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Introduction: Urinary incontinence is a major public health problem. Although, as a condition, it is well documented in the literature, there is little information on its social representations. The study of its representations could make it possible to improve the way it is handled and the treatment suffers receive., Purpose of the Research: The aim of this study was to understand the representations of the general French population on the subject of urinary incontinence., Methods: This involved carrying out a declarative quantitative study using questionnaires. To do this, 1803 people were surveyed all over France. First, a descriptive statistical analysis was carried out using the participants’ socio-demographic data. Second, a logistic regression-type association was made between the dependent and independent variables., Results: Urinary incontinence elicits a certain level of disgust in the general population. Still a taboo subject, it seems to be of little interest to some members of the population. The condition is also often poorly understood, especially by men, the younger generations, and the inhabitants of urban areas in western France., Conclusions: This quantitative study helped shed key light on the French population’s perceptions of urinary incontinence and the methods of prevention available. It also helped determine the participant profiles associated with these representations. Going forward, it seems worthwhile to focus on informing and educating these populations on the subject.

Background: The associative network method is a technique for studying social representations of a phenomenon. Although it is little known and used, it can be widely used in nursing research, particularly to understand the representations of a population on a disease or a professional practice., Objectives: This article aims to describe the associative network method, proposed by De Rosa in 1995, through a concrete example., Methods: The associative network is a technique that allows us to identify the content, structure, and polarity of social representations of a phenomenon. It was used with 41 participants to describe their representations of urinary incontinence. First, the data were collected following the four steps described by De Rosa. The analysis was then carried out manually and using Microsoft Excel. The different themes evoked by the 41 participants, the number of words in each theme, the rank of appearance of the themes, the indices of polarity and neutrality, and the rank of hierarchy were thus analyzed., Results: We were able to describe in depth the representations of caregivers and people from the general population on urinary incontinence and, more specifically, their content and structure. The spontaneous answers of the participants allowed us to explore several dimensions of their representations. We were also able to obtain rich information, both qualitatively and quantitatively., Discussion: The associative network-which is easy to understand and implement-is a method that can be adapted to various studies., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman's decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12-49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30-39 years ( p = 0.015) and those who had given birth once ( p = 0.049), twice ( p = 0.003), 3-5 times ( p = 0.004), and >5 times ( p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum.

Urinary incontinence is a major public health problem that affects nearly 9% of the world's population. Numerous studies have defined it, as well as its frequency, contributing factors, means of prevention and therapeutic approaches, but there are very few publications on its social representations. However, the literature raises that a better understanding of the social representations associated with this phenomenon could improve its management. This study focuses on its representations, and more specifically those of Internet users. Its ambition is to bring out some of the representations related to this phenomenon and thus provide initial factual and useful elements for the following research program. We conducted a webometric study and drew on Moliner's social representations theory. Using textual and iconographic data posted on the search engines and social networks most used by Internet users between January 1st, 2015 and October 15th, 2020, this research examined how urinary incontinence is perceived by English- and French-speaking Internet users. For quantitative data analysis, two textometric analysis software packages were used: Lexico® and Iramuteq®. For qualitative data, the analysis was carried out with ATLAS Ti® 9 software. Formerly hidden, urinary incontinence seems to be nowadays less and less a taboo subject and has been arousing growing interest for several years. However, this study also highlights the many preconceived ideas, false beliefs and the obvious lack of knowledge about this phenomenon. It also shows that urinary incontinence should not be trivialized nor the difficulty for the patients concerned to live with it. This study made it possible to understand the representations that a part of the population has on the phenomenon of urinary incontinence. It was the first of a larger research program which aims at improving the care of institutionalized elderly people suffering from urinary incontinence.

The impact of chronic diseases on people's daily lives and the exponential number of people affected is a major public health issue. The consequences on individuals and their families is significant, particularly in terms of quality of life. In the literature, this phenomenon is well described in terms of care policy and cost. Although there is a link between a supportive environment and empowerment, there is little literature describing a supportive environment and the daily lives of people living with cardiovascular disease. The objectives of this study are to identify the strategies people use to develop an enabling environment. It will be a qualitative ethnographic study that will address both human behavior and the notion of culture in a broad sense. In the context of this study, an orientation towards critical ethnography will be considered for its particular interest in vulnerable people and in the power relations that may exist in the socio-cultural system. Data will be collected directly in people's homes through observations and interviews with 10 people with cardiovascular disease. For each person, the data collection will take place over three days and will represent approximately 210 h of observation. This protocol was registered in the Research Register on 30 June 2021 and its number is 6933. This study will explore strategies for developing an enabling environment for people living with heart disease and eventually provide recommendations for nursing practices in terms of support.

Nurses play an important role in the management of chronic diseases. Here, we discuss the components of a novel system aimed at empowering patients living with chronic diseases, such as chronic obstructive pulmonary disease (COPD), in a context of precariousness for patients and health personnel, including nurses. This project aimed to evaluate the impact of nursing consultation and remote monitoring on the quality of life in patients with COPD. Two essential elements were linked to promote patient empowerment, which included a network of relationships among the community, hospital, and academic institutions as well as the promotion, contextualization, and co-management of therapeutic education programs among patients. Our results are applicable to all countries with vulnerable populations., Competing Interests: The authors declare no conflict of interest.

Urinary incontinence (UI) is a major public health problem. Although trivialized, it affects nearly 9% of the world's population and its prevalence increases with age. It affects many people living in nursing homes. In the literature, there is a lot of information on its symptoms, risk factors and therapeutic approaches, but its social representations are rarely studied. The objective of this qualitative focus-group study is to understand the social representations of urinary incontinence of caregivers of institutionalized elderly people, but also of the general population. Seven focus groups were organized with 41 participants. The data collected were analyzed both manually and using Atlas.Ti software. For caregivers and the general population, urinary incontinence remains a misunderstood and disturbing subject: judged as too intimate, embarrassing, and shameful, it is even considered uninteresting by those who are not affected, with some going so far as to make fun of those affected. It is also represented as a real difficulty for relationships: it can be a source of conflict, but also of questioning by the role of caregiver. However, it is also represented as a means of increasing the empowerment of the residents concerned, thanks to the choice of their means of protection. This study has enabled us to gain a deeper understanding of the social representations of caregivers and the general population on urinary incontinence in the elderly, but also to highlight the various preventive and educational actions that could be taken to improve the management of this health problem. It is part of a larger research program that aims at understanding the representations of urinary incontinence of caregivers, the general population, but also of course, of residents in nursing homes and their carers.

