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Genna C, Thekkan KR, Geremia C, Di Furia M, Cecchetti C, Rufini E, Salata M, Perrotta D, Dall'Oglio I, Tiozzo E, Raponi M, Gawronski O. Parents' Trigger Tool for Children with Medical Complexity - PAT-CMC: Development of a recognition tool for clinical deterioration at home. J Adv Nurs 2024. [PMID: 38661213 DOI: 10.1111/jan.16201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
AIM To develop a trigger tool for parents and lay caregivers of children with medical complexity (CMC) at home and to validate its content. DESIGN This was a multi-method study, using qualitative data, a Delphi method and a concept mapping approach. METHODS A three-round electronic Delphi was performed from December 2021 to April 2022 with a panel of 23 expert parents and 30 healthcare providers, supplemented by a preliminary qualitative exploration of children's signs of deterioration and three consensus meetings to develop the PArents' Trigger Tool for Children with Medical Complexity (PAT-CMC). Cognitive interviews with parents were performed to assess the comprehensiveness and comprehensibility of the tool. The COREQ checklist, the COSMIN guidelines and the CREDES guidelines guided the reporting respectively of the qualitative study, the development and content validity of the trigger tool and the Delphi study. RESULTS The PAT-CMC was developed and its content validated to recognize clinical deterioration at home. The tool consists of 7 main clusters of items: Breathing, Heart, Devices, Behaviour, Neuro-Muscular, Nutrition/Hydration and Other Concerns. A total of 23 triggers of deterioration were included and related to two recommendations for escalation of care, using a traffic light coding system. CONCLUSION Priority indicators of clinical deterioration of CMC were identified and integrated into a validated trigger tool designed for parents or other lay caregivers at home, to recognize signs of acute severe illness and initiate healthcare interventions. IMPACT The PAT-CMC was developed to guide families in recognizing signs of deterioration in CMC and has potential for initiating an early escalation of care. This tool may also be useful to support education provided by healthcare providers to families before hospital discharge. PATIENT OR PUBLIC CONTRIBUTION Parents of CMC were directly involved in the selection of relevant indicators of children's clinical deterioration and the development of the trigger tool. They were not involved in the design, conducting, reporting or dissemination plans of this research.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Di Furia
- Department of Anesthesia, Resuscitation and Surgical Compartment, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emilia Rufini
- Pediatric Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michele Salata
- Center for Pediatric Palliative Care, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Daniela Perrotta
- Department of Anesthesia, Resuscitation and Surgical Compartment, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Ciccone O, Lepri A, Zaffini O, Camanni G, Vallasciani M, Baglioni A, Tinarelli C, Ilicini S, Jenkner A, Salata M, Elisei S. Pain Assessment in People with Intellectual Disability: Improving Skills of Health and Educational Personnel at Istituto Serafico of Assisi, Italy. Psychiatr Danub 2023; 35:42-52. [PMID: 37994060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Assessment of pain in people with intellectual disability (PWID) is a difficult clinical task. Poor knowledge and confidence in assessing pain in PWID result in underestimation and undertreatment. Available resources for healthcare personnel and caregivers on pain assessment in PWID are still very limited. The aim of the study was to measure the level of knowledge and confidence in assessing pain in PWID of health and education personnel at Istituto Serafico, before and after training. SUBJECTS AND METHODS The Istituto Serafico is a neuro-rehabilitation center caring for people with complex disabilities. Nurses, rehabilitation therapists, social health workers (SHW) and educators were invited to participate in a 4-hours theoretical and practical training. Participants were assessed through a knowledge and confidence questionnaire on pain assessment in PWID, administered before and after the training. RESULTS 123 participants attended both the theoretical and practical sessions. Median age was 43 years (range 23-67); 89 were females and 34 males. They were 10 (8%) nurses, 9 (7%) rehabilitation therapists, 77 (63%) SHW, 27 (22%) educators. Only 7 (6%) participants (5 nurses and 2 SHW) declared to have previously received formation on pain. Participants who felt "quite confident" in assessing pain increased from 28% to 73% after the training. The median score to the 24 knowledge questions raised from 15/24 correct answers (range 6-22, 62.5%) in the pre-test to 21/24 (range 11-24, 87.5%) in the post-tests (p=0.001) Conclusions: The study highlights the great need of education programs for health and educational personnel working with PWID on pain assessment and the potential to improve knowledge and confidence through theoretical and practical training. A greater awareness of pain causes, clinical manifestations and consequences of untreated pain, could improve patient care, quality of life and rehabilitation goals.
