Non-invasive ventilation in the care of patients with chronic obstructive pulmonary disease with palliative care needs: a scoping review.

BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) could have palliative care (PC) needs because of unmet needs such as dyspnoea. This may lead to anxiety and may have an impact on patients' ability to perform daily activities of living. PC can be started when patients with COPD have unmet needs and can be provided alongside disease-modifying therapies. Non-invasive ventilation (NIV) could be an important measure to manage dyspnoea in patients with COPD in need of PC. A scoping review was conducted to gain an overview of the existing research and to identify knowledge gaps. The aim of this scoping review was to systematically map published studies on the use of NIV in patients with COPD with PC needs, including the perspectives and experiences of patients, families, and healthcare professionals (HCPs). METHODS: This review was conducted following the framework of Arksey and O'Malley. The reporting of the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The review protocol was published. AMED, CINAHL, Embase, MEDLINE, PEDro, and PsycInfo were searched from inception to November 14, 2022. The included studies had to report the perspectives and experiences of COPD patients, relatives, and HCPs regarding NIV in the care of patients with COPD with PC needs. In pairs, the authors independently assessed studies' eligibility and extracted data. The data were organised thematically. The results were discussed in a consultation exercise. RESULTS: This review included 33 papers from 32 studies. Four thematic groupings were identified: preferences and attitudes towards the use of NIV; patient participation in the decision-making process of NIV treatment; conflicting results on the perceived benefits and burdens of treatment; and heterogenous clinical outcomes in experimental studies. Patients perceived NIV as a 'life buoy' to keep them alive. Many patients wanted to take part in the decision-making process regarding NIV treatment but expressed varying degrees of inclusion by HCPs in such decision-making. Conflicting findings were identified regarding the perceived benefits and burdens of NIV treatment. Diversity in heterogeneous clinical outcomes were reported in experimental studies. CONCLUSIONS: There is a need for more studies designed to investigate the effectiveness of NIV as a palliative measure for patients with COPD with PC needs using comprehensive outcomes. It is especially important to gain more knowledge on the experiences of all stakeholders in the use of home-based NIV treatment to these patients.

Time and change: a typology for presenting research findings in qualitative longitudinal research.

BACKGROUND: Qualitative longitudinal research (QLR) is an emerging methodology used in health research. The method literature states that the change in a phenomenon through time should be the focus of any QLR study, but in empirical studies, the analysis of changes through time is often poorly described, and the emphasis on time/change in the findings varies greatly. This inconsistency might depend on limitations in the existing method literature in terms of describing how QLR studies can present findings. The aim of this study was to develop and describe a typology of alternative approaches for integrating time and/or change in QLR findings. METHODS: In this method study, we used an adapted scoping review design. Articles were identified using EBSCOhost. In total, methods and results sections from 299 QLR articles in the field of health research were analyzed with inspiration from content analysis. RESULTS: We constructed a typology of three types and seven subtypes. The types were based on the underlying structural principles of how time/change was presented: Type A) Findings have a low utilization of longitudinal data, Type B) Findings are structured according to chronological time, and Type C) Findings focus on changes through time. These types differed in 1) the way the main focus was on time, change or neither; 2) the level of interpretation in the findings; and 3) how theoretical understandings of time/change were articulated in the articles. Each type encompassed two or three subtypes that represented distinct approaches to the aim and results presentation of QLR findings. CONCLUSIONS: This method study is the first to describe a coherent and comprehensive typology of alternative approaches for integrating time/change into QLR findings in health research. By providing examples of various subtypes that can be used for results presentations, it can help researchers make informed decisions suitable to their research intent.

Nurses' and Doctors' Experiences of Transferring Adolescents or Young Adults With Long-Term Health Conditions From Pediatric to Adult Care: A Metasynthesis.