Introduction: Urinary incontinence (UI) is a major public health problem. It affects many institutionalised elderly people. In the literature, the phenomenon is well defined. Its frequency, risk factors, individual and social costs, as well as the different therapeutic approaches, are described. However, there are few publications on its representations, both from the point of view of the patient and that of the carers. However, the literature shows that a better understanding of the social representations of this phenomenon could be a vector for improving care. We aim at understanding the perception of UI, to model its representations and to understand and characterise the logics of action in terms of protection., Methods and Analysis: This will be a mixed-method concurrent study with a quantitative and a qualitative component. Data will be collected through 100 semistructured interviews, 8 focus groups and 10 000 surveys from 4 populations: institutionalised elderly people, caregivers, carers and individuals from the general population. The qualitative part will be analysed both manually and with ATLAS.Ti software, which will be used to centralise and organise all qualitative data collected. For the analysis of the quantitative part, a descriptive statistical analysis and a logistic regression type association will be carried out. These analyses will be enforced using R software. Then, an overlay and combination of quantitative and qualitative information for the triangulation analytical approach will be carried out. The study started in August 2021 and will continue until June 2022., Ethics and Dissemination: The study protocol was approved by the Descartes ethics and research committee on 1 June 2021, with the IRB number 00012021-43. The findings will be published in peer-reviewed journals and presented at national and international conferences., Trial Registration Number: This protocol was registered with the Research Registry on 12 July 2021 and is numbered researchregistry6965., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Lebanon has the fastest growing older adult population in the Arab region but few social resources to address their needs. No studies have explored the experience of patients with chronic obstructive pulmonary disease (COPD) in Lebanon., Aims: Exploring the experiences of individuals living with COPD in Lebanon., Method: Using a descriptive phenomenological research design, qualitative individual semi-structured interviews were conducted with COPD patients living in Lebanon, between May 2019 and September 2019., Results: Fifty participants agreed to be interviewed. The majority were men (56%) and had moderate COPD (40%). Mean age was 71.5 (standard deviation 9.0) years. We found that COPD affects three dimensions of patients' lives: educational, organizational and psychosocial., Conclusion: The results highlight the need for multidisciplinary strategies to address the needs of people with COPD in Lebanon, including their caregivers. Strategies include patient education and the development of new methods to facilitate and promote partnership between health care professionals, COPD patients and their caregivers., (Copyright © World Health Organization (WHO) 2022. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Conflicts between residents' families and professionals are frequently described in nursing homes. This phenomenological study aims to describe and understand the experience, expectations and needs of residents' relatives. Forty-three interviews were conducted in six selected nursing homes. The main expectations voiced by the 43 relatives was that the nursing home respect the "humanity" of their loved one and improvements in communication between the family and staff. This study yielded original findings that are poorly described in the literature, namely the need for psychological assistance for relatives when loved ones enter a nursing home. Relatives wanted the administrative formalities to be separated in time from the time when their loved one entered the home. They wanted psychological support and training to better understand their loved one's illness. Finally, relatives strove to be a collaborative partnership with the staff team in the nursing home. These expectations fit the strengths-based philosophy. Training professionals, directors and leaders to apply this paradigm shift could improve the relationship between relatives and nursing home care.

Background: Nurses face multiple stressors that can influence their lifestyle, thus affecting their health status. Scarce are the scientific data on the nutritional status of nurses, especially during health crises. The aim of this study was to assess the impact of the COVID-19 pandemic on the eating habits of hospital nurses in the context of an exceptional economic situation in Lebanon., Methods: A cross-sectional study was conducted using a web-based questionnaire, targeting a non-random sampling of frontline nurses using the snowball technique. Descriptive and bivariate analyses were carried out. The population of the study included all registered nurses working in the Lebanese hospitals. A total of 533 nurses completed the questionnaire; 500 surveys were selected after excluding the ones presenting conditions that may affect their eating behavior., Results: The majority of the respondents were women (78.6%) with a mean age of 33 years [18-60] [SD,7.44 years]. Most of them (57.6%) had a crowding index ≥1. The consumption of different food groups decreased during these crises. There was a significant correlation between stress and deterioration of healthy food consumption, which provides beneficial nutrients and minimizes potentially harmful elements, especially for meat (OR 2.388, CI 1.463 to 3.898, P < 0.001). The decrease in monthly income showed a real impact on the consumption of healthy food such as meat (OR 2.181, CI 1.504 to 3.161, P < 001), fruits (OR 1.930, CI 1.289 to 2.888, P = 0.001), and milk and dairy products (OR 1.544, CI 1.039 to 2.295, P = 0.031)., Conclusions: The pandemic and in particular the economic crisis has changed the consumption of healthy food among hospital nurses in Lebanon. Similar research and support may be extended to include other frontline health care workers., (© 2022. The Author(s).)

Background: Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management., Methods: An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used., Results: A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment., Conclusion: This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised., (© 2021. The Author(s).)

Dissensions between residents' families and professionals are frequently described in nursing homes. This phenomenological study aims to describe and understand experience, expectations and needs of residents' relatives. Forty-three interviews were conducted in the 6 selected nursing homes. The main expectations from the 43 relatives was the respect of "humanity" of their loved one by the nursing home and improving family-staff communication. This study yielded original findings that are poorly described in the literature, namely the need for psychological help for relatives when their love one enters the nursing home. Relatives wanted the administrative formalities to be separated in time from the moment of their loved one's admission. They wanted psychological support and training to better understand their loved one's illness. Finally, relatives aimed to be a collaborative partnership with the team in the nursing home. These expectations fit the Strengths-Based philosophy. Thus, training professionals, directors and leaders to apply this paradigm shift could improve the relationship between relatives and nursing home care.

The multitude of national strategies used against the COVID-19 pandemic makes it necessary to review and synthesize them in order to identify potential gaps and shortcomings, and to help prioritize future control efforts. This systematic mapping review is aimed at identifying the coronavirus pandemic management strategies adopted by France, Tunisia, and Germany during the early stage of the COVID-19 outbreak. A set of government websites in addition to the PubMed and Google Scholar databases were searched to identify scientific articles and institutional documents related to the national strategies of the three countries up until July 2020. The references included were mapped and narratively synthesized based on the pillars of the Monitoring and Evaluation Framework of the Strategic Preparedness and Response Plan defined by the World Health Organization. Of the 2765 records screened, 65 documents were included in the study. The analysis of these documents showed that Germany was the first country to implement mass screening of cases and that France was the first country to implement measures to impose general containment at the national level. It also showed that Tunisia was the only country to have imposed the confinement of passengers on repatriation flights in dedicated containment centers and at the expense of the state.

