Measurement of parent satisfaction in french-speaking PICUs: a need for translation and cultural adaptation of the empathic questionnaire

Background and aims: Family-centred care is an expected standard in PICU and parent reported outcomes are rarely measured. The Dutch validated EMPATHIC questionnaire provides accurate measures of parental perceptions of family-centred care in PICU. A French version would provide an important resource for quality control and benchmarking with other PICUs. The study aimed to translate and to assess the French cultural adaptation of the EMPATHIC questionnaire. Methods: In September 2012, following approval from the developer, translation and cultural adaptation were performed using a structured method (Wild et al. 2005). This included forward-backward translation and reconciliation by an official translator, harmonization assessed by the research team, and cognitive debriefing with the target users' population. In this last step, a convenience sample of parents with PICU experience assessed the comprehensibility and cultural relevance of the 65-item French EMPATHIC questionnaire. The PICUs in Lausanne, Switzerland and Lille, France participated. Results: Seventeen parents, including 13 French native and 4 French as second language speakers, tested the cognitive equivalence and cultural relevance of the French EMPATHIC questionnaire. The mean agreement for comprehensibility of all 65 items reached 90.2%. Three items fell below the cut-off 80% agreement and were revised for inclusion in the final French version. Conclusions: The translation and the cultural adaptation permitted to highlight a few cultural differences that did not interfere with the main construct of the EMPATHIC questionnaire. Reliability and validity testing with a new sample of parents is needed to strengthen the psychometric properties of the French EMPATHIC questionnaire.

Index Codicum Cabbalistic. MSS. quibus Jo. Picus, Mirandulanus Comes, usus est

Jaques Gaffarel

Dignified death: Concept development involving nurses and doctors in Pediatric Intensive Care Units

The aim of this study was to develop the concept of the dignified death of children in Brazilian pediatric intensive care units (PICUs). The Hybrid Model for Concept Development was used to develop a conceptual structure of dignified death in PICUs in an attempt to define the concept. The fieldwork study was carried out by means of in-depth interviews with nine nurses and seven physicians working in PICUs. Not unexpectedly, the concept of dignified death was found to be a complex phenomenon involving aspects related to decisions made by the multidisciplinary team as well as those related to care of the child and the family. Knowledge of the concept`s dimensions can promote reflection on the part of healthcare professionals regarding the values and beliefs underlying their conduct in end-of-life situations. Our hope is that this study may contribute to theoretic and methodological development in the area of end-of-life care.

A Delphi study on National PICU nursing research priorities in Australia and New Zealand.

BACKGROUND: There is a lack of evidence to direct and support nursing practice in the specialty of paediatric intensive care (PIC). The development of national PIC nursing research priorities may facilitate the process of undertaking clinical research and translating evidence into practice. PURPOSE: To (a) identify research priorities for the care of patients and their family as well as for the professional needs of PIC nurses, (b) foster nursing research collaboration, (c) develop a research agenda for PIC nurses. METHODS: Over 13 months in 2007-2008, a three-round questionnaire, using the Delphi technique, was sent to all specialist level registered nurses working in Australian and New Zealand PICUs. This method was used to identify and prioritise nursing research topics. Content analysis was used to analyse Round I data and descriptive statistics for Round II and III data. RESULTS: In Round I, 132 research topics were identified, with 77 research priorities (mdn>6, mean MAD(median) 0.68±0.01) identified in subsequent rounds. The top nine priorities (mean>6 and median>6) included patient issues related to neurological care (n=2), pain/sedation/comfort (n=3), best practice at the end of life (n=1), and ventilation strategies (n=1), as well as two priorities related to professional issues about nurses' stress/burnout and professional development needs. CONCLUSION: The research priorities identified reflect important issues related to critically ill patients and their family as well as to the nurses caring for them. These priorities can be used for the development of a research agenda for PIC nursing in Australia and New Zealand.