The transfer of adolescents and young adults (AYA) with long-term health conditions from pediatric to adult care is a multidisciplinary enterprise where nurses and doctors play an important role. This review aimed to identify and synthesize evidence from qualitative primary reports on how nurses and doctors experience the transfer of AYA aged 13 to 24 years with long-term health conditions to an adult hospital setting. We systematically searched seven electronic databases for reports published between January 2005 and November 2021 and reporting nurses' and doctors' experiences. We meta-summarized data from 13 reports derived from 11 studies published worldwide. Using qualitative content analysis, we metasynthesized nurses' and doctors' experiences into the theme "being boosters." Boosting AYA's transfer was characterized by supporting AYA's and their parents' changing roles, smoothening AYA's transition from pediatric to adult care, and handling AYA's encounters with a different care culture.

Fundamental nursing care focusing on older people's needs and continuity of long-term care: a scoping review protocol.

INTRODUCTION: Knowledge about long-term care services ability, regardless of if the service is home-based or facility-based, to provide an optimal and comprehensive fundamental nursing care (understood as focusing on physical, relational and psychosocial needs) consistently over time is sparse. Research into nursing indicates the presence of a discontinuous and fragmented healthcare service, and that fundamental nursing care such as mobilisation, nutrition and hygiene among older people (65 years and above) seems to be, regardless of reasons, systematically rationed by nursing staff. Thus, our scoping review aims to explore the published scientific literature on fundamental nursing care and continuity of care targeting older people's needs while also describing identified nursing interventions with the same foci in a long-term care context. METHODS AND ANALYSIS: The upcoming scoping review will be conducted in accordance with Arksey and O'Malley's methodological framework for scoping studies. Search strategies will be developed and adjusted to each database, for example, PubMed, CINAHL and PsychINFO. Searches will be limited to the years 2002-2023. Studies focusing our aim, regardless of study design, will be eligible for inclusion. Included studies will be quality assessed and data will be charted using an extraction form. Textual data will be presented through a thematic analysis and numerical data by a descriptive numerical analysis. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol checklist. ETHICS AND DISSEMINATION: The upcoming scoping review will take into consideration ethical reporting in primary research as part of the quality assessment. The findings will be submitted to an open-access peer-reviewed journal. Under the Norwegian Act on Medical and Health-related Research, this study does not need ethical clearance by a regional ethical review authority as it will not generate any primary data or obtain sensitive data or biological samples.

How to support fathers of preterm infants in early parenthood - An integrative review.

PROBLEM: Preterm birth is a stressful event. Paternal experiences of having a preterm infant indicate a need for tailored support. However, it is unclear which interventions work best. This review presents the evidence on existing healthcare interventions to support fathers of preterm infants in early parenthood, how effective they are and paternal experiences with the interventions. ELIGIBILITY CRITERIA: The integrative review process of Whittemore and Knafl was used to guide the study. A structured and comprehensive literature search was conducted in PubMed (MEDLINE), Embase, CINAHL, PsycInfo, Cochrane, Scopus, Web of Science, SweMed+, and Proquest Dissertation & Thesis Global. SAMPLE: A total of 18 qualitative and quantitative studies were included in the review. The Mixed Methods Appraisal Tool was used to assess quality. RESULTS: Three overall themes were identified in the analysis: 1) Skin-to-skin contact supported interaction between infant and father, 2) information impacted paternal experiences of stress, anxiety, and development of fatherhood, 3) fathers' relationships with the nurses oscillated between conflict and assistance. CONCLUSIONS: Our findings show that targeted interventions could support father-infant interaction and reduce stress among fathers of preterm infants. IMPLICATIONS: Fathers of preterm infants rely on nurses to support their engagement in early parenthood, while nurses facilitate the interventions that engage the fathers. It is also essential to develop a culture within the neonatal intensive care unit that encourages the presence of fathers and enhances educational nursing strategies for supporting fathers of preterm infants during early parenthood.

Qualitative longitudinal research in health research: a method study.

