readily applicable to all patients. [18F]GE-180 PET imaging is therefore a promising new tool for the assessment of focal inflammatory activity in MS.

Analysis of potential for reducing emissions of greenhouse gases in municipal solid waste in Brazil, in the state and city of Rio de Janeiro.

This paper examines potential changes in solid waste policies for the reduction in GHG for the country of Brazil and one of its major states and cities, Rio de Janeiro, from 2005 to 2030. To examine these policy options, trends in solid waste quantities and associated GHG emissions are derived. Three alternative policy scenarios are evaluated in terms of effectiveness, technology, and economics and conclusions posited regarding optimal strategies for Brazil to implement. These scenarios are been building on the guidelines for national inventories of GHG emissions (IPCC, 2006) and adapted to Brazilian states and municipalities' boundaries. Based on the results, it is possible to say that the potential revenue from products of solid waste management is more than sufficient to transform the current scenario in this country into one of financial and environmental gains, where the negative impacts of climate change have created a huge opportunity to expand infrastructure for waste management.

[Nursing: partnership with the medical profession on equal terms]. / Pflege: Partnerschaft mit Ärzten auf Augenhöhe.

Partnership on equal terms between the nursing and medical profession at the Surgical Department of the University Hospital Heidelberg has become evident as shown exemplarily in central patient management, wound management and acute pain service. By using the skills of both professions, aims to improve patient care and operational procedures have been agreed. The transfer of competencies and responsibilities needed to achieve these aims has led to an increase in recognition of the nursing profession. Physicians have experienced a clear relief in pressure and quality has simultaneously been improved. This partnership leads to an atmosphere of respect and recognition.

[HeiCare®: a project aiming to improve medication communication across health care sectors]. / HeiCare® : ein Projekt zur Verbesserung der sektorenübergreifenden Arzneimittelkommunikation.

BACKGROUND AND OBJECTIVE: Changes between health care sectors represent a critical phase in long-term pharmacotherapy. The aim of the Hei CARE(®) project was to close the communication gap at the interface between primary care physicians (PCP), hospital physicians and patients, and to improve quality and safety of pharmacotherapy. METHODS: Physicians who enrolled patients with long-term pharmacotherapy were able to participate in the Hei CARE(®) project. After enrolment the patient's medication was entered in the internet-based medication knowledge data base AiD PRAXIS and checked for medication interactions and optimized if necessary. At hospitalisation medication was transferred electronically to the hospital (AiD KLINIK(®)) and on discharge integrated in the discharge letter and faxed to the primary care physician (PCP). The project was evaluated using quantitative and qualitative methods. Hei CARE(®) -cases, in which medication was transferred electronically as planned, were compared with the other cases. PCPs' experiences were collected in focus groups. RESULTS: One thousand and three chronically ill patients of 56 primary care practices participated. 259 patients were hospitalized between October 2005 and March 2009 of which entrance and discharge medication were transferred both ways via the electronic prescribing platform in 67 cases. The number of changes in medication was reduced in comparison to the other cases. Participating PCPs reported positive changes through Hei CARE(®) as well as further potential for optimizing communication across health care sectors. CONCLUSION: Use of a common internet-based medication knowledge data base (Hei CARE(®) ) in both health care sectors reduced the number of changes in pharmacotherapy. Seamless care in chronically ill patients was thereby improved. The project also demonstrated that improving communication across health care sectors is a slow process.

Reverse logistics in the Brazilian construction industry.

In Brazil most Construction and Demolition Waste (C&D waste) is not recycled. This situation is expected to change significantly, since new federal regulations oblige municipalities to create and implement sustainable C&D waste management plans which assign an important role to recycling activities. The recycling organizational network and its flows and components are fundamental to C&D waste recycling feasibility. Organizational networks, flows and components involve reverse logistics. The aim of this work is to introduce the concepts of reverse logistics and reverse distribution channel networks and to study the Brazilian C&D waste case.

[Health insurance discount contracts: problems and risks for the general practitioner in the medical care of patients with chronic illness]. / Krankenkassen-Rabattverträge: Probleme und Risiken für den Hausarzt bei der Betreuung chronisch kranker Patienten.

