Use of a User-Friendly Tablet Application to Communicate with Pediatric Patients on Mechanical Ventilators / Uso de una aplicación user-friendly para tableta en la comunicación con pacientes pediátricos sometidos a respirador artificial / Uso de um aplicativo para tablet fácil de usar para comunicação com pacientes pediátricos em ventilação mecánica

ABSTRACT Objectives: To examine the effect of using a tablet application as a communication aid with mechanically ventilated pediatric patients on communication satisfaction of nursing staff and caregiver-patient dyads. Materials and method: The one-group pretest-posttest design was used to examine communication satisfaction for the nursing staff, and a nonequivalent pretest-posttest control group design was used for caregivers. The sample comprised 44 nursing staff and 18 dyads of caregivers and the ventilated pediatric patients from two hospitals in Thailand. A paired t-test was used for comparison of nursing staff, the Mann-Whitney U test for comparison of caregivers, and descriptive statistics to describe the children's satisfaction. Results: The nursing staff was more satisfied with communication using the tablet application than regular communication methods (t = -9.13, df = 43, p < .001). Caregivers who used the tablet application also reported more communication satisfaction, compared to those who used regular communication methods (U = -3.41, p < .001). Nearly 90% of the pediatric patients reported being completely satisfied with the use of the application. Conclusions: The tablet application designed for facilitating communication with mechanically ventilated pediatric patients improved communication satisfaction. It should be encouraged as one of the assistive communication devices for wide use.

RESUMEN Objetivos: examinar cómo el uso de una aplicación para tableta como ayuda en la comunicación con pacientes pediátricos con respirador artificial afecta el nivel de satisfacción con la comunicación por parte del personal de enfermería y en las diadas cuidador-paciente. Materiales y método: se utilizó el diseño pretest-postest de un solo grupo para analizar el nivel de satisfacción del personal de enfermería con la comunicación y se utilizó un diseño de grupo de control pretest-postest no equivalente para los cuidadores. La muestra estaba conformada por 44 miembros del personal de enfermería y 18 díadas de cuidadores y pacientes pediátricos con ventilación de dos hospitales en Tailandia. Se utilizó una prueba de T pareada para comparar al personal de enfermería, la prueba U de Mann-Whitney para comparar los cuidadores y una estadística descriptiva para describir la satisfacción de los niños. Resultados: el personal de enfermería se sintió más satisfecho con la comunicación al usar la aplicación de la tableta que los métodos de comunicación regulares (t = -9,13, df = 43, p < ,001). Los cuidadores que usaron la aplicación para tableta también reportaron una mayor satisfacción con la comunicación respecto a aquellos que usaron los métodos de comunicación regulares (U = -3,41, p < ,001). Casi el 90 % de los pacientes pediátricos reportaron sentirse completamente satisfechos con el uso de la aplicación. Conclusiones: la aplicación para tableta diseñada para facilitar la comunicación con pacientes pediátricos con respirador artificial mejoró los niveles de satisfacción con la comunicación y debe promoverse como uno de los dispositivos de comunicación de asistencia para uso amplio.

RESUMO Objetivos: examinar como o uso de um aplicativo auxiliar na comunicação com pacientes pediátricos em ventilação mecânica afeta o nível de satisfação com a comunicação da equipe de enfermagem e das díades cuidador-paciente. Materiais e método: usou-se o pré-teste pós-teste de um único grupo para analisar o nível de satisfação da equipe de enfermagem com a comunicação e um desenho de grupo de controle pré-teste pós-teste não equivalente para os cuidadores. A amostra estava composta por 44 membros da equipe de enfermagem e 18 díades de cuidadores e pacientes pediátricos em ventilação mecânica de dos hospitais na Tailândia. Usou-se um teste T pareado para comparar a equipe de enfermagem, o teste U de Mann-Whitney para comparar os cuidadores e uma estatística descritiva para descrever a satisfação das crianças. Resultados: a equipe de enfermagem sentiu-se mais satisfeita com a comunicação usando o aplicativo para tablet do que os métodos de comunicação comuns (t = -9,13, df = 43, p < ,001). Os cuidadores que usaram o aplicativo para Tablet também relataram maior satisfação com a comunicação em comparação com os que usaram métodos de comunicação comuns (U = -3,41, p < ,001). Quase 90% dos pacientes pediátricos relataram sentir-se completamente satisfeitos com o uso do aplicativo. Conclusões: o aplicativo para tablet desenhado para facilitar a comunicação com pacientes pediátricos em ventilação mecânica melhorou os níveis de satisfação com a comunicação e deve ser promovida como um dos dispositivos de comunicação de assistência para ampla utilização.

Impact of a group-based treatment program on adipocytokines, oxidative status, inflammatory cytokines and arterial stiffness in obese children and adolescents.