BACKGROUND: Qualitative longitudinal research (QLR) comprises qualitative studies, with repeated data collection, that focus on the temporality (e.g., time and change) of a phenomenon. The use of QLR is increasing in health research since many topics within health involve change (e.g., progressive illness, rehabilitation). A method study can provide an insightful understanding of the use, trends and variations within this approach. The aim of this study was to map how QLR articles within the existing health research literature are designed to capture aspects of time and/or change. METHODS: This method study used an adapted scoping review design. Articles were eligible if they were written in English, published between 2017 and 2019, and reported results from qualitative data collected at different time points/time waves with the same sample or in the same setting. Articles were identified using EBSCOhost. Two independent reviewers performed the screening, selection and charting. RESULTS: A total of 299 articles were included. There was great variation among the articles in the use of methodological traditions, type of data, length of data collection, and components of longitudinal data collection. However, the majority of articles represented large studies and were based on individual interview data. Approximately half of the articles self-identified as QLR studies or as following a QLR design, although slightly less than 20% of them included QLR method literature in their method sections. CONCLUSIONS: QLR is often used in large complex studies. Some articles were thoroughly designed to capture time/change throughout the methodology, aim and data collection, while other articles included few elements of QLR. Longitudinal data collection includes several components, such as what entities are followed across time, the tempo of data collection, and to what extent the data collection is preplanned or adapted across time. Therefore, there are several practices and possibilities researchers should consider before starting a QLR project.

Advanced Clinical Neonatal Nursing Students' Transfer of Performance: From Skills Training With Real-Time Feedback on Ventilation to a Simulated Neonatal Resuscitation Scenario.

Background: Advanced clinical neonatal nurses are expected to have technical skills including bag-mask ventilation. Previous studies on neonatal bag-mask ventilation skills training focus largely on medical students and/or physicians. The aim of this study was to investigate whether advanced clinical neonatal nursing students' bag-mask ventilation training with real-time feedback resulted in transfer of bag-mask ventilation performance to a simulated setting without feedback on ventilation. Materials and Methods: Students in advanced clinical neonatal nursing practiced bag-mask ventilation on a premature manikin (Premature Anne, Laerdal Medical, Stavanger, Norway) during skills training. A flow sensor (Neo Training, Monivent AB, Gothenburg, Sweden) was placed between the facemask and the self-inflating bag (Laerdal Medical), and visual feedback on mask leak (%), expiratory tidal volume (VT e in ml/kg), ventilation rate and inflation pressure was provided. Two months later, the students participated in a simulated neonatal resuscitation scenario. The same variables were recorded, but not fed back to the students. We compared ventilation data from skills- and simulation training. A structured questionnaire was used to investigate the students' self-perceived neonatal ventilation competence before and after the skills- and simulation training. Results: Mask leakage and ventilation rate was higher, and VT e lower and highly variable in the simulated scenario compared with skills training (all p < 0.001). There was no statistically significant difference in inflation pressure (p = 0.92). The fraction of ventilations with VT e within the target range was lower during simulation (21%) compared to skills training (30%) (p < 0.001). There was no difference in the students' self-perceived competence in bag-mask ventilation before vs. after skills- and simulation training. Conclusion: Skills training with real-time feedback on mask leak, ventilation rate, tidal volume, and inflation pressure did not result in objective or subjective improvements in bag-mask ventilation in a simulated neonatal resuscitation situation. Incorrect VT e delivery was common even when feedback was provided. It would be of interest to study whether more frequent training, and training both with and without feedback, could improve transfer of performance to a simulated resuscitation setting.

Non-invasive ventilation in the palliative care of patients with chronic obstructive pulmonary disease: a scoping review protocol.

INTRODUCTION: Patients with advanced chronic obstructive pulmonary disease (COPD) experience a great symptom burden. Breathlessness is a very frequently reported symptom that negatively affects all aspects of daily life and could lead to fear of dying. Non-invasive ventilation (NIV) could be an important palliative measure to manage breathlessness in patients with advanced COPD. We decided to conduct a scoping review to attain an overview of the existing research and to identify knowledge gaps. This scoping review aims to systematically map published studies on the use of NIV in the palliative care of COPD patients, including the perspectives and experiences of patients, families and healthcare professionals. METHODS AND ANALYSIS: This scoping review will employ the framework of Arksey and O'Malley. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A comprehensive and systematic search strategy will be developed in cooperation with an experienced librarian. Database searches will be conducted in AMED, PEDro, Embase, CINAHL, PsycInfo and MEDLINE in February 2021. Pairs of authors will independently assess studies' eligibility and extract data using a standardised data-charting form. The data will be inductively summarised and organised thematically. The results will be discussed with an advisory board consisting of nurses and physicians from respiratory and intensive care units. ETHICS AND DISSEMINATION: Approval for the workshop with the advisory board has been attained from the Norwegian Centre for Research Data (480222), and approval will be attained from the Personal Data Protection Officers of the participating hospitals. All advisory board participants will sign an informed written consent before participation. The results could contribute to developing the body of evidence on the use of NIV in the palliative care of COPD patients and serve to identify directions for future research.