Français 2444

Contient : 1° Le « Songe » de « Charles, comte de Taillebourt », par « ROBERT FRESCHER, maistre es ars, bacchelier en theologie » ; 2° « Le Livre de la doctrine salutaire », par « PICUS MIRANDULA », traduction par « ROBERT FRESCHER », avec prologue

Pandémie H1N1 : comparaison Canada-France des enfants hospitalisés en Soins Intensifs Pédiatriques Étude épidémiologique descriptive à partir de 2 cohortes nationales

Rationnel : La pandémie de grippe A(H1N1)pdm09 a induit un grand nombre d’hospitalisation d’enfants en soins intensifs pédiatriques (SIP). L’objectif de cette étude a été de comparer l’incidence et la mortalité des enfants admis en SIP durant l’automne 2009 entre le Canada et la France, deux pays qui diffèrent essentiellement par l’immunisation de la population contre ce virus (première vague en été et taux de couverture vaccinale supérieur à 50% au Canada ; pas de vague estivale et couverture vaccinale de 18% en France). Méthodes : Nous avons comparé deux cohortes nationales qui ont inclue tous les patients avec une infection A(H1N1)pdm09 documentée, admis en SIP au Canada et en France entre le 1er Octobre 2009 et le 31 janvier 2010. Résultats : Au Canada, 160 enfants (incidence=2,63/100000 enfants) en 6 semaines ont été hospitalisés en SIP comparé aux 125 enfants (incidence=1,15/100000 enfants) en 11 semaines en France (p<0,001). Le taux de vaccination avant l’admission était inférieur à 25% parmi les enfants en situation critique dans les deux pays. La gravité à l’admission en SIP et le taux de mortalité ont été similaires au Canada et en France (4,4% en France vs 6,5% au Canada, p=0,45, respectivement). Au Canada, la vaccination contre le virus H1N1pdm09 a été associée avec une diminution du recours à la ventilation invasive (Odd Ratio 0.30, intervalle de confiance à 95% [0,11-0,83], p=0,02). Au Canada comparé à la France, les durées médianes de séjour en SIP et de ventilation invasive ont été plus courtes (2,9 vs 3 jours, p=0,03 et 4 vs 6 jours, p=0,02, respectivement). Conclusion : Les enfants canadiens et français critiquement malades ont été beaucoup moins nombreux à recevoir le vaccin contre le virus influenza A (H1N1)pdm09 en comparaison avec l’ensemble des enfants dans ces deux populations. Au Canada, où la couverture vaccinale a été élevée, le risque d’avoir une détresse respiratoire sévère était moins important parmi les enfants en situation critique ayant été vaccinés avant l’admission.

Spechte als ökologische Indikatoren in Natur- und Wirtschaftswäldern im Bialowiera-Wald (Ostpolen)