Background Dysregulation of adipocytokines, inflammatory cytokines and oxidative stress are associated with the pathogenesis of obesity-related complications. This study aimed to evaluate the effect of a group-based lifestyle modification program on adipocytokines, inflammatory cytokines, oxidative status and arterial stiffness in obese youth. Methods A 1-year weight-reduction program was conducted. The program consisted of initial hospitalization and five outpatient group-based sessions held at 1, 2, 3, 6 and 9 months. Pre- and post-intervention measurements included anthropometric data, blood tests, body composition and brachial-ankle pulse wave velocity (ba-PWV). Results A total of 126 obese youths were recruited, and 115 of those completed the study. Twenty-four participants had increased percentage weight for height at the end of the study (group A), 30 had minimal reduction (group B) and 61 had substantial reduction (group C). Lean mass significantly increased in all three groups (all p<0.001). A significant decrease in leptin (group A, p=0.021; group B, p=0.005; group C, p<0.001), interleukin-6 (IL-6) (group A, p=0.019; group B, p=0.004; group C, p<0.001) and ba-PWV (group A, p=0.031; group B, p=0.015; group C, p<0.001) was also observed. No significant change in the oxidative status was found among the groups. Reduction in ba-PWV was correlated with decreases in plasma malondialdehyde (pMDA) (r=0.233, p=0.036) and homeostasis model assessment of insulin resistance (HOMA-IR) (r=0.253, p=0.025). Conclusions A group-based healthy lifestyle program for obese youths had beneficial effects on adipocytokines, inflammatory cytokines and arterial stiffness. Participants without change in weight status also benefited. These improvements may reduce the risk of obese youths developing atherosclerosis.

Outcomes of group-based treatment program with parental involvement for the management of childhood and adolescent obesity.

OBJECTIVE: An uncontrolled study was conducted to evaluate the effects of a group-based program on weight control, metabolic profiles, and obesity-related complications in obese youth. METHODS: The program consisted of an initial in-patient session and five group sessions, one, two, three, six, and nine months into the study, providing participants and their parents with information about the consequences of obesity and lifestyle modifications. The severity of obesity and obesity-related complications were evaluated at baseline and 12 months after the intervention. The participants' and their parents' perceptions of the program were assessed. RESULTS: Of the obese youth recruited (n=126), 115 completed the study. Their percentage weight for height and percentage body fat decreased significantly (both p<0.001), and their insulin resistance, lipid profiles, and transaminases levels improved (all p<0.01). The prevalence of prediabetes, dyslipidemia, and elevated transaminases decreased significantly (all p<0.05). The participants and their parents perceived the program as valuable. CONCLUSION: A group-based program is effective in managing childhood obesity, improving metabolic profiles, and alleviating certain obesity-related complications. PRACTICE IMPLICATIONS: A group-based program that provides education and raises the awareness of obese children and their parents about the consequences of obesity is an effective model for treating childhood obesity.

Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital.

This retrospective study was undertaken to evaluate and identify some difficulties encountered in the process of interhospital transport of pediatric critically ill patients from remote hospitals to the Pediatric Intensive care unit (PICU) of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The study was conducted between 1st June, 2001 and 30th June, 2003. Total number of patients transferred to PICU were 36. Most patients suffered from respiratory diseases (14 cases, 38.9%) and cardiovascular diseases (8 cases, 22.2%) prior to transfer. Five patients (13.9%) had cardiac arrest and required CPR prior to the transfers. Twelve cases (30%) were transferred at the parents' request or and due to socioeconomic problems. All patients were transported by ambulance. The longest transfer duration was from a hospital in Chiangmai province (11 hours by road transfer). The majority of accompanying medical personnel were nurses (55.5%) with no experience in intensive care pediatrics. In no cases were any doctors or trained paramedics presented with the transport team. Prior to transportation, the PICU physician was phone-contacted by the referring physician. The patients' status prior to being transferred to PICU were as follows; 23 cases (63.9%) were intubated, 4 (11.1%) cases had intravenous cut down and 10 (27.8%) were infused inotropic drug. None of the patients had any record on important patient's data (e.g. vital signs, oxygen saturation) or adverse events during transport such as equipment problems and clinical deteriorations. Twenty eight patients (77.8%) stayed in PICU average length of less than 7 days. Eleven patients died (mortality rate of 30.59%). In conclusion, the major obstacle in properly transporting patients to the PICU was the lack of experience/knowledge of transport team to perform safe transfer in pediatrics during transport. The second problem was lack of documentation or record of vital signs and adverse events observed during the transfer. Organization of effective team working in pediatric transfer to PICU is inevitably needed to improve the outcome of these critically ill patients.