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Affiliation(s)
- Ornella Ciccone
- Istituto Serafico di Assisi, Viale Guglielmo Marconi, 6, 06081 Assisi, Perugia, Italy,
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Tofani M, Mustari M, Tiozzo E, Dall'Oglio I, Morelli D, Gawronski O, Salata M, Cantonetti L, Castelli E, Di Lallo D, Raponi M. The development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY) Core Sets: a systematic review. Disabil Rehabil 2023; 45:3951-3960. [PMID: 36271731 DOI: 10.1080/09638288.2022.2136269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this systematic review is to verify the development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), investigating methodology and how many core sets have been created. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Six bibliographic databases were searched: MEDLINE, SCOPUS, Web of Sciences, CINHAL, PEDro, and OT Seeker. Papers included in the study have the following characteristics: (a) pediatric population with different health conditions, (b) assessment of ICF domains, (c) development of ICF-CY core set in different health conditions, and (d) recommendation for clinical uses. RESULTS Search strategies allowed to identify 270 research papers. After the elimination of duplicates, 154 articles were analyzed. Finally, 28 records were included for qualitative synthesis. Twelve different ICF-CY Core Sets were identified. Autism spectrum disorder, attention-deficit/hyperactivity disorder, and cerebral palsy were the main health conditions studied at international level. Most of the studies involved international experts using Cieza' methodology to inform ICF-CY Core Set. CONCLUSIONS After 15 years since the adoption of ICF-CY, it still finds some barriers to use. Concrete actions should be taken to develop further core sets following a rigorous methodology and to contribute implementing the ICF framework.Implication for rehabilitationIn 15 years since the implementation of International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), only 12 core sets have been developed.To develop ICF-CY Core Set, health professionals should follow methodology described by Cieza et al.Strong collaboration between low- and middle-income countries and high-income countries are recommended.
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Affiliation(s)
- Marco Tofani
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Martina Mustari
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Daniela Morelli
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Michele Salata
- Center for Pediatric Palliative Care, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Laura Cantonetti
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children Hospital, Rome, Italy
| | - Enrico Castelli
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children Hospital, Rome, Italy
| | - Domenico Di Lallo
- Medical Directorate, Bambino Gesù Children Hospital IRCCS, Rome, Italy
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Spitaletta G, Biagioli V, Greco F, Mascolo R, Liburdi A, Manzi G, Gawronski O, Ricci R, Tiozzo E, Vellone E, Grimaldi Capitello T, Salata M, Raponi M, Dall’Oglio I. Self-care in children and young people with complex chronic conditions: a qualitative study using Emotional Text Mining. Front Pediatr 2023; 11:1170268. [PMID: 37576150 PMCID: PMC10420086 DOI: 10.3389/fped.2023.1170268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives To explore: (1) self-care behaviors in children and young people (range: 6 months-24 years) with complex chronic conditions, characterized by the diagnosis of a severe chronic condition, substantial family-identified needs, functional limitations associated with technology dependence, and intensive use of healthcare services; (2) the contribution to self-care of family members and other persons involved in the child's health and daily life context (e.g., health professionals and teachers), and (3) the principal factors that might have influenced the self-care process associated with developmental age. Methods A qualitative descriptive study was conducted in an Italian academic tertiary pediatric hospital between September 2020 and May 2021. Overall, 25 focus groups and 7 online interviews were conducted via videoconferencing. Textual data were analyzed using Emotional Text Mining to identify three levels of communication: the factors, the main themes (clusters), and the sub-themes. Results A total of 104 participants were enrolled, including 27 patients with complex chronic conditions (12 males, mean age = 11.1 ± 4.40), 33 parents, 6 siblings, 33 health professionals, and 5 teachers. Participants described the process of self-care through four main factors: "self-care", "external settings", "family", and "management". Five clusters (themes) were identified: (1) Self-care management (device; consulting); (2) Shift of agency (influencing factors; parents; school); (3) Self-care support (normal life and personal development; multidisciplinary support); (4) Daily self-care maintenance/monitoring; (5) Treatment adherence. Self-care management was mostly relevant for parents of children aged between 6 months and 3 years. Conclusion The self-care process varies according to the needs related to the specific developmental age and the evolution of the clinical condition over time. The contribution of the family, health professionals, and social networks is fundamental for adequate self-care. To help families manage the unstable condition of their children at home, it is necessary to strengthen support networks implement home care, and ensure continuity of care.