Die vorliegende Untersuchung analysiert die Eignung der "Spechtgemeinschaft" als ökologische Indikatorengruppe und formuliert vor dem Hintergrund der Ergebnisse Forderungen und Empfehlungen für einen "spechtgerechten" Umgang mit Wäldern. Die Habitatnutzung von sieben Spechtarten beim Nahrungserwerb wurde über einen Zeitraum von zwei Jahren in urwaldartigen und forstlich genutzten Beständen verschiedener Waldgesellschaften systematisch beobachtet. Das Untersuchungsgebiet ist der Bialowieza-Wald im äußersten Osten Polens, wo in enger räumlicher Nachbarschaft Natur- und Wirtschaftswaldflächen bearbeitet werden konnten. Die Beobachtungen erfolgten zwischen Anfang März 1999 und Ende Februar 2001 und wurden zu allen Jahreszeiten durchgeführt. Vier der insgesamt sechs Probeflächen repräsentieren die wichtigste Laubwaldgesellschaft des Gebietes, das Tilio-Carpinetum, die übrigen zwei die wichtigste Nadelwaldgesellschaft, das Peucedano-Pinetum. Die Hälfte der zwischen 42 und 54 ha großen Probeflächen lag im streng geschützten Urwaldreservat des Bialowieza-Nationalparkes, die übrigen in forstlich genutzten Waldbeständen. Zusätzlich wurde ein 2,5 km langes Transekt durch bewirtschafteten Erlen-Eschen-Auenwald und sehr naturnahen Erlenbruch bearbeitet. Die Probeflächen wurden in ein Raster aus 50x50m großen Quadranten unterteilt. Zur Beobachtung der Spechte beim Nahrungserwerb erfolgten 21 Begehungen je Probefläche bzw. Transekt. Die Probeflächen wurden dazu auf parallelen Linien mit Abständen von je 100m begangen, Startpunkt und Startrichtung wurden variiert. Zur Charakterisierung der Vegetation und Bestandesstruktur erfolgten Erhebungen zur Baumartenzusammensetzung, Größenklassenverteilung der Bäume, Totholzanteil und Krautvegetation. 1332 Beobachtungen von Spechten beim Nahrungserwerb konnten ausgewertet werden. Der Buntspecht wurde in allen Flächen am häufigsten gesehen. Mittel-, Weißrücken- und Kleinspecht wurden überwiegend in den Tilio-Carpineten beobachtet, in den Naturwäldern häufiger als in den bewirtschafteten Beständen. Der Dreizehenspecht wurde im Nadelwald und stärker mit Fichten durchmischtem Laubwald angetroffen. Bei Schwarz- und Grauspecht konnte keine klare Vorliebe für bestimmte Waldgesellschaften ermittelt werden. Der Buntspecht ernährte sich vor allem im Herbst und Winter überwiegend von fetthaltigen Samen und wurde dann meist beim Bearbeiten von Fichten- oder Kiefernzapfen in Schmieden beobachtet. Der Mittelspecht suchte als "Sammelspecht" seine Nahrung vor allem an den Oberflächen der Stämme und Äste. Klein-, Weißrücken-, Dreizehen- und Schwarzspecht traten als Hackspechte in Erscheinung. Die wenigen Daten zum Grauspecht reichen nicht zur Ermittlung der bevorzugten Nahrungserwerbstechnik aus. Bei Bunt-, Mittel- und Weißrückenspecht konnte eine deutliche Vorliebe für die Stieleiche als Nahrungsbaum nachgewiesen werden. Der Dreizehenspecht ist jedoch die einzige der beobachteten Arten mit einer weitgehenden Spezialisierung auf eine bestimmte Baumart, er nutzte in allen Waldgesellschaften meist die Fichte. Insgesamt bevorzugten die Spechte Bäume mit großen Stammdurchmessern, beim Kleinspecht ist diese Vorliebe allerdings nur schwach ausgeprägt. Totholz wurde von Weißrücken-, Dreizehen- und Kleinspecht bei der Nahrungssuche bevorzugt, vom Mittelspecht jedoch nur gelegentlich genutzt. Beim Buntspecht zeigte der Totholz-Nutzungsanteil erhebliche Unterschiede zwischen verschiedenen Baumarten. Liegendes Totholz spielte in den Tilio-Carpineten im Vergleich zu stehendem Totholz und toten Teilen lebender Bäume nur eine geringe Rolle für Nahrung suchende Spechte.

End-of-life practices in seven Brazilian pediatric intensive care units

Objective: To evaluate the incidence of life support limitation and medical practices in the last 48 hrs of life of children in seven Brazilian pediatric intensive care units (PICUs). Design. Cross-sectional multicenter retrospective study based on medical chart review. Setting: Seven PICUs belonging to university and tertiary hospitals located in three Brazilian regions: two in Porto Alegre (southern region), two in Sao Paulo (southeastern region), and three in Salvador (northeastern region). Patients. Medical records of all children who died in seven PICUs from January 2003 to December 2004. Deaths in the first 24 hrs of admission to the PICU and brain death were excluded. Interventions: Two pediatric intensive care residents from each PICU were trained to fill out a standard protocol (K = 0.9) to record demographic data and all medical management provided in the last 48 hrs of life (inotropes, sedatives, mechanical ventilation, full resuscitation maneuvers or not). Student`s t-test, analysis of variance, chi-square test, and relative risk were used for comparison of data. Measurements and Main Results. Five hundred and sixty-one deaths were identified; 97 records were excluded (61 because of brain death and 36 due to <24 hrs in the PICU). Thirty-six medical charts could not be found. Cardiopulmonary resuscitation was performed in 242 children (57%) with a significant difference between the southeastern and northeastern regions (p =.0003). Older age (p = .025) and longer PICU stay (p = .001) were associated with do-not-resuscitate orders. In just 52.5% of the patients with life support limitation, the decision was clearly recorded in the medical chart. No ventilatory support was provided in 14 cases. Inotropic drug infusions were maintained or increased in 66% of patients with do-not-resuscitate orders. Conclusions. The incidence of life support limitation has increased among Brazilian PICUs but with significant regional differences. Do-not-resuscitate orders are still the most common practice, with scarce initiatives for withdrawing or withholding life support measures.