A better understanding of the expectations and needs of the families of nursing home residents is needed for a constructive and sustainable relationship of mutual trust. The objective of this study was to understand the expectations of families of nursing home residents described in the literature. A systematic integrative review of the literature was conducted. After a rigorous selection made by two researchers, independently, 53 articles were selected out of 1,094 results. The expectations of families are quality care, consideration complying with human dignity of the resident, collaboration, honesty, and mutual confidence that ties together families, staff, and physicians. This study reveals that families consider themselves as a strength for a resident's support services, in line with Gottlieb's strength-based approach. This approach offers promising implications for practice and for a new type of management in nursing homes based on strong values.

Background: Nutrition surveys in many refugee settings routinely estimate anemia prevalence in high-risk population groups. Given the lack of information on anemia design effects (DEFF) observed in surveys in these settings, the goal of this paper is to better understand the magnitude and distribution of DEFFs and intracluster correlation coefficients (ICCs) in order to inform future survey design., Methods: Two-stage cluster surveys conducted during 2013-2016 were included if they measured hemoglobin in refugee children aged 6-59 months and/or non-pregnant women aged 15-49 years. Prevalence of anemia, anemia DEFFs and ICCs, mean cluster size, number of clusters, and total sample size were calculated per-survey for non-pregnant women and children. Non-parametric tests were used to assess differences and correlations of ICC and DEFF between women and children and inter-regional differences., Results: Eighty-seven unique cluster surveys from nine countries were included in this analysis. More than 90% of all surveys had ICC values for anemia below 0.10. Median ICC for children was 0.032 (IQR: 0.015-0.048), not significantly different from that observed for non-pregnant women for whom the median was 0.024 (IQR: -0.002-0.055). DEFFs were significantly higher for children [1.54 (IQR: 1.21-1.82)] versus women [1.20 (IQR: 0.99-1.46)]. Regional differences in DEFFs and ICCs were observed., Conclusions: Both ICCs and DEFF were relatively small for both non-pregnant women and preschool children and fall in a narrow range. Differences in ICCs between women and children were non-significant, suggesting similar inter-cluster distributions of anemia; significant differences in DEFF were likely attributable to differing cluster sizes. Given regional differences in both ICCs and DEFFs, location-specific values are preferred. However, in the absence of other context-specific information, we suggest using DEFFs of 1.4-1.8 if mean cluster size is around 20, and DEFFs of 1.2-1.4 if mean cluster size is around 10., Competing Interests: The authors have declared that no competing interests exist.

Due to their frontline position to fight the coronavirus disease 2019 (COVID-19), the professional and personal life of nurses was severely disrupted. To understand and describe their lived experiences and perceptions during the pandemic's first wave in France, we interviewed 49 nurses, including 16 nursing students, and 48 of their family members from June to July 2020. Using a purposeful sampling, the semi-structured interviews were scripted according to Abric's method with probing questions. The interview analysis led to the identification of six paradoxical perceptions concerning the pandemic's consequences: the Silence Paradox, the Hero Paradox, the Workforce Paradox, the Learning Paradox, the Symbolic Exchange Paradox, and the Uncertainty Paradox. However, despite different experiences, the nurses perceived their frontline position both as a burden jeopardizing their safety and well-being and as a spotlight of nurses' tough working conditions. Indeed, because they were in the frontline position, nurses and nursing students were psychologically vulnerable, even more so when they felt alone and inadequately protected. Besides, their families were vulnerable too, as they were also exposed to the consequences of the nurses' frontline engagement. Thus, to preserve their safety and well-being, institutions should also provide them with better organizational support and inclusive leadership, without neglecting their families.

Abstract: Hemangioblastoma (HB) is the most common primary intra-axial posterior fossa tumor in adults and is a benign vascular neoplasm. We report the case of a 73-year-old man suffering from biochemical recurrence of prostate cancer where intense overexpression of prostate-specific membrane antigen (PSMA) was observed in HB in a PSMA PET/CT. Overexpression of PSMA in tumor-associated vascular structures has been proposed as an explanation of PSMA ligand uptake in several nonprostatic tumors. Given the pathological nature of HB, this mechanism may explain the intense overexpression of PSMA observed in present case., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

In nursing homes, due to time constraints, lack of communication can influence the quality of information exchanged, which influences the outcomes of healthcare for residents. Nurses' proximity to the nursing home resident, their knowledge, and skill serve as an opportunity to communicate and facilitate patient-centered goals and improve treatment decision-making. Concepts within the cybernetic communication literature entail systemic interactive relationships that enable the sharing of knowledge and expertise. These interactions are based on nursing's theoretical knowledge, clinical judgment, and empowerment and are based on patient-centered goals.

To support reflective skills development, French nursing students write analyses of professional situations (Situation Analysis) experienced during their practice. Sixteen nursing schools in Paris have developed a common framework to support and evaluate students on these skills. The aims of the study were to assess and understand the implementation of the Situation Analysis in French nursing schools as well as their effects on students' learning. A quantitative approach was based on two questionnaires: students (n = 1525, 27.6% of participation) and teachers (n = 131, 49.2%). The results showed that there were variations in teaching of situation analysis. There were correlations between the perception of learning and the modalities of implementation. Not always easy to choose, the situations described were authentic for 97.8% of students, concerned mainly their own practice and relationship with patients. Emotional situations were less frequent. Feedback was generally present and encouraging, but not enough on the students' self-evaluation skills. Slightly more than half of students and teachers were satisfied of the situation analysis. Both of them made positive and negative comments. The study highlights what can be improved in teaching to increase student's learning through situation analysis, for example teamdefined objectives., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Due to demographic change within an aging population as announced by the WHO, the involvement of caregivers is essential. Caregivers are required to change their roles within the family unit. Such life transitions experienced by caregivers to people confronted with dementia-type pathologies are sometimes difficult, necessitating the acquisition and development of certain skills. Few studies have shown that caregivers develop specific and essential skills to promote quality care and safety. To characterize their skills, there is a need to identify the abilities, knowledge, resources, obstacles and constraints that contribute to caregivers' transitions. The research question for this study was: What skills do caregivers use to care for their loved one with dementia?, Methods: Qualitative observational research based on the epistemological paradigm of socioconstructivist knowledge was conducted. The study was carried out in the canton of Geneva and recruitment was carried out through the participation of the Alzheimer's association and the association for the support and assistance of elderly people in medical and social institutions and their families (APAF). Observations and semi-structured interviews were conducted in the homes of 14 family carers caring for their loved one with dementia. The observations were transcribed on observation grids and the interviews were recorded. Subsequently, according to the classic distinction of Denzin (Interpretive interractionism, 2001), we analysed the observation notes and verbatims, then as recommended by Miles et al. (Qualitative data analysis: a methods sourcebook, 2014), two researchers triangulated the results., Results: The results identified five types of situations regularly experienced by caregivers. The study characterized 11 skills that caregivers use to cope with their daily lives. The learning process and maladaptive behaviours in caring for their loved ones with dementia were also highlighted., Conclusion: This study was able to point out that today's caregivers have developed more competency than their predecessors. This evolution can be explained by new paradigms of care requiring caregivers to be more involved. Although some caregivers need training, others through their experiences can act upon and provide knowledge. To improve the quality and safety of care for people with dementia, this expertise can be the subject of partnerships between caregivers and health care staff.