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Affiliation(s)
- Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Greco
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Michele Salata
- Paediatric Palliative Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Biagioli V, Spitaletta G, Kania V, Mascolo R, Gawronski O, Liburdi A, Manzi G, Salata M, Vellone E, Tiozzo E, Dall'Oglio I. Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review. Front Pediatr 2022; 10:832453. [PMID: 35419323 PMCID: PMC8995847 DOI: 10.3389/fped.2022.832453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.
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Affiliation(s)
- Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Kania
- Department of Paediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michele Salata
- Rheumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Dall’Oglio I, Gasperini G, Carlin C, Biagioli V, Gawronski O, Spitaletta G, Grimaldi Capitello T, Salata M, Vanzi V, Rocco G, Tiozzo E, Vellone E, Raponi M. Self-Care in Pediatric Patients with Chronic Conditions: A Systematic Review of Theoretical Models. Int J Environ Res Public Health 2021; 18:ijerph18073513. [PMID: 33800684 PMCID: PMC8037526 DOI: 10.3390/ijerph18073513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
Background: To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support. Aims: (1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework. Methods: A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0–24 years) with chronic conditions were included. Results: Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed. Conclusions: By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable.
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Affiliation(s)
- Immacolata Dall’Oglio
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
- Correspondence: ; Tel.: +39-0668592984; Fax: +39-0668592100
| | - Giulia Gasperini
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Claudia Carlin
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Valentina Biagioli
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Orsola Gawronski
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Giuseppina Spitaletta
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Teresa Grimaldi Capitello
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Michele Salata
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Valentina Vanzi
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship-Nursing Professional Order of Rome, Viale Giulio Cesare, 78, 00192 Rome, Italy;
| | - Emanuela Tiozzo
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Massimiliano Raponi
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
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Crocoli A, Zaccara AM, Pisaturo ML, Salata M, Conforti A, Schettini S, Rivosecchi M. Prenatal Features of Bladder Agenesis in a Female Fetus with Genital Transposition. Fetal Pediatr Pathol 2016; 35:37-42. [PMID: 26720091 DOI: 10.3109/15513815.2015.1122122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bladder agenesis is a rare condition, mostly affecting females, where diagnosis is usually made in infancy when investigating urinary incontinence. Neonatal cases are uncommon, and none have been reported antenatally. The few male patients with this condition rarely survive: among associated anomalies, different degrees of penoscrotal transposition are the most evident feature. The association of genital transposition in a female infant with prenatal description of bladder agenesis has not been previously reported. Early diagnosis is important, enabling planning of surgical reconstruction early in life and appropriate parental counseling.