BACKGROUND AND OBJECTIVE: The German federal Health Insurance law to strengthen competition between the pharmaceutical companies commits pharmacies to hand out drugs from discount contract drug suppliers of a patient's health insurance company. Thus patients are confronted with constantly changing drug packets. This study aimed at exploring whether patients have been properly informed about the new discount contracts and if they have experienced changes and problems in their long- term medications. METHODS: Between May and June 2008 male and female patients older than 50 years who had a statutory health insurance and had been diagnosed with coronary heart disease for at least one year answered a standardized questionnaire filled in by doctors' assistants or general practitioners in the doctors' network "Weschnitztal". RESULTS: Of the 188 patients participated in this study 63,8% were informed about health insurance discount contracts. 31,3% of the patients reported that a positive effect due to the discount contracts was that they were discharged from paying the drug prescription fee, 22,2% mentioned that cost saving for the health insurance could also be positive. 120 patients (63,8%) knew that the names of their long-term drugs could change.101 of the questioned patients (53,7%) identified a change in their long-term drugs, 51,5% felt insecure about the permanent changes. 21,7% experienced adverse e effects due to the new drugs. 19% of the patients had serious problems regarding medication intake. CONCLUSION: This study demonstrates that the information which patients have on the new health insurance law is not adequate enough. Many of them felt insecure because of the changes of long-term medications. One fifth of the patients reported errors in their drug intake or their confusion about their drugs. There is a high risk that these circumstances may trigger further diseases or complications. The cost savings as intended by the health insurance companies may therefore not be achieved by discount contracts.

Evaluation of investments in recycling centres for construction and demolition wastes in Brazilian municipalities.

There are very few construction and demolition (C&D) waste recycling centres in Brazil. To encourage the building and operation of new units, data were collected and analysed relating to C&D waste management and recycling in Brazil. Based on the results of this analysis, a conceptual model is presented for conducting viability studies of future C&D waste recycling centres. Applying this model to verify the viability of private recycling centres, the results show that under current market conditions in Brazil, C&D waste recycling centres are not financially feasible based solely on revenue from the sale of processed products. Nevertheless, under the same market conditions, the recycling centres could be economically viable for public authorities depending on the particular circumstances of each municipality. The feasibility, however, depends on continuity and the production volume reached. The conceptual model, the results of its applications and the discussions about the experiences of existing centres can strongly support public authorities and private initiatives in their decision-making about investments in Brazil and in other developing countries.

Lung transplant recipients holding companion animals: impact on physical health and quality of life.

Since lung transplant recipients are susceptible to infections and inhaled pollution, many centers warn against pets. However, data supporting this recommendation are lacking. Our program is less restrictive regarding pets. This study, for the first time, investigates the association of pets with physiological and psychological parameters in these patients. A questionnaire concerning pets was sent to 104 lung transplant recipients. Lung function tests, levels of exhaled nitric oxide (FE(NO)), need for antibiotic treatments and hospitalizations, creatinine clearance, body mass index (BMI) and demographic data were assessed. Additionally, the questionnaire of life satisfaction (FLZ), a question on summarized life satisfaction (LS), the life orientation test (LOT), the hospital anxiety depression scale (HADS) and the social support questionnaire (F-SozU) were assessed. Response rate was 86%. Fifty-two percent defined themselves as pet owners, whereas 48% did not. The two groups did not differ in demographic or physiological data. Significant differences in FLZ (79/65, p = 0.04), in LS (4.3/3.9, p = 0.01), LOT (32/29, p = 0.006) and F-SozU (4.5/4.2, p = 0.04) were found in favor of pet owners. In lung transplant recipients keeping pets the frequency of somatic complications is not higher compared to lung transplant recipients without pets. After lung transplantation, pets are associated with a better quality of life.

Pilot project of mechanical-biological treatment of waste in Brazil.

By mechanical-biological treatment (MBT) of residual municipal solid waste the behaviour of landfills can be significantly improved. After MBT the organic content (COD and BOD5), total organic carbon, and total nitrogen in the leachate, as well as the gas production rate, are reduced to values lower than 90% of the fresh untreated waste. The volume of the stabilized material to be disposed on landfills decreases enormously, by up to 70%. The monitoring effort for a landfill constructed under these conditions is reduced to a minimum and the stabilized material can be used in other ways, as material for reforestation, for cover material or for thermal utilization to produce energy. Environmental conditions are important in MBT, as well as waste characteristics. This paper describes the results of a pilot project of MBT performed in Rio de Janeiro, Brazil. The results have shown that this technology can be used successfully in developing countries, with economy for the society and important results for the environment.

[Relaparotomy in secondary peritonitis Planned relaparotomy or relaparotomy on demand?]. / Relaparotomie bei sekundärer Peritonitis. Programmierte Relaparotomie oder Relaparotomie "on demand"?