Elderly people are the main victims of discontinuities in their treatment because they require appropriate care. The current system is no longer able to satisfactorily cover all these complex and increasingly important demands due to the lengthening of life expectancy and the profound crisis affecting health professionals. Feedback from the experience of nurses with a Master's degree in Advanced Practice in Gerontology since 2012 shows that in this new and critical context, they are a serious solution to be adopted by the legislator to meet these public health challenges., (Copyright © 2020. Published by Elsevier Masson SAS.)

Background: Chronic obstructive pulmonary disease (COPD) has a significant impact on quality of life and is costly to the health care system. It has been demonstrated that a self-management program improves quality of life, but programs are not universally available and telehealth interventions can provide home-based support, but have mixed results., Aim: The aims of this study are to (1) assess the feasibility and acceptability of a 6 weeks' educational program related to self-management with remote monitoring for Lebanese COPD patients; (2) pre-test its impact on quality of life, emergency visits, and rate of rehospitalization, and (3) to make recommendations for a future randomized trial., Methods: Validated questionnaires will be adapted to meet the context of our study in terms of acceptability, adoption, adequacy, fidelity, cost, and coverage. The impact of this program on quality of life will be measured with the COPD assessment test (CAT) and the COPD clinical questionnaire (CCQ), and the Hospital Anxiety and Depression (HAD) scale will be used to measure anxiety. All measures will be delivered pre- and post-intervention. To evaluate the impact of our program on the rate of hospitalization and emergency visits, the number of hospitalizations and emergency room visits during the year preceding the intervention will be collected from the hospital register of each participant., Discussion: This study is the first to evaluate the application of telehealth to optimize COPD management in Lebanon. The results of this study will provide evidence regarding the efficacy and feasibility of this approach for Lebanese patients with moderate to severe COPD.

Introduction: To date, little guidance is available to support the development of effective programs for improving self-management in chronic obstructive pulmonary disease (COPD) patients. Yet, given the global burden of this disease, it seems important to identify the components of a self-management program that are effective in terms of health outcomes for COPD patients., Objectives: This review aims to identify effective elements of a self-management program for COPD patients, the ones that may impact quality of life, emergency visits, and rehospitalization rates., Material and Methods: A systematic literature search of three databases (Medline, Cochrane, and CINHAL) was conducted to identify studies on self-management of COPD, with three limiting parameters: published in twelve years prior to November 2019, in English or French, and including patients over 40 years old. Prisma was used to guide the work process., Results: The search yielded 361 studies from the three electronic databases by applying limiting criteria, and after removing duplicates. Sixty-five articles were identified as relevant based on their titles and abstracts. However, 16 documents were retained after full reading. The analysis of the included articles identified 4 components in self-management programs for COPD patients: initiation stage of the intervention, educational sessions, support and monitoring methods., Conclusions: Although the combination of self-management program initiation, educational sessions, support and monitoring methods were effective, further research is needed to identify the components that have better impact on COPD patients' skills and quality of life.

Introduction: Displaced persons have a unique risk for developing anaemia due to often limited diets, overcrowding, new infections and inadequate sanitation and hygiene. The lack of anaemia prevalence estimates among the displaced inhibit global planning for anaemia reduction., Methods: We analysed population representative, cross-sectional nutrition surveys from 2013 to 2016 conducted by the United Nations High Commissioner for Refugees and partner agencies. Included surveys measured haemoglobin concentration among children 6-59 months, non-pregnant women 15-49 years, or both groups. For each survey, we calculated mean haemoglobin and prevalence of total anaemia (<110 g/L in children, <120 g/L in women), and classified public health severity following WHO guidelines. Pearson correlations between indicators from women and children surveys were calculated where both subpopulations were measured., Results: Analysis included 196 surveys among children and 184 surveys among women from 121 unique refugee settings in 24 countries. The median prevalence of total anaemia in children and women was 44% and 28%, respectively. Sixty-one per cent of child surveys indicated a problem of severe public health importance compared with 25% of surveys in women. The prevalence of total anaemia in children and women was strongly correlated (ρ=0.80). Median prevalence of total anaemia was approximately 55% greater and mean haemoglobin was 6 g/L lower among children age 6-23 months compared with children 24-59 months. West and Central Africa region had the highest median prevalence of anaemia both in women and children., Conclusion: While the burden of anaemia is high among the displaced, it mirrors that of the general population. Haemoglobin should continue to be measured in nutrition surveys in refugee settings. Sustained, multisectoral efforts to reduce anaemia are needed, with specific focus on children under 2 years of age and refugee settings in the West and Central Africa region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses' influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods: An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results: Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents' infections. Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest. Conflict of interests: the authors declare no conflict of interests., (©Copyright: the Author(s), 2019.)

Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin's analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors' responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504.

Background: In the context of an ageing population and an increase in the appearance of chronic diseases, the commitment of caregivers makes it possible for people confronted with disease to remain at home. Over time, they need support to overcome their difficulties. They also show a need for recognition for their participation in the economic maintenance of the health system. To promote this support, so-called "win/win" partnerships are envisaged. Research is needed to identify the building blocks of an innovative intervention., Methods: A cross-sectional descriptive study was carried out with health institutions in the canton of Geneva to identify the proportion of institutions with a positive opinion on partnership with caregivers. It has also identified potential partnerships with caregivers of people facing dementia and possible compensation in exchange for the provision of their skills. Descriptive statistics are presented according to their frequencies and relative percentages (categorical variables), as well as by their mean, standard deviation and median (continuous variables). Logistic regression models were used to assess the factors associated with a favorable opinion towards win/win partnerships., Results: The proportion of executives of health-related institutions with a positive opinion of partnership with caregivers is high: 74.7% (95% CI: 64.8-83.1%). Several types of potential partnerships have been identified between health institutions and caregivers. Areas in which certain activities have been identified as being able to be carried out by caregivers include governance, care, provision of services, accompaniment and support, training and research. Types of compensation for caregivers have also been highlighted., Conclusion: This study shows that some areas activities of health facilities in the canton of Geneva could be the subject of win-win partnerships with caregivers of people with dementia. Positive view of health executives on partnership with caregivers is encouraging. In the future, innovative projects can emerge to meet the needs of each party.

