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Technology continues to form an important part of the educational landscape, although the value of portable devices as learning tools is still being explored and debated. In light of the technology-based teaching methods suddenly brought into effect in response to the COVID-19 pandemic, the deliberate use of technology for learning is increasingly significant. The purpose of this article is to highlight student perspectives of learning with portable devices to inform the use of portable technology in the Canadian school system going forward. To gather student perceptions, the research team surveyed 704 students in grades 6 to 9 about their use of iPads in the classroom during a 1:1 technology initiative. While students were enthusiastic about the presence of portable technology, they also shared mixed feelings about the use of such technology as a learning tool. Key themes fell into three categories—engagement, inclusivity, and learning—as students shared their insight into the academic, social, and physical barriers that exist as a result of the technology. In the discussion, we identify lessons learned, especially in the area of self-regulation, and make recommendations on how to harness the power of this multi-faceted learning tool and minimize the chaos it can create when not utilized deliberately and carefully.

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Abstract Background Low mobility during an acute hospitalization is frequent and associated with adverse effects, including persistent functional decline, institutionalization and death. However, we lack effective interventions to improve mobility that are scalable in everyday practice. The INTOMOB trial – INtervention to increase MOBility in older hospitalized medical patients – will test the effect of a multilevel intervention to improve mobility of older hospitalized patients on functional mobility. Methods The INTOMOB multicenter superiority parallel cluster randomized controlled trial will enroll in total 274 patients in Swiss hospitals. Community-dwelling adults aged ≥ 60 years, admitted to a general internal medicine ward with an anticipated length of hospital stay of ≥ 3 days, will be eligible for participation. Unit of randomization will be the wards. A multilevel mobility intervention will be compared to standard of care and target the patients (information and exercise booklets, mobility diary, iPad with exercise videos), healthcare professionals (e-learning, oral presentation, mobility checklist), and environment (posters and pictures on the wards). The primary outcome will be life-space level, measured by the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), at 30 days after enrollment. The LSA is a measure of functional mobility, i.e., how far participants move from bedroom to outside town. Secondary outcomes include, among others, LSA at 180 days, mobility and falls during hospitalization, muscle strength at discharge, and falls, emergency room visits, readmissions, and death within 180 days. Discussion This study has the potential to improve outcomes of older hospitalized patients through an intervention that should be scalable in clinical practice because it fosters patient empowerment and does not require additional resources. The tools provided to the patients can help them implement better mobility practices after discharge, which can contribute to better functional outcomes. The choice of a functional patient-reported outcome measure as primary outcome (rather than a “simple” objective mobility measure) reinforces the patient-centeredness of the study. Trial registration clinicaltrials.gov (NCT05639231, released on December 19 2022); Swiss National Clinical Trial Portal (SNCTP000005259, released on November 28 2022).

Background: To reduce adverse outcomes of low hospital mobility, we need interventions that are scalable in everyday practice. This study assessed the feasibility and acceptability of the INTOMOB multilevel intervention addressing barriers to hospital mobility without requiring unavailable resources. Methods: The INTOMOB intervention, targeting older patients, healthcare professionals (HCPs) and the hospital environment, was implemented on acute general internal medicine wards of three hospitals (12/2022–03/2023). Feasibility and acceptability of the intervention were assessed and two types of accelerometers compared in a mixed methods study (patient and HCP surveys and interviews). Quantitative data were analyzed descriptively and qualitative data using a deductive approach. Results were integrated through meta-inferences. Results: Of 20 patients (mean age 74.1 years), 90% found the intervention helpful and 82% said the environment intervention (posters) stimulated mobility. The majority of 44 HCPs described the intervention as clear and helpful. There was no major implementation or technical issue. About 60% of patients and HCPs preferred a wrist-worn over an ankle-worn accelerometer. Conclusions: The INTOMOB intervention is feasible and well accepted. Patients’ and HCPs’ feedback allowed to further improve the intervention that will be tested in a cluster randomized trial and provides useful information for future mobility-fostering interventions.