The core characteristics and nursing care activities in psychiatric intensive care units in Sweden

Internationally, research on psychiatric intensive care units (PICUs) commonly reportsresults from demographic studies such as criteria for admission, need for involuntary treatment, andthe occurrence of violent behaviour. A few international studies describe the caring aspect of thePICUs based specifically on caregivers’ experiences. The concept of PICU in Sweden is not clearlydefined. The aim of this study is to describe the core characteristics of a PICU in Sweden and todescribe the care activities provided for patients admitted to the PICUs. Critical incident techniquewas used as the research method. Eighteen caregivers at a PICU participated in the study bycompleting a semistructured questionnaire. In-depth interviews with three nurses and two assistantnurses also constitute the data. An analysis of the content identified four categories that characterizethe core of PICU: the dramatic admission, protests and refusal of treatment, escalating behaviours, andtemporarily coercive measure. Care activities for PICUs were also analysed and identified as controlling– establishing boundaries, protecting – warding off, supporting – giving intensive assistance, andstructuring the environment. Finally, the discussion put focus on determining the intensive aspect ofpsychiatric care which has not been done in a Swedish perspective before. PICUs were interpreted asa level of care as it is composed by limited structures and closeness in care.

Jaw musculature of the Picini (Aves: Piciformes: Picidae)

The Picini tribe comprises 25 Old World woodpecker species grouped into seven genera that are widely distributed in Asia and include several representatives from the Eurasian region. Given the absence of detailed anatomical studies of Picini in the literature, the purposes of this study were to describe the jaw musculature of 14 species of Picini in detail and to compare the musculature patterns of these species. The results of this analysis indicate the following: (1) there is a clear association between the ventralis lateralis and dorsalis lateralis muscles through fleshy fibers that are connected in all species, (2) the jaw musculature of the genus Picus differs from that of other Picini genera in terms of the poor development of the protractor muscle system of the quadrate (M. protractor quadrati and M. protractor pterygoidei), (3) generally, the M. pseudotemporalis superficialis originates in the ventrocaudal region of the laterosphenoid (the lower part of the orbit), with the only noteworthy exception being an origin in the upper part of the orbit in Dinopium javanense, and (4) the protractor pterygoidei muscle is more developed in Blythipicus rubiginosus, Dinopium rafflesii, and D. javanense than in the other species. © 2012 Reginaldo José Donatelli.

Cranial osteology of Picini (Aves: Piciformes: Picidae)

The Picini is composed of 26 species of woodpeckers from the old world that are grouped into seven genera. Given the absence of detailed studies on the cranial osteology of the Picini, the purpose of this study is to describe the cranial osteology of 14 species of Picini from six genera and to compare these species with each other, with other species of woodpeckers and with other bird groups. The results of the analysis of the bone structures of the skull of the Picini indicate that there are seven outstanding characteristic of bones involved in the functional mechanistics of the jaw apparatus. In the ossa cranii, these include the frontal overhang, the postorbital process, the extension of the parietal versus the frontal region and the temporal fossa. In the ossa faciei, these include the rostral expansion of the pterygoid, the ventral palatine fossa and the orbital process of the quadrate bone. For all of the structures associated with the cranial osteology of the investigated species, there is a clear distinction between the species of the genus Picus and the other species studied. Blythipicus rubiginosus, Chrysocolaptes lucidus, Reinwardtipicus validus, Gecinulus viridis and the species of the genus Dinopium exhibit additional particularities. © 2012 The Royal Swedish Academy of Sciences.

Relationship Between Jaw Apparatus, Feeding Habit, and Food Source in Oriental Woodpeckers

Associations among feeding habit, beak type, and food source in birds have been widely studied and are well known to exist. The relationship between feeding habit and jaw apparatus in birds has not attracted attention from ornithologists, perhaps because of the complexity of the skeletal morphology of the feeding system of birds. The goal of this study was to compare the jaw apparatus and foraging strategies of various Oriental species of the Picidae (Meiglyptini and Picini tribes) using a morphofunctional analysis of the skeletal structure of the jaw apparatus. This study showed that there are at least three types of jaw apparatus in these woodpeckers, as follows: 1) robust, developed, and complex; 2) complexity and development intermediate, as observed in Meiglyptes tristis and Dinopium spp., whose main foraging method involves gleaning, probing, and tapping; and 3) poorly developed, as observed in Picus miniaceus and Hemicircus concretus. The success of woodpeckers as a natural group is due not only to their feeding diversity, but also their ability to explore a wide range of different resources, as appropriate to their jaw apparatus.