Antimicrobial resistance is a major public health threat worldwide. Some authors have suggested that end-users of nursing homes have an influence on antibiotic prescribing. The objective of this study is to describe the views of end-users and professionals on residents' behavior towards antibiotic therapy in terms of knowledge, beliefs, and attitudes towards this drug class and its prescribing process. This is a concurrent mixed methodology study using questionnaires and semi-directive individual interviews with nursing homes residents, nurses, and doctors practicing in these facilities. The questionnaires analyzed were collected from 35 residents (24.3%) and 109 nurses (75.7%). The qualitative interview involved 26 of total participants that agreed to be interviewed. We noticed misconceptions being held by the residents regarding the antibiotic resistance phenomenon. Additionally, nurses were not considered as a source of information about antibiotics. Nurses and residents had conflicting opinions about residents requesting antibiotics, and the findings depict a stereotypical view of the nurse profession as a reflection of a cognitive representation. The authors conclude that, despite many campaigns, further efforts are needed to tackle antimicrobial resistance. Initiatives could include raising awareness about antimicrobial resistance, clarifying the role of nurses, and communicating well with residents about their needs in nursing homes.

Elderly residents in long-term care facilities (LTCFs) constitute a population noted to have a large number of medications prescribed and administered. The aim of this article is to explore the nursing role for medication management, with an emphasis on antimicrobial stewardship, guided by disciplinary knowledge of King's theory of goal attainment and skill-based medication knowledge. The outcome is a nursing workforce truly engaged in working with interdisciplinary colleagues and focusing on care planning that includes medication management to improve the health status of residents in long-term care facilities.

Introduction: A changing and aging population contributes to an increase of Alzheimer-type or related dementia. Encouraged by health policies, home care for patients suffering from these conditions is often dependent on their caregivers' contribution. The demands of such a role may weaken the caregivers and cause them a feeling of burden requiring the recourse to periods of respite. An ancillary study of a research program carried out in the Geneva agglomeration, our study aims to characterize, for the caregivers of patients with dementia, the determinants of a recourse to the devices of respite., Method: Qualitative research conducted by focus groups of caregivers of patients with dementia. Three focus groups were conducted, with 12 participants in the cities of Geneva (Switzerland) and Rouen (France)., Results: Our study notes the concomitance of the evolution of the assisted person's disorder and the emergence of a feeling of burden on the caregiver, related to the duration and the intensity of the aid provided. Our results help to identify the determinants of a recourse to respite periods for the caregiver or institutions and to modelize these determinants., Conclusion: Devices of respite must be coordinated and adapted to the needs of caregivers, both in terms of format and quality, in order to facilitate the use of the most vulnerable populations and to avoid too late recourse.

Introduction: Urinary tract infection (UTI) is common in elderly living in nursing homes, and antibiotics prescription for this infection is particularly challenging. In these facilities, due to the absence of on-site physicians, nurses play an essential role when an infection is suspected, as they are the ones who collect and communicate by phone all the information needed by the physician for the decision-making process. In that context, our study aims to reduce antibiotic consumption in nursing homes, using a multimodal intervention, by strengthening nurses' involvement during the process of prescription for UTI., Methods/design: This is a planned 2-arm cluster randomized study of 40 nursing homes randomly assigned either to the control group or to the intervention group, using a 1:1 ratio. The intervention consists of reinforcing the nurses' knowledge concerning antibiotics and UTI; assist their clinical judgment using a decision aid diagram; improving their communication skills with the residents, their relatives, and the prescribers; and also increasing their involvement in the intervention' process by organizing a competition opposing the nursing homes of the interventional group to select additional intervention tools., Analysis: The main outcome is the reduction of the relative frequency of antibiotics prescription for UTIs in the interventional group., Ethics and Dissemination: Ethics approval was obtained from the French Committee for the Protection of Persons (N. 19.01.04/SI CNRIPH 18.12.07.48123). An article including the main outcome will be submitted to a peer review journal.

Background: Due to the increase in the number of people with dementia, relatives often provide in-home care. This care constitutes a cornerstone of the healthcare system, and maintaining these caregivers' well-being is therefore of paramount importance. Although respite interventions are generally considered an effective support system, they tend to be underutilized. The aim of this integrative literature review is to highlight the factors that promote and impede the use of respite interventions., Methods: Searches were conducted on the PubMed and CINAHL databases for studies of respite interventions from 1980 to 2016, and they yielded 51 articles of relevance., Results: Analysis of these articles revealed modifiable and immutable factors that influence the use of respite. The most cited topic categories in the literature were attributes of respite services and workload managed by caregivers, which is characterized by the onset of burden., Conclusion: The factors promoting or impeding the use of respite interventions identified by our analysis highlight the need to adapt respite service attributes and use caregivers' skills to foster the partnership between healthcare teams and caregivers and to ensure the accompanying dyad's quality and safety., Competing Interests: Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction: This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV., Methods: This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method., Results: Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance., Conclusion: Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed., Competing Interests: The authors declare no competing interests.

