Márcia Pestana-Santos

Background: Discrete choice experiments (DCEs) are quantitative preference-elicitation methods, developed largely within health economics, in which participants choose repeatedly between hypothetical scenarios composed of systematically varied attributes. Their growing use with children supports children’s right to be heard in decisions affecting their care, yet it also raises ethical challenges that general paediatric research ethics guidance does not address in operational detail: sustained cognitive demand, potential emotional distress, assent that can blur under clinical stress, parental influence, clinician–researcher role conflict, and the processing of children’s personal data. Methods: We developed a prospective ethical governance framework during the preparatory phase of the PREF-ANX Kids study (Preferences for Preoperative Anxiety Management in Children), a planned multicentre DCE examining preferences for nursing interventions to manage preoperative anxiety among children aged 6–12 years undergoing elective surgery in Portuguese public hospitals, their parents, and healthcare professionals. Development combined a pragmatic, non-systematic synthesis of ethical, regulatory, and methodological guidance with iterative structured discussion within an interdisciplinary team. No formal consensus method was applied, and no children or families were involved in development; we identify this as a limitation. Framework: The framework comprises four domains operating across the research lifecycle: relational participation, cognitive and emotional safeguarding, reflexive professional responsibility, and privacy stewardship. For each domain it specifies planned procedures (continuous assent and dissent monitoring, adapted task burden, structured reflexive documentation, and a prospective data protection impact assessment) together with their normative justification, and it distinguishes elements specific to PREF-ANX Kids from elements potentially adaptable to other paediatric DCEs. Trade-offs between competing ethical and methodological priorities are made explicit rather than resolved silently. Conclusions: The framework is prospective: it has not yet been implemented or empirically evaluated, and no claims of demonstrated effectiveness are made. It is intended to support transparent ethical planning of DCEs involving children aged 6–12 years and will be assessed during the PREF-ANX Kids study. Future refinement should incorporate co-design with children and families and empirical evaluation of feasibility, acceptability, participant experience, and data quality.

Healthcare-associated infections (HAIs) remain a major public health concern, particularly in sub-Saharan Africa, where limited resources, workforce shortages, and infrastructure constraints hinder...

Introduction: Every year, millions of children and adolescents undergo surgery, 50%-75% of them experience fear and anxiety. Children are particularly susceptible to stress and anxiety surrounding surgery as a result of their cognitive development, previous experiences, and knowledge about healthcare; this leads to additional interventions to prevent and reduce these symptoms. Objective: To evaluate the effectiveness of family-centered educational interventions in the children’s and adolescents’ anxiety, pain, and behaviors and their parents’ anxiety during the perioperative period. Methods: This review will follow the Joanna Briggs Institute guidelines for systematic reviews of effectiveness and will consider those studies (experimental and quasi-experimental) in which perioperative educational interventions have been applied to children and adolescents and their parents; these studies measured children and adolescents’ pain, anxiety, and behaviors, as well as their parent’s anxiety. An initial search of MEDLINE and CINAHL will be followed by a second search for published and unpublished studies from January 2007 on, available in English, Spanish and Portuguese. After all full texts are retrieved, the methodological quality assessment and data extraction will be independently and critically evaluated by two reviewers, and the data will then be presented in a tabular format. An explanatory synthesis will accompany the results. Whenever possible, a meta-analysis will be performed, and a Grading of Recommendations, Assessment, Development, and Evaluation Summary of Findings will be presented. Expected Results: This review will provide guidance on how family-centred educational interventions can be used as a resource to manage anxiety, pain, and behavior in children, adolescents and their relatives during the perioperative processes.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To compare the benefits and harms of pharmacological and non-pharmacological preoperative interventions (alone or in combination) for reducing anxiety in school-age children undergoing elective surgery under general anaesthesia, and to rank the interventions according to their efficacy and safety.

Patients undergoing joint replacement often struggle with preparation and rehabilitation. Anxiety, uncertainty and fragmented transitions blunt recovery gains. At the same time, health services are moving suitable procedures to day-case pathways and community-based follow-up, increasing the need for safe, effective support at home. This narrative article proposes a nurse-led approach that combines a mobile application, delivering short, accessible education, daily reminders and checklists, and secure in-app messaging, with wearable devices that provide continuous information on physiological parameters and physical activity after discharge. This fictional vignette illustrates how a nurse-led app and wearable pathway can guide prehabilitation, support mobilisation and provide timely escalation after discharge. Contemporary guidance stresses the importance of patient information, early mobilisation and timely rehabilitation across the perioperative pathway, while emerging evidence suggests that remote rehabilitation can improve short-term functional outcomes after total knee arthroplasty and that continuous wearable monitoring may identify clinical deterioration earlier than intermittent checks. We offer a practical implementation blueprint (co-design, induction with teach-back, explicit escalation rules and equity safeguards) and outline governance aligned with United Kingdom frameworks. The discussion provides evidence in support of app and wearable pathways improving adherence and continuity of care around arthroplasty in a way that is safe, equitable and practical. We end with evidence on service evaluation and relevant pragmatic trials.

Objectives: This scoping review will aim to map the clinical pathways for patients undergoing adult hip, knee, or shoulder arthroplasties. The review will also map the indicators and measurement tools used to evaluate the effectiveness of these pathways. Introduction: Clinical pathways are structured, multidisciplinary care plans designed to standardize and optimize patient care. Clinical pathways reduce clinical heterogeneity, decrease malpractice risk, ensure high-quality care, and lower costs. The evidence characterizing these pathways and their evaluation indicators remains fragmented. Eligibility criteria: This review will consider studies of any type on hip, knee, and shoulder arthroplasty; performed on adults; that describe clinical pathways, including their components, implementation, and evaluation. Methods: This review will follow the JBI methodology for scoping reviews. A 3-step search strategy will be used to identify published and unpublished studies across multiple databases: PubMed, CINAHL (EBSCOhost), Scopus, Web of Science Core Collection, and the Cochrane Library. Gray literature will also be searched for. Studies published in English, Portuguese, and Spanish will be included, with no date limitations on the searches. Two independent reviewers will screen study titles, abstracts, and full texts, and extract data using a predefined extraction form. Data will be presented in tabular format and synthesized narratively. Review registration: OSF https://osf.io/ysrw8

RESUMO Objetivo: Compreender como enfermeiras da atenção primária compreendem e integram os direitos reprodutivos no contexto do planejamento familiar. Método: Pesquisa-ação desenvolvida entre setembro e novembro de 2023 com cinco enfermeiras de uma Unidade Básica de Saúde da região central do Rio Grande do Sul. Os dados foram coletados por meio de grupos focais e analisados pela técnica da análise de conteúdo. Resultados: As enfermeiras destacaram a autonomia reprodutiva, com aumento na demanda por laqueaduras; a educação personalizada sobre contracepção; o impacto socioeconômico no acesso do planejamento familiar; e desafios relacionados à inclusão masculina, com estratégias voltadas à corresponsabilidade no planejamento. Considerações finais: Enfermeiras desempenham papel essencial na promoção dos direitos reprodutivos. Pelo respeito às individualidades e o contexto social, as enfermeiras promovem a responsabilidade compartilhada e fortalecem a autonomia feminina, as quais estão alinhadas aos Objetivos do Desenvolvimento Sustentável que visam a igualdade de gênero e a redução das desigualdades.