Being cross pressured-parents' experiences of the transfer from paediatric to adult care services for their young people with long term conditions: A systematic review and qualitative research synthesis.

BACKGROUND: Family members of young people (13-24 years) with long-term conditions tend to experience multiple challenges when their children transfer from paediatric to adult care, as do the patients themselves. OBJECTIVES: To identify, interpret and theoretically conceptualise the meaning of parents' experiences of the transfer from paediatric to adult care of their young people with long-term conditions. DESIGN: A qualitative research synthesis. DATA SOURCES: We obtained articles from Medline, CINAHL, PsycINFO, EMBASE, Scopus, and Web of Science. Unpublished theses and dissertations were searched for using Google Scholar, Mednar, and ProQuest Dissertations and Theses. REVIEW METHODS: Based on a previously published protocol, we followed the guidelines from the Joanna Briggs Institute. Sandelowski and Barroso's qualitative research synthesis approach guided the metasynthesis. Articles published between 1999 and March 2019 were systematically searched for. FINDINGS: Twenty-three reports from seven Western countries representing 454 parents including significant others such as aunts and grandparents of 462 young people with various diagnoses contributed to the review. 'Being cross-pressured' was the metasynthesis found to reflect parents' experiences of the transfer from paediatric to adult care of their young people with long-term conditions. The metasynthesis comprised four themes: 'Fluctuating between parental roles', 'Navigating contrasting healthcare contexts', 'Making decisions in the face of inner conflict', and 'Trusting their child's self-management ability'. CONCLUSIONS: Our metasynthesis finding of parents' experiences of being cross-pressured provides a new way of thinking about the study phenomena which is supported by transitions theory holding that multiple transitions can take place simultaneously involving myriads of concurrent and conflicting demands. The cross pressure may overwhelm parents. The clinical implications are to recognise parents' experiences and distress in healthcare planning to promote safe and predicable transfers of their young people. Provision of healthcare to parents during transfer needs to be tailored to a collaborative decision-making process between parents, their young people, and involved practitioners across paediatric and adult healthcare services. Tweetable abstract: Parents experienced being cross-pressured when their young people with long-term conditions were transferred from paediatric to adult care.

Physical activity experiences of children and adolescents with asthma: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to synthesize existing knowledge about experiences of children and adolescents with asthma related to participation in, or limitation of, physical activity. INTRODUCTION: Limitations of physical activity, expressed as a barrier of bodily movement, may relate to physiological restraints, as well as emotional and social delimitation, in children and adolescents with asthma. Participation in physical activity is related to management of asthma and is important for social inclusion. Through childhood and adolescence, physical activity enhances physical, cognitive, and social development, and a dose-response relationship between physical activity and several indicators of improved health has been established. Knowledge is needed about experiences of physical activity in children and adolescents with asthma to tailor care and implement exercise and physical activity supporting interventions into clinical practice. INCLUSION CRITERIA: This review will consider qualitative studies that include subjective experiences related to participation in, or limitation of, physical activity in children and adolescents (six to 18 years of age) with asthma. All contexts and countries will be included. METHODS: MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, SocINDEX, and Social Science Citation Index List will be searched for relevant studies. Studies published in English with no date limitation will be included. Study selection, assessment of methodological quality, data extraction, synthesis, and assessment of confidence in the findings will be conducted using the JBI meta-aggregation approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020164797.

Inter-rater reliability of two paediatric early warning score tools.