Background: Corticosteroids are often preferred over enteral nutrition (EN) as induction therapy for Crohn's disease (CD). Prior meta-analyses suggest that corticosteroids are superior to EN for induction of remission in CD. Treatment failures in EN trials are often due to poor compliance, with dropouts frequently due to poor acceptance of a nasogastric tube and unpalatable formulations. This systematic review is an update of a previously published Cochrane review., Objectives: To evaluate the effectiveness and safety of exclusive EN as primary therapy to induce remission in CD and to examine the importance of formula composition on effectiveness., Search Methods: We searched MEDLINE, Embase and CENTRAL from inception to 5 July 2017. We also searched references of retrieved articles and conference abstracts., Selection Criteria: Randomized controlled trials involving patients with active CD were considered for inclusion. Studies comparing one type of EN to another type of EN or conventional corticosteroids were selected for review., Data Collection and Analysis: Data were extracted independently by at least two authors. The primary outcome was clinical remission. Secondary outcomes included adverse events, serious adverse events and withdrawal due to adverse events. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). A random-effects model was used to pool data. We performed intention-to-treat and per-protocol analyses for the primary outcome. Heterogeneity was explored using the Chi 2 and I 2 statistics. The studies were separated into two comparisons: one EN formulation compared to another EN formulation and EN compared to corticosteroids. Subgroup analyses were based on formula composition and age. Sensitivity analyses included abstract publications and poor quality studies. We used the Cochrane risk of bias tool to assess study quality. We used the GRADE criteria to assess the overall quality of the evidence supporting the primary outcome and selected secondary outcomes., Main Results: Twenty-seven studies (1,011 participants) were included. Three studies were rated as low risk of bias. Seven studies were rated as high risk of bias and 17 were rated as unclear risk of bias due to insufficient information. Seventeen trials compared different formulations of EN, 13 studies compared one or more elemental formulas to a non-elemental formula, three studies compared EN diets of similar protein composition but different fat composition, and one study compared non-elemental diets differing in glutamine enrichment. Meta-analysis of 11 trials (378 participants) demonstrated no difference in remission rates. Sixty-four per cent (134/210) of patients in the elemental group achieved remission compared to 62% (105/168) of patients in the non-elemental group (RR 1.02, 95% CI 0.88 to 1.18; GRADE very low quality). A per-protocol analysis (346 participants) produced similar results (RR 1.04, 95% CI 0.91 to 1.18). Subgroup analyses performed to evaluate the different types of elemental and non-elemental diets (elemental, semi-elemental and polymeric) showed no differences in remission rates. An analysis of 7 trials including 209 patients treated with EN formulas of differing fat content (low fat: < 20 g/1000 kCal versus high fat: > 20 g/1000 kCal) demonstrated no difference in remission rates (RR 1.03; 95% CI 0.85 to 1.26). Very low fat content (< 3 g/1000 kCal) and very low long chain triglycerides demonstrated higher remission rates than higher content EN formulas. There was no difference between elemental and non-elemental diets in adverse event rates (RR 1.00, 95% CI 0.63 to 1.60; GRADE very low quality), or withdrawals due to adverse events (RR 1.29, 95% CI 0.80 to 2.09; GRADE very low quality). Common adverse events included nausea, vomiting, diarrhea and bloating.Ten trials compared EN to steroid therapy. Meta-analysis of eight trials (223 participants) demonstrated no difference in remission rates between EN and steroids. Fifty per cent (111/223) of patients in the EN group achieved remission compared to 72% (133/186) of patients in the steroid group (RR 0.77, 95% CI 0.58 to 1.03; GRADE very low quality). Subgroup analysis by age showed a difference in remission rates for adults but not for children. In adults 45% (87/194) of EN patients achieved remission compared to 73% (116/158) of steroid patients (RR 0.65, 95% CI 0.52 to 0.82; GRADE very low quality). In children, 83% (24/29) of EN patients achieved remission compared to 61% (17/28) of steroid patients (RR 1.35, 95% CI 0.92 to 1.97; GRADE very low quality). A per-protocol analysis produced similar results (RR 0.93, 95% CI 0.75 to 1.14). The per-protocol subgroup analysis showed a difference in remission rates for both adults (RR 0.82, 95% CI 0.70 to 0.95) and children (RR 1.43, 95% CI 1.03 to 1.97). There was no difference in adverse event rates (RR 1.39, 95% CI 0.62 to 3.11; GRADE very low quality). However, patients on EN were more likely to withdraw due to adverse events than those on steroid therapy (RR 2.95, 95% CI 1.02 to 8.48; GRADE very low quality). Common adverse events reported in the EN group included heartburn, flatulence, diarrhea and vomiting, and for steroid therapy acne, moon facies, hyperglycemia, muscle weakness and hypoglycemia. The most common reason for withdrawal was inability to tolerate the EN diet., Authors' Conclusions: Very low quality evidence suggests that corticosteroid therapy may be more effective than EN for induction of clinical remission in adults with active CD. Very low quality evidence also suggests that EN may be more effective than steroids for induction of remission in children with active CD. Protein composition does not appear to influence the effectiveness of EN for the treatment of active CD. EN should be considered in pediatric CD patients or in adult patients who can comply with nasogastric tube feeding or perceive the formulations to be palatable, or when steroid side effects are not tolerated or better avoided. Further research is required to confirm the superiority of corticosteroids over EN in adults. Further research is required to confirm the benefit of EN in children. More effort from industry should be taken to develop palatable polymeric formulations that can be delivered without use of a nasogastric tube as this may lead to increased patient adherence with this therapy.

Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and its partner organisations implement blanket supplementary feeding programmes using a range of special nutritional products as one approach to address these issues. The evidence base for the efficacy and effectiveness of a small quantity lipid-based nutrient supplement, Nutributter®, in reducing stunting and anaemia is limited. Secondary data analysis was used to assess the effectiveness of Nutributter® distribution on anaemia and stunting in children aged 6-23 months (programme target group) and 6-59 months (the standard age group sampled in routine nutrition surveys). Analysis was conducted using routine pre and post-intervention cross-sectional nutrition survey data collected between 2008-2011 in five refugee camps in Kenya and Djibouti. Changes in total anaemia (Haemoglobin<110g/L), anaemia categories (mild, moderate and severe), and stunting (height-for-age z-score <-2) were explored using available data on the Nutributter® programme and contextual factors. A significant reduction in the prevalence of anaemia in children aged 6-23 months and 6-59 months was seen in four of five, and in all five camps, respectively (p<0.05). Reductions ranged from 12.4 to 23.0, and 18.3 to 29.3 percentage points in each age group. Improvements were largely due to reductions in moderate and severe anaemia and occurred where the prevalence of acute malnutrition was stable or increasing. No change in stunting was observed in four of five camps. The replicability of findings across five sites strongly suggests that Nutributter® distribution was associated with a reduction in anaemia, but not stunting, among refugee children in the Horn of Africa. Benefits were not restricted to the 6-23 month target group targeted by the nutrition programme. However, even following this intervention anaemia remained a serious public health problem and additional work to define and evaluate an effective intervention package is warranted.