Abstract Background Workplace programmes to test staff for asymptomatic COVID-19 infection have become common, but raise a number of ethical challenges. In this article, we report the findings of a consultation that informed the development of an ethical framework for organisational decision-making about such programmes. Methods We conducted a mixed-method consultation – a survey and semi-structured interviews during November–December 2020 in a UK case study organisation that had introduced asymptomatic testing for all staff working on-site in its buildings. Analysis of closed-ended survey data was conducted descriptively. An analysis approach based on the Framework Method was used for the open-ended survey responses and interview data. The analyses were then integrated to facilitate systematic analysis across themes. Inferences were based on the integrated findings and combined with other inputs (literature review, ethical analysis, legal and public health guidance, expert discussions) to develop an ethical framework. Results The consultation involved 61 staff members from the case study organisation (50 survey respondents and 11 interview participants). There was strong support for the asymptomatic testing programme: 90% of the survey respondents viewed it as helpful or very helpful. Open-ended survey responses and interviews gave insight into participants’ concerns, including those relating to goal drift, risk of false negatives, and potential negative impacts for household members and people whose roles lacked contractual and financial stability. Integration of the consultation findings and the other inputs identified the importance of a whole-system approach with appropriate support for the key control measure of isolation following positive tests. The need to build trust in the testing programme, for example through effective communication from leaders, was also emphasised. Conclusions The consultation, together with other inputs, informed an ethical framework intended to support employers. The framework may support organisational decision-making in areas ranging from design and operation of the programme through to choices about participation. The framework is likely to benefit from further consultation and refinement in new settings.

Plain English summary On the basis of what has been written about medication literacy and the experiences of experts, we developed a new questionnaire to measure medication literacy (MED-fLAG) in older adults and/or informal caregivers. MED-fLAG was then submitted to older adults, informal caregivers and healthcare professionals to retrieve their feedback concerning the relevance, comprehensibility and exhaustiveness of the proposed items. In future, MED-fLAG will allow health professionals to evaluate medication literacy skills in older patients during hospitalization and/or in their informal caregivers when they are responsible for preparing or administering the medications, and then propose individualised support.

Background Crystal methamphetamine (‘ice’) use is a large and growing worldwide problem, yet few research studies have explored the impact of crystal methamphetamine use on affected friends and family members. We explored the experiences and narratives of family members and friends of people who use methamphetamine to inform the development of a Family and Friend Support Program. Methods This paper reports on a subset of findings from a mixed method study, which sought to better understand the experiences of family members and friends of people who use methamphetamine. Participants were recruited via Facebook advertising and asked to complete a survey outlining their experiences. At the end of the survey, participants were invited to be interviewed by a clinical psychologist on the research team, to discuss their experiences in greater depth; seventeen people agreed to be interviewed. This paper is based on a qualitative thematic analysis of these interviews using Braun and Clarke’s 6-stage approach to identify key areas of concern for friends and family members of people who use methamphetamine. Results Through thematic analysis, five key themes were developed, namely: (1) loss, (2) stigma, (3) support (or lack thereof), (4) ways of coping, and (5) the value in sharing personal experiences. The results of this study revealed the profound sadness, frustration and loss friends and family members experienced when caring for a loved one who uses methamphetamine. This loss was further complicated by societal stigma surrounding the use of methamphetamine, which often extended to friends and family members themselves. Since experiences of grief and loss were interwoven across the three themes, concepts of ambiguous loss, disenfranchised grief, and narrative constructivist approaches to understanding loss, were applied to the discussion of results. Conclusion This study provides a more complete picture of family and caregiver experiences when caring for a loved one using methamphetamine, which may further help inform the design of intervention programs. Implications for future research and practice with this population are considered.

Background: Medication literacy encompasses the cognitive and social skills necessary for individuals to obtain, comprehend, communicate, calculate, and process medication-related information necessary to make informed decisions. Personal and contextual factors are widely recognized to influence the way that individuals acquire and maintain medication literacy skills. Despite a growing number of studies on medication literacy, current definitions remain general, lacking consideration for the specificities of older adults and hospitalization. Objective: The project was conducted to identify, compare, and summarize the attributes, antecedents, and consequences of medication literacy in hospitalized older adults and to propose a refined definition. Methods: A three-phase hybrid model of concept development was performed that included a literature review and focus groups with hospital nurses. In the final analytic phase, findings from the literature and focus groups were compared, and a refined definition of the concept was elaborated. Key Results: From the synthesis of 24 publications and the narrative data of 14 hospital nurses, 19 themes were described: 4 related to attributes, 8 to antecedents, and 7 to consequences. Medication literacy of hospitalized older adults has been further defined as the degree to which older adults and/or their natural caregivers can develop and maintain multidimensional skills, namely functional, interactive, and critical medication literacy skills. Adjustment of these skills is characterized by a dynamic and potentially complex process. In practice, optimal medication literacy might be achieved through control of and involvement in the medication regimen and the decisions related to it, and/or by using practical means to facilitate medication self-management (e.g., using lists, notes, reminders). Conclusions: The proposed refined definition might enhance professionals' common understanding of the concept and its application in practice, policy, and research. Managing a medication regimen is a complex activity that requires a high level of integration and coordination of cognitive and social skills. [HLRP: Health Literacy Research and Practice. 2022;6(2):e70–e83.] Plain Language Summary: Based on the literature on medication literacy and the experiences of nurses working in hospitals, this article defines medication literacy in hospitalized older adults. This definition will help professionals to better understand challenges related to medication literacy in older patients and to propose adequate support (i.e., provide education, simplify medication prescriptions, propose practical aids such as a pillbox).