BACKGROUND: Paediatric early warning score (PEWS) assessment tools can assist healthcare providers in the timely detection and recognition of subtle patient condition changes signalling clinical deterioration. However, PEWS tools instrument data are only as reliable and accurate as the caregivers who obtain and document the parameters. OBJECTIVE: The aim of this study is to evaluate inter-rater reliability among nurses using PEWS systems. DESIGN: The study was carried out in five paediatrics departments in the Central Denmark Region. Inter-rater reliability was investigated through parallel observations. A total of 108 children and 69 nurses participated. Two nurses simultaneously performed a PEWS assessment on the same patient. Before the assessment, the two participating nurses drew lots to decide who would be the active observer. Intraclass correlation coefficient, Fleiss' κ and Bland-Altman limits of agreement were used to determine inter-rater reliability. RESULTS: The intraclass correlation coefficients for the aggregated PEWS score of the two PEWS models were 0.98 and 0.95, respectively. The κ value on the individual PEWS measurements ranged from 0.70 to 1.0, indicating good to very good agreement. The nurses assigned the exact same aggregated score for both PEWS models in 76% of the cases. In 98% of the PEWS assessments, the aggregated PEWS scores assigned by the nurses were equal to or below 1 point in both models. CONCLUSION: The study showed good to very good inter-rater reliability in the two PEWS models used in the Central Denmark Region.

Clinical profile of children experiencing in-hospital clinical deterioration requiring transfer to a higher level of care.

Few studies have described the various reasons for unplanned transfer to a higher level of care due to clinical deterioration and the clinical profile of those paediatric patients. However, an understanding of the nature of illness is important to patient safety. This study aimed to describe the frequency and clinical characteristics of children who experience unplanned transfer to a higher level of care due to clinical deterioration. A retrospective, descriptive registry study design was used. Of the 92 paediatric patients included, 69% (n = 64) was male. The median age was 2.1 years (interquartile range 0.4-6.9) with 33% being infants under 1 year. The highest number (61.3%) of transfers occurred between 8 and 16 hours. In the 24 hours leading up to a transfer due to clinical deterioration, 15 patients had no vital parameters documented, and 77 patients had least one vital parameter measured. Physiological abnormalities were present in 19 (37.7%) of the 77 patients where vital parameters were documented. This study provides essential baseline data to inform further research to improve care and treatment for critically ill children in paediatric wards. This study's findings suggest reporting of vital parameters is incomplete and infrequent.

Comparison of Two Pediatric Early Warning Systems: A Randomized Trial.

PURPOSE: Pediatric early warning systems (PEWS) are used to detect clinical deterioration in hospitalized children. Few PEWSs have been validated in multicenter studies and the performance in many single-center studies varies. We wanted to compare two PEWS in a multicenter study. DESIGN AND METHODS: Randomized multicenter unblinded trial conducted at all pediatric departments in the Central Denmark Region. A random sample of 16,213 pediatric patients (31,337 admissions) were enrolled from November 2014 to March 2017. Patients were randomized to The Bedside PEWS or CDR PEWS. The primary outcome was the sum of hospitalized children experiencing in-hospital clinical deterioration requiring transfer to a higher level of care. RESULTS: Of the 21,077 pediatric patients who met the inclusion criteria, 16,213 (from 31,337 admissions) were enrolled. 22 unplanned transfers to a higher level of care were identified: 14 in The Bedside PEWS group and 8 in the CDR PEWS group, a non-statistical difference (P = 0.20). No significant difference in predicting unplanned transfer to a higher level of care (P = 0.78) were detected and no significant difference was observed in the secondary outcomes. CONCLUSIONS: The CDR PEWS prevents as many critical events as The Bedside PEWS. Shorter median time to PEWS reassessment when CDR PEWS was used and fewer reassessments being done to late could reflect that the CDR PEWS was more acceptable to staff. PRACTICE IMPLICATIONS: The results from this study should be interpreted with caution as very few patients experiencing clinical deterioration and further studies should also focus on challenges trying to evaluate PEWS.

Significant others' experience of hospitalized patients' transfer to home: A systematic review and meta-synthesis.