Secondary peritonitis is associated with serious morbidity and a persistent high mortality in recent decades, this despite improvement in antibiotic, intensive care and surgical treatment. The available literature regarding the surgical treatment of secondary peritonitis was searched through Pubmed (1966- January 2005) as well as a hand search of references of retrieved articles. Definitions, pathophysiology and classification of secondary peritonitis are discussed, as well as the scientific rationale for the surgical treatment in secondary peritonitis. The historical development and the scientific foundation of present-day relaparotomy strategies in secondary peritonitis are evaluated, with an emphasis on two frequently applied surgical treatment strategies: planned relaparotomy and relaparotomy on demand. Criteria for relaparotomy after the initial laparotomy and potential areas for further research to reduce both morbidity and mortality are discussed. Furthermore, the care of patients with secondary peritonitis is evolving from a surgical entity to a more multidisciplinary challenge uniting surgeons, intensivists, radiologists and microbiologists. Research needs to be expanded into novel fields to further decrease morbidity and mortality.

[Diagnostic modalities in diagnosis of adult patients with acute abdominal pain]. / Aanvullende diagnostiek bij volwassenen met acute buikpijn.

In order to provide an accurate diagnosis and management strategy for adult patients with acute abdominal pain and peritoneal irritation, it is important to understand the value of various forms of diagnostics modalities. History, physical examination and laboratory results can generally differentiate between an acutely serious and a less serious abdominal problem. Patients with acute abdominal pain and no increase in either the leukocyte count or the concentration of C-reactive protein should be re-evaluated after 12 hours. If laboratory values are increased, then diagnostic imaging is necessary. For patients with diffuse abdominal pain and for patients with signs of shock or respiratory insufficiency, a CT-scan is the imaging method of choice. If symptoms are located in the left upper quadrant, an upright chest radiograph or a plain abdominal film are recommended. If symptoms are located in the right upper quadrant, ultrasonography will be preferred. If the diagnosis is still uncertain, a CT-scan will be performed. A CT-scan is indicated for lower abdominal pain in women with increased inflammatory parameters and in men aged 50 years or older with increased inflammatory parameters. If the cause of the abdominal pain is still unclear following a CT-scan, then diagnostic laparoscopy may be considered for fertile women of childbearing age and for men aged less than 50 years with signs of appendicitis.

Meta-analysis of relaparotomy for secondary peritonitis.

BACKGROUND: Planned relaparotomy and relaparotomy on demand are two frequently employed surgical treatment strategies for patients with abdominal sepsis. METHODS: The available literature was evaluated to compare the efficacy of both surgical treatment strategies. A systematic search for studies comparing planned and on-demand relaparotomy strategies in adult patients with secondary peritonitis was employed. Studies were reviewed independently for design features, inclusion and exclusion criteria, and outcomes. The primary outcome measure was in-hospital mortality. RESULTS: No randomized studies were found; eight observational studies with a total of 1266 patients (planned relaparotomy, 286; relaparotomy on demand, 980) met the inclusion criteria and were included in the meta-analysis. These eight studies were heterogeneous on clinical and statistical grounds (chi2= 40.7, d.f. = 7, P < 0.001). Using a random-effects approach, the combined odds ratio for in-hospital mortality was 0.70 (95 per cent confidence interval 0.27 to 1.80) in favour of the on-demand strategy. CONCLUSION: The combined results of observational studies show a statistically non-significant reduction in mortality for the on-demand relaparotomy strategy compared with the planned relaparotomy strategy when corrected for heterogeneity in a random-effects model. Owing to the non-randomized nature of the studies, the limited number of patients per study, and the heterogeneity between studies, the overall evidence generated by the eight studies was inconclusive.

Nursing process documentation systems in clinical routine--prerequisites and experiences.

Documentation of the nursing process is an important, but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems, such as low quality and high writing efforts, are reported. However, it is still unclear if computer-based documentation systems can reduce these problems. At the Heidelberg University Medical Center, computer-based nursing process documentation projects began in 1998. A computer-based nursing documentation system has now been successfully introduced on four wards of three different departments, supporting all six phases of the nursing process. The introduction of the new documentation system was accompanied by systematic evaluations of prerequisites and consequences. In this paper, we present preliminary results of this evaluation, focusing on prerequisites of computer-based nursing process documentation. We will discuss in detail the creation and use of predefined nursing care plans as one important prerequisite for computer-based nursing documentation. We will also focus on acceptance issues and on organizational and technical issues.

Just the facts, please: a guide to effective documentation.

Although most health care professionals would wish it otherwise, documentation will never be eliminated completely. It can be ignored and complained about, but documentation will always be there to remind us, "If it wasn't documented, it wasn't done." Home care providers need to be cognizant of the imperative for effective documentation. Corporate compliance initiatives, fraud and abuse issues, and changes in reimbursement mechanisms make documentation more important than ever. Home care providers must create an environment conducive to effective documentation practices.