Background: Point of care testing (POCT) for infectious diseases is testing conducted near the patient. It allows clinicians to offer the most appropriate treatment more quickly. As POCT devices have increased in accuracy and become more cost-effective, their use has grown, but a systematic assessment of their use for clinical and public health management of infectious diseases in EU/EEA countries has not been previously undertaken.Methods: A scoping review of the literature on POCT in EU/ EEA countries as at November 2019, and a survey of key stakeholders.Results: 350 relevant articles were identified and 54 survey responses from 26 EU/EEA countries were analysed. POCT is available for a range of infectious diseases and in all countries responding to the survey (for at least one disease). POCT is commonly available for influenza, HIV/AIDS, Legionnaires' disease and malaria, where it is used in at least half of EU/EEA countries. While POCT has the potential to support many improvements to clinical care of infectious diseases (e.g., faster diagnosis, more appropriate use of antimicrobials), the results suggest POCT is infrequently used to support public health functions (e.g., disease surveillance and reporting).Conclusion: Although POCT is in use to some extent in all EU/EEA countries, the full benefits of POCT in wider public health functions have yet to be realised. Further research on barriers and facilitators to implementation is warranted.

Introduction : Dans les hôpitaux, la prévalence de la douleur a été signalée comme étant élevée. Or, une prise en charge infirmière efficace et constante de la douleur n’est pas optimale. Objectif : Cette étude visait à évaluer le transfert des connaissances à la suite d’une formation e-Learning sur la douleur, suivie par 47 infirmières et personnels d’assistance d’une unité de réadaptation gériatrique d’un centre hospitalier universitaire de Suisse francophone. Méthodes : Les infirmières et personnels d’assistance ont complété un questionnaire de satisfaction et un questionnaire de connaissances. Une analyse des dossiers-patients a été réalisée et des entretiens de groupe auprès de professionnels ont permis de compléter l’évaluation. Résultats : Les résultats démontrent une satisfaction élevée quant aux contenus abordés dans le e-Learning et une acquisition des connaissances au terme de la formation. Toutefois, l’analyse des dossiers-patients montre que les recommandations de bonnes pratiques en matière de dépistage et d’évaluation de la douleur ne sont pas systématiquement appliquées. Les entretiens de groupe ont permis de décrire plusieurs causes à cet écart. Discussion et conclusion : Pour que la formation bénéficie aux patients, le transfert des connaissances nécessite d’anticiper des stratégies d’accompagnement au développement des compétences, incluant un partenariat entre formateurs et cadres d’unités de soins, ainsi que l’évaluation des facteurs impliqués dans le transfert des connaissances.

Background Despite evidence that opioids might relieve chronic breathlessness, physicians may still be reluctant to prescribe them due to safety concerns. By contrast, benzodiazepine (BDZ) prescribing often seeks to reduce chronic breathlessness despite no evidence of net benefit. Prescribing patterns and indications for these medications in severe interstitial lung disease (ILD) are unknown. Here, our objective was to evaluate the indications, medications and temporal patterns of BDZ and opioid prescriptions in people with oxygen-dependent ILD. Methods This was an observational, population-based, longitudinal study of adults starting long-term oxygen therapy (LTOT) for ILD between 2005 and 2014 in the Swedish National Registry for Respiratory Failure (Swedevox). People dispensed BDZs (n=2000) and opioids (n=2000) from 6 months before start of LTOT throughout follow-up (first of death or study end) were analysed. Results Of 1635 included patients, 651 (39.8%) received BDZs and 710 (43.4%) received opioids during the study period; 373 (22.8%) patients received both. The most frequently prescribed BDZs and opioids were oxazepam (85.6%) and oxycodone (28.7%), respectively. Indications for breathlessness were uncommon for BDZs (1.4%) and opioids (6.4%). During the last year of life, opioid indications for breathlessness increased from 2.5% (12–10 months before death) to 10.2% in the last 3 months of life (p=0.048). Conclusions In oxygen-dependent ILD, opioids are rarely prescribed for breathlessness even in the last months of life, when chronic breathlessness often increases in prevalence and intensity.