BACKGROUND: Significant others are individuals representing family members or neighbors, friends, colleagues or members of the same household, who act as relatives or surrogates. Significant others play an important role when patients are transferred or discharged after hospitalization. OBJECTIVE: The objective of this review is to identify, appraise and synthesize the best available evidence exploring significant others' experiences of the discharge or transfer of adult patients after hospitalization. METHODS: A qualitative comprehensive systematic review and meta aggregation. TYPES OF PARTICIPANTS: Participants of this review are the 'significant other(s); persons who are important or influential to the patient's life. PHENOMENA OF INTEREST: How the significant others' experience hospitalized patients' transitions and the psychosocial and existential issues during transfer from hospital to home. CONTEXT: Studies that investigate the organizational culture during hospitalization. TYPES OF STUDIES: Studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. SEARCH STRATEGY: The search aimed at finding published and unpublished studies in English, German, Danish, Swedish and Norwegian, and was unrestricted by time. Eleven electronic databases and eleven websites were searched. CRITICAL APPRAISAL: Methodological validity of the qualitative papers was assessed independently by two reviewers using the standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Qualitative research findings were synthesized. RESULTS: A total of 189 findings from twelve studies were aggregated into three categories. An aggregated finding was generated based on the primary studies: SOs existential strength is linked to preparations for the discharge including care planning meeting(s) and learning-by-doing care activities led by health care providers during hospitalizations. CONCLUSIONS: The studies in this review provided useful and credible statements from caregivers' voices that are not previously aggregated nor presented. The findings enlighten both positive and burdensome experiences in the everyday life of caring for a significant other after discharge.

Parents' experiences of neonatal transfer. A meta-study of qualitative research 2000-2017.

Transfers of critically ill neonates are frequent phenomena. Even though parents' participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents' experiences of neonatal transfer is lacking. This paper describes a meta-study addressing qualitative research about parents' experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological issues of qualitative studies concerning parents' experiences of neonatal transfer over the course of this meta-study (2000-2017). Meta-theory and meta-method analyses showed that caring, transition, and family-centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta-data-analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified 'wavering and wandering' as a metaphoric representation of the parents' experiences. The findings add knowledge about meta-study as an approach for comprehensive qualitative research and point at the value of meta-theory and meta-method analyses.

Pediatric Early Warning Score Systems, Nurses Perspective - A Focus Group Study.

PURPOSE: Pediatric early warning score (PEWS) systems are used to monitor pediatric patients' vital signs and facilitate the treatment of patients at risk of deteriorating. The aim of this study was to gain knowledge about nurses' experiences with PEWS and to highlight factors facilitating and impeding the use of PEWS tools in clinical practice. DESIGN AND METHODS: An exploratory qualitative design was chosen using focus group interviews to gain a deeper understanding of nurses' experiences with PEWS. A total of five focus group interviews were conducted at three hospitals, and a qualitative meaning condensation analysis as described by Kvale and Brinkmann was performed. RESULTS: Seven themes were identified, including i) lack of interdisciplinary awareness, ii) clinical judgment and PEWS-a multi-faceted approach, iii) PEWS supports a professional language, iv) monitoring the patient's - a challenge, v) PEWS helps to visualize the need for escalating care, vi) an inflexible and challenging tool, and vii) supportive tools enhance the nurses' experiences of PEWS positively. CONCLUSIONS: Our findings suggest that attention should be given to nurses' perceptions of how both clinical judgment and PEWS should be seen as essential in providing nurses with information about the patients' conditions. If not, the risk of failing to recognize patients' deteriorating conditions will remain as this can have an impeding influence on nurses' use of PEWS. From the nurses' perspective, medical doctors seemed unaware of their role in using PEWS.

Relationship between physical activity level and psychosocial and socioeconomic factors and issues in children and adolescents with asthma: a scoping review.