Aim: To describe the impact of a mandatory internal mobility policy on nurses working in French state-funded health establishments., Background: Public hospitals in France rely on the internal mobility of nursing staff to respond to organisational needs, to reduce costs and to increase productivity. However, there is very little data on the impact of such management practices on the nurses themselves., Method: A cross-sectional study, including 3077 nurses from 35 hospitals in the region of Paris, was conducted. Data were collected using a validated self-assessment questionnaire., Results: Forty per cent of French nurses are required to work in different units. This mobility differs according to individual characteristics [age (P = 0.04), length of service (P = 0.017)] and type of environment [hospital (P < 0.0001), specialty (P < 0.0001)]., Conclusion: We can distinguish two types of approaches for implementing a mandatory staff nurse mobility policy. The first is an event that is regular, planned and lasts for several days. The second is an event that is irregular, short and organised the day before or the day of the change. Overall, while nurses are dissatisfied with all types of mandatory unit changes, this dissatisfaction is primarily a result of the irregular mobility events., Implications for Nursing Management: This study demonstrates the importance of implementing a planned inter-unit mobility event and proposes recommendations for this type of implementation., (© 2016 John Wiley & Sons Ltd.)

Healthcare research is developing in France, notably through hospital nursing and paramedical research programmes. Few research projects involve the patients as investigators as part of collaborative studies. These approaches favour the involvement of all the players concerned. Thereby, healthcare research, due to its holistic dimension, encourages the development of collaborative practices between researchers, patients and caregivers., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

For several decades, hospitals have been faced with the voluntary departures of nurses. In parallel to this external mobility, internal mobility is also on the rise and is not always initiated by the nurse. This new mode of management has repercussions for professionals, patients as well as for the quality of care., (Copyright © 2015. Published by Elsevier Masson SAS.)

Background: The development of nursing research capacity and interactions with cultural and structural issues is at various stages throughout Europe. This process appears to be remarkably similar irrespective of the country. Sweden has developed this capacity since the 1990s, whereas France is experiencing a transition. Nevertheless, knowledge about how nurses conceive their learning about nursing research and transitioning toward being researchers is scarce., Objectives: The aim of this study was to explore French and Swedish RNs' conceptions of research education and educational passage toward research and to describe how learning research contributes to the understanding of their norms and practices., Design: A phenomenographic approach was used to understand and describe the qualitatively different ways in which French and Swedish RNs conceive research and its apprenticeship., Settings and Participants: A purposive maximum variation sampling of five French and five Swedish Nurse Researchers with PhDs., Methods: Individual in-depth interviews conducted in France and Sweden between November 2012 and March 2013 were analysed using phenomenography., Findings: The analysis revealed one main category, "Organisational factors to sustain individual apprenticeship". Three descriptive categories have emerged from the data and its variations amongst French and Swedish nurses: (1) entrance into research--modes of commitment; (2) nurses' engagement--the need for dedicated support; and (3) research as the means to resolve nursing situations., Conclusions: This study demonstrates how registered nurses have integrated nursing and researcher roles following different efficient paths. Education in nursing research is part of the strategy needed for the development of nursing research and is supported by the integration of research and practice., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Aim: To report from a study aimed at illuminating how French Registered Nurses experience and engage in nursing research in clinical practice., Background: Nursing research in France is mainly conducted by nurses working at clinical research units rather than by dedicated nurse researchers. Education, i.e. advanced degrees, in the field of nursing research is still in its infancy and not yet consistent with the international context. Outside France, the general perception is that nursing research is a unified part of professional nursing. Consequently, in-depth knowledge about how nurses in a French clinical context might experience and engage in nursing research is still lacking., Design: The design of this study was influenced by an ethnographic approach as described by the French anthropologists Beaud and Weber., Method: Data, participatory observations, field notes and interviews (n = 6) were collected in a teaching hospital between April-August 2012. The field consisted of a wound-care unit and clinical research units. Collected data were analysed based on Beaud and Weber's description of analysis., Results: Three beliefs were identified: being a unified part of a research team, being an integral part of 'crosswise - across' activities and being part of research activities., Conclusion/implication for Research: Commitment to nursing research was strengthened by patient-related issues. Based on this context, nursing research would likely benefit from the support of a naturalized reciprocity between clinical practice and research., (© 2014 John Wiley & Sons Ltd.)

Clinical research is of major importance to today's society, as scientific evidence is increasingly demanded as a basis for progress, whether this involves developing new healthcare products, improving clinical practice and care protocols or progress in prevention. Clinical research therefore requires professionals who are both experienced and increasingly well trained. Against this background, allied health professionals are becoming involved more and more, both as team members supporting clinical research projects and as managers or coordinators of projects in their own field. Clinical research activities provide an ideal opportunity for continuing professional development. All of this means that the professional skills of the allied health professions and clinical research support professions must be enhanced, their role promoted in the context of lecturer status and in the longer term, their status recognised by the supervisory authorities., (© 2014 Société Française de Pharmacologie et de Thérapeutique.)

Nursing in France is undergoing a transition. In 2009, the preregistration nursing education program was reformed in line with the European Bologna Process, bringing nursing education to the universities. In 2010, the French Programme Hospitalier de Recherche Infirmière, the first national French nursing research funding program, was launched by the French Health Ministry. Of the 149 French research proposals submitted by registered nurses in 2010 and 2011, 13 were mixed-method proposals. The registered nurse principal investigator argued for a complementary use of qualitative and quantitative methods. These trends highlight major issues regarding mixed-method and nursing research. We can reasonably assume that mixed-method research has a broad appeal for nurse scholars, particularly for the exploration of complex phenomena related to nursing. Moreover, the recent movement in the domain of nursing education and research experienced in France highlights the need for dedicated research education in the development of nursing research capacity., (© The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.)

Background: Stunting, acute malnutrition, and micronutrient malnutrition are persistent public health problems in refugee populations worldwide. In recent years there has been an increase in the availability and use of special nutritional products in emergency and development contexts to help address inadequate nutrient intakes from low-diversity diets. The availability of new special nutritional products, and the decision by the United Nations High Commissioner for Refugees (UNHCR) to use blanket supplementary feeding programs to prevent stunting and anemia, raised new challenges for designing, monitoring, and evaluating nutritional programs., Objective: To develop an Operational Guidance on the use of special nutritional products for the prevention of micronutrient malnutrition, stunting, and acute malnutrition in refugee populations. Methods. A literature review and a series of consultations with technical experts, operational organizations, and field staff were performed over a period of 2 years. The Operational Guidance was finalized and released in December 2011., Results: The Operational Guidance describes six stages for defining nutritionalproblems and identifying possible solutions; assessing and managing risks; testing acceptability and adherence, program design and implementation; and monitoring and evaluation. Key performance indicators are defined and a working nomenclature for new special nutritional products is described., Conclusions: The UNHCR Operational Guidance has filled an important gap in helping field staff deal with the opportunities and challenges of preventing undernutrition through the use of new products in blanket supplementary feeding programs. The need for further integration of guidance on selective feeding programs is discussed.