Objective: To describe the clinical and epidemiological characteristics, and to determine prognostic factors, event-free survival (EFS) and overall survival (OS) of patients with Ewing sarcoma family tumors (ESFT). Materials and methods: A retrospective study conducted in patients under 18 years of age with ESFT, treated at the Unit of Pediatric and Adolescent Oncology of the Hospital Edgardo Rebagliati between January 2006 and June 2016. The descriptive analysis was performed by frequency distribution. Kaplan-Meier curves were used for EFS and OS analysis. Univariate and multivariate analyses were performed according to the Cox regression model for demographic, clinical and surgical variables, and prognostic factors. The measure of strength of association was expressed in hazard ratio (HR) and 95% confidence interval (95% CI), and p

This research focuses on evaluating the effectiveness of a training course in a hospital setting, using indicators of effect size and heterogeneity index. The evaluation focused on a training course in intermediate care for nurses. The course lasted 23 days and included clinical teaching at the patient’s bedside. The competencies were measured at the beginning and end of the training course, using an observation grid based on five domains: Clinical Expert, Communicator, Collaborator, Leader and Learner-Trainer. Cohen’s and Glass’s estimators demonstrated significant effects of training on the five domains while the heterogeneity index showed a reduction in behavioural disparities within the nursing group at the end of the training course. The discussion addresses issues relating to the boundaries used to interpret effect sizes.

Cette recherche porte sur l’évaluation de l’efficacité d’une formation en milieu hospitalier à partir d’indicateurs de taille d’effet et d’indice d’hétérogénéité. L’évaluation portait sur une formation en soins intermédiaires destinée aux infirmières et infirmiers d’une durée de 23 jours et qui intégrait notamment trois jours d’enseignement clinique au chevet du patient. Les compétences ont été mesurées en début et en fin de formation, à partir d’une grille d’observation standardisée basée sur les rôles d’expert clinique, de communicateur, de collaborateur, de manager et d’apprenant-formateur. Les estimateurs de Cohen et de Glass ont démontré des effets significatifs de la formation sur les cinq domaines, tandis que l’indice d’hétérogénéité a mis en évidence une réduction des disparités de comportements au sein du groupe au terme de la formation. La discussion aborde la question des balises utilisées pour interpréter les tailles d’effet.

Mechanical characterization of living cells undergoing substantial external strain promises insights into material properties and functional principles of mechanically active tissues. However, due to the high strains that occur in physiological situations (up to 50%) and the complex structure of living cells, suitable experimental techniques are rare. In this study, we introduce a new system composed of an atomic force microscope (AFM), a cell stretching system based on elastomeric substrates, and light microscopy. With this system, we investigated the influence of mechanical stretch on monolayers of keratinocytes. In repeated indentations at the same location on one particular cell, we found significant stiffening at 25% and 50% strain amplitude. To study the contribution of intermediate filaments, we used a mutant keratinocyte cell line devoid of all keratins. For those cells, we found a softening in comparison to the wild type, which was even more pronounced at higher strain amplitudes.

Cellular communication constitutes a fundamental mechanism of life, for instance by permitting transfer of information through synapses in the nervous system and by leading to activation of cells during the course of immune responses. Monitoring cell-cell interactions within living adult organisms is crucial in order to draw conclusions on their behavior with respect to the fate of cells, tissues and organs. Until now, there is no technology available that enables dynamic imaging deep within the tissue of living adult organisms at sub-cellular resolution, i.e. detection at the level of few protein molecules. Here we present a novel approach called multi-beam striped-illumination which applies for the first time the principle and advantages of structured-illumination, spatial modulation of the excitation pattern, to laser-scanning-microscopy. We use this approach in two-photon-microscopy--the most adequate optical deep-tissue imaging-technique. As compared to standard two-photon-microscopy, it achieves significant contrast enhancement and up to 3-fold improved axial resolution (optical sectioning) while photobleaching, photodamage and acquisition speed are similar. Its imaging depth is comparable to multifocal two-photon-microscopy and only slightly less than in standard single-beam two-photon-microscopy. Precisely, our studies within mouse lymph nodes demonstrated 216% improved axial and 23% improved lateral resolutions at a depth of 80 µm below the surface. Thus, we are for the first time able to visualize the dynamic interactions between B cells and immune complex deposits on follicular dendritic cells within germinal centers (GCs) of live mice. These interactions play a decisive role in the process of clonal selection, leading to affinity maturation of the humoral immune response. This novel high-resolution intravital microscopy method has a huge potential for numerous applications in neurosciences, immunology, cancer research and developmental biology. Moreover, our striped-illumination approach is able to improve the resolution of any laser-scanning-microscope, including confocal microscopes, by simply choosing an appropriate detector.