BACKGROUND: Asthma is a heterogeneous chronic airway disease which may reduce capability for physical activity. In healthy peers, physical activity is influenced by psychosocial and socioeconomic factors. Knowledge about the role of these factors has not been mapped in children and adolescents with asthma. OBJECTIVE: The main objective of this scoping review was to identify psychosocial and socioeconomic factors associated with physical activity level in children and adolescents with asthma in the literature. The specific objectives were to map the instruments used to measure these factors, report on the construction and validation of these instruments, map psychosocial and socioeconomic issues related to physical activity level reported in qualitative studies, and identify gaps in knowledge about the relationship between psychosocial and socioeconomic factors and physical activity level in children and adolescents with asthma. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Children and adolescents with asthma aged six to 18 years. CONCEPT: Psychosocial and socioeconomic factors related to physical activity level and participation. CONTEXT: All physical activity contexts. TYPES OF SOURCES: Quantitative and qualitative primary studies in English, with no date limit. SEARCH STRATEGY: The databases searched included nine major databases for health and sports science, and five databases for unpublished studies. After screening and identification of studies, the reference lists of all identified reports were searched, and forward citation searches were conducted using four databases. EXTRACTION OF THE RESULTS: The following data were extracted: (a) relevant study characteristics and assessment of physical activity level, (b) instruments used to assess psychosocial and socioeconomic factors, (c) association between physical activity level and these factors, (d) construction and validation of instruments, and (e) psychosocial and socioeconomic issues related to physical activity participation. PRESENTATION OF THE RESULTS: Twenty-one quantitative and 13 qualitative studies were included. In cross-sectional studies, enjoyment, physical self-concept, self-efficacy, attitudes and beliefs about physical activity and health, psychological distress, health-related quality of life, and social support were more often reported as being correlated with physical activity level. In three studies, the construct validity was assessed by factor analysis and construct reliability tests for the study population. Qualitative studies reported 10 issues related to physical activity participation, and capability and being like peers were most commonly reported. There was no direct evidence that qualitative research informed the development or adjustment of instruments in quantitative studies. CONCLUSIONS: Seven psychosocial factors correlated with physical activity level; capability and being like peers were the most commonly reported issues. Reports of the construction and validation of instruments were sparse.

A multicentre, randomised intervention study of the Paediatric Early Warning Score: study protocol for a randomised controlled trial.

BACKGROUND: Patients' evolving critical illness can be predicted and prevented. However, failure to identify the signs of critical illness and subsequent lack of appropriate action for patients developing acute and critical illness remain a problem. Challenges in assessing whether a child is critically ill may be due to children's often uncharacteristic symptoms of serious illness. Children may seem relatively unaffected until shortly before circulatory and respiratory failure and cardiac arrest. The Bedside Paediatric Early Warning Score has been validated in a large multinational study and is used in two regions in Denmark. However, healthcare professionals experience difficulties in relation to measuring blood pressure and to the lack of assessment of children's level of consciousness. In addition, is it noteworthy that in 23,288-hour studies, all seven items of the Bedside Paediatric Early Warning Score were recorded in only 5.1% of patients. This trial aims to compare two Paediatric Early Warning Score (PEWS) models to identify the better model for identifying acutely and critically ill children. The hypothesis is that the Central Denmark Region PEWS model is superior to the Bedside PEWS in terms of reducing unplanned transfers to intensive care or transfers from regional hospitals to the university hospital among already hospitalised children. METHODS/DESIGN: This is a multicentre, randomised, controlled clinical trial where children are allocated to one of two different PEWS models. The study involves all paediatric departments and one emergency department in the Central Denmark Region. The primary outcome is unplanned transfer to the paediatric intensive care unit or transfer from regional hospitals to the university hospital. Based on preliminary data, 14,000 children should be included to gain a power of 80% (with a 5% significance level) and to detect a clinically significant difference of 30% of unplanned transfers to intensive care or from regional hospitals to the paediatric department at the university department. A safety interim analysis will be performed after inclusion of 7000 patients. DISCUSSION: This is the first randomised trial to investigate two different PEWS models. This study demonstrates the safety and effectiveness of a new PEWS model and contributes to knowledge of hospitalised children's clinical deterioration. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02433327 . Registered on 27 April 2015.

Relationship between physical activity level and psychosocial and socioeconomic factors and issues in children and adolescents with asthma: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The first objective of this scoping review is to identify and map information about instruments used to measure psychosocial and socioeconomic factors associated with level of physical activity (PA) in children and adolescents with asthma that have been reported in quantitative literature, and to report on the construction and validation of these instruments. The second objective is to identify and map psychosocial and socioeconomic issues related to PA level reported in qualitative literature and gaps in the evidence on the relationship between psychosocial and socioeconomic factors and PA level in children and adolescents with asthma.Specifically the review questions are as follows.