Shortened hospital stays, high patient acuity and technological advances demand that nurses increasingly make decisions under conditions of uncertainty and risk (Ebright et al., 2003). With rising trends towards out-patient care, nurses will need to perform complex problem-solving within a dynamic and changing environment for which there is not one clear solution (Schofield et al., 2010; Wolff et al., 2009). The development of sharp clinical reasoning skills, as well as skills in detection, monitoring, investigation and evaluation are therefore essential (Aitken et al., 2002). Yet few nursing students have long-term exposure to home-care and community situations. This is primarily due to scarce human resources and the time-consuming requirements of student supervision (Duque et al., 2008). When students are given the opportunity to experience home-care or community visits these tend to be unstructured leading to wide variations in their competencies. New pedagogical tools are needed to adequately and consistently prepare nurses for the skills they will need to care for patients outside acute care settings. Advances in Information and Communications Technologies (ICT) offer an opportunity to explore innovative pedagogical solutions that could help students develop these skills in a safe environment. A three-phased project is underway that aims to create and test a Serious Game to improve nurses' clinical reasoning and detection skills in home-care and community settings. The first phase of this project involves the development of a scenario, the game engine and the graphic design and will be the focus of this paper. The second and third phases will test the Serious Game as an educational intervention and will be reported in subsequent papers., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Nurses in clinical settings still do not fully rely on scientific knowledge to guide their practices and only rarely resort to the literature to find answers to their questions or clinical concerns. The sustainable implementation of projects that use knowledge founded on scientific evidence presents an important challenge that nursing research must address. The goal of this article is to present a strategy adopted by the Réseau infirmier et partenaires de soins (RI-PS) of the Université de Montréal (Québec). The strategy's aim is to promote the optimal and perennial use of scientific knowledge in clinical settings and to incorporate the use of best practices based on scientific evidence to their operating procedure. First, we will present a brief overview of the evolution of nursing research and its impacts, followed by an inventory of the success factors of the use of scientific knowledge in practical settings, and finally the presentation of a model, Implementation Science, on which the RI-PS strategy relies for its projects. We also outline the network and one of its developments, the knowledge transfer portal and healthcare partners (PES).

Background: The treatment of complicated urinary tract infection in children is still a matter of debate. In our hospital, antimicrobial treatment is initiated intravenously, and the duration of this treatment is adapted according to the results of a Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy., Aim: This study was conducted to evaluate retrospectively the frequency and the importance of late renal sequelae when treating intravenously for 7 days those patients with an abnormal acute DMSA., Methods: A review was conducted of the medical charts of all patients consecutively admitted between 2005 and 2008 with positive urine culture and clinical and biological evidence of complicated urinary tract infection (UTI)., Results: There were 144 patients (59 %) with abnormal early DMSA scintigraphy and 98 (41 %) with normal scintigraphy. The median duration of intravenous treatment was 7.0 days in the children with DMSA lesions and 5.0 days in those without lesions. Obvious renal sequelae were observed on late DMSA scintigraphy in 4 (6 %) out of the 65 patients with an abnormal early DMSA who came back for control scintigraphy., Conclusion: Sequelae of acute DMSA lesions observed during complicated UTI treated 7 days intravenously were infrequent. Whether the mode and duration of antimicrobial treatment might explain the low rate of sequelae remains to be demonstrated.

Purpose: To evaluate inter- and intra-observer reproducibility of renographic quantitative parameters of input and output in children., Methods: 100 children with unilateral or bilateral uropathy were selected, aiming to cover the entire range of ages, overall glomerular filtration rate (GFR), differential renal function (DRF) and quality of drainage. Renograms were acquired and processed according to the EANM guidelines, using a non-commercial software. Following parameters were tested: DRF using integral and Patlak methods, normalized residual activity (NORA) and output efficiency (OE) at 20 min and on the late post-erect post-micturition acquisition. Three observers from the same department and one from Santiago (Chile) processed independently the 100 renograms using the same renal software. Two observers reprocessed the 100 renograms again two months later in order to evaluate the intra-observer reproducibility., Results and Conclusion: No significant difference was observed between the four observers, whatever the considered parameter of input function or output. For left DRF (Integral and Patlak methods), 95% of the individual differences were between -5% and +5 %. They were between -0.5 and +0.5 units for both NORA 20 and NORA PM, and between -10% and +10% for OE 20 and OE PM. Inter-and intra- observer reproducibility were comparable. Outliers tended to be more frequent for Patlak than for Integral. Very low GFR (< 20 mL/min/1.73 m(2)), very young age (first days of life), huge megaureters, NORA values higher than 2.0, OE values below 60% and bladder in the renal background area (ectopic kidney) were the main characteristics of extreme differences.

Objectives: To assess the impact of a hygiene-encouragement program on reducing infection rates (primary end point) by 5%., Design: A cluster randomized study was carried out over a 5-month period., Settings and Participants: Fifty nursing homes (NHs) with 4345 beds in France were randomly assigned by stratified-block randomization to either a multicomponent intervention (25 NHs) or an assessment only (25 NHs)., Intervention: The multicomponent intervention was targeted to caregivers and consisted of implementing a bundle of infection prevention consensual measures. Interactive educational meetings using a slideshow were organized at the intervention NHs. The NHs were also provided with color posters emphasizing hand hygiene and a kit that included hygienic products such as alcoholic-based hand sanitizers. Knowledge surveys were performed periodically and served as reminders., Measurements: The primary end point was the total infection rate (urinary, respiratory, and gastrointestinal infections) in those infection cases classified either as definite or probable. Analyses corresponded to the underlying design and were performed according to the intention-to-treat principle. This study was registered (#NCT01069497)., Results: Forty-seven NHs (4515 residents) were included and followed. The incidence rate of the first episode of infection was 2.11 per 1000 resident-days in the interventional group and 2.15 per 1000 resident-days in the control group; however, the difference between the groups did not reach statistical significance in either the unadjusted (Hazard Ratio [HR] = 1.00 [95% confidence interval (CI) 0.89-1.13]; P = .93]) or the adjusted (HR = 0.99 [95% CI 0.87-1.12]; P = .86]) analysis., Conclusion: Disentangling the impact of this type of intervention involving behavioral change in routine practice in caregivers from the prevailing environmental and contextual determinants is often complicated and confusing to interpret the results., (Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)