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Affiliation(s)
- Alessandro Crocoli
- a Surgery Unit, Surgical Regional Network , Bambino Gesù Children Hospital-IRCCS , Rome Italy
| | - Antonio Maria Zaccara
- a Surgery Unit, Surgical Regional Network , Bambino Gesù Children Hospital-IRCCS , Rome Italy
| | - Maria Laura Pisaturo
- b Operative Unit of Obstetrics and Gynecology , Azienda Ospedaliera Regionale San Carlo , Potenza , Italy
| | - Michele Salata
- c Pediatrics Unit, Pediatrics Regional Network , Bambino Gesù Children Hospital-IRCCS , Rome , Italy
| | - Andrea Conforti
- d Neonatal Surgery Unit, Department of Medical and Surgical Neonatology , Bambino Gesù Children Hospital-IRCCS , Rome , Italy
| | - Sergio Schettini
- b Operative Unit of Obstetrics and Gynecology , Azienda Ospedaliera Regionale San Carlo , Potenza , Italy
| | - Massimo Rivosecchi
- a Surgery Unit, Surgical Regional Network , Bambino Gesù Children Hospital-IRCCS , Rome Italy
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Rusalen F, Ferrante A, Pò C, Salata M, Agosto C, Benini F. Pain therapy, pediatric palliative care and end-of-life care: training, experience, and reactions of pediatric residents in Italy. Eur J Pediatr 2014; 173:1201-7. [PMID: 24718654 DOI: 10.1007/s00431-014-2304-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/10/2014] [Accepted: 03/24/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED Pediatric palliative care represents the ideal response to life-limiting and life-threatening diseases and requires a specific and multidisciplinary training. This study aims at evaluating in Italy the training programs offered in pain therapy and pediatric palliative care, the exposure, and the personal experience concerning end-of-life care management. The data have been obtained through a survey addressed to all the residents specializing in pediatrics in Italy. Three hundred forty-eight of 1,200 residents from 33 of the 41 schools of pediatrics existing in Italy responded to the questionnaire. One hundred seventy-four of them (50 %) declared they received training in end-of-life care at least once: 146 during their graduation course of medicine, 84 during the pediatric residency, and 54 in both occasions. Sixty percent of respondents were present at one death at least, with an increasing percentage in the last years of residency (91.5 % in the fifth year) but only 12 % were directly involved in the management (36.2 % in the fifth year); 5.7 % managed at least one communication of death; 12.6 % followed sedo-analgesia protocols. Only 11 % of residents felt ready to face end-of-life care management. CONCLUSION The training in end-of-life care in Italy is not currently satisfactory. Further efforts are therefore required to create a comprehensive and multidisciplinary training.
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Affiliation(s)
- Francesca Rusalen
- Pediatric Pain and Palliative Care Service, Department of Pediatrics, University of Padua, Via Giustiniani, 3, 35127, Padua, Italy,
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De Vito R, Alisi A, Masotti A, Ceccarelli S, Panera N, Citti A, Salata M, Valenti L, Feldstein AE, Nobili V. Markers of activated inflammatory cells correlate with severity of liver damage in children with nonalcoholic fatty liver disease. Int J Mol Med 2012; 30:49-56. [PMID: 22505182 DOI: 10.3892/ijmm.2012.965] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/13/2012] [Indexed: 01/01/2023] Open
Abstract
Concomitantly to the obesity epidemic, nonalcoholic fatty liver disease (NAFLD) has become the leading cause of liver disease in children. NAFLD encompasses a spectrum of histological damage ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), with possible progression to cirrhosis. There is growing evidence that the immune system plays a pivotal role in the initiation and progression to NASH but the cellular nature of the hepatic inflammation is still unknown. The present study includes 34 children with biopsy-proven NAFLD. Liver damage was evaluated by the NAFLD activity score (NAS), and the inflammatory infiltrate was characterized by immunohistochemistry for CD45, CD3 and CD163 which are markers of leukocytes, T cells and activated Kupffer cells/macrophages, respectively. Our results have shown that CD45+ (P<0.0001) and CD163+ (P<0.0001) cells were markedly increased in children with severe histological activity (NAS≥5) compared to children with lower activity (NAS<5), whereas CD3+ cells were significantly lower (P<0.01) in children with severe histological activity. There was a significant association between the numbers of CD45+, CD3+ and CD163+ cells, regarding both the portal tract and liver lobule, and the severity of steatosis, ballooning and fibrosis (P<0.01). These data suggest that the severity and composition of the inflammatory infiltrate correlate with steatosis and the severity of disease in children with NAFLD. Moreover, a decrease in CD3+ cells may be involved in the pathogenesis of liver damage. Future studies should evaluate whether it can predict the progression of liver disease independently of established histological scores.
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Salata M, Golbus J, Richardson BC. Diminished response to an inhibitory signal in lymphocytes from patients with systemic lupus erythematosus. Clin Exp Immunol 1988; 71:439-44. [PMID: 3260156 PMCID: PMC1541662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Systemic lupus erythematosus is an autoimmune disease characterized by B-cell hyperactivity, resulting in polyclonal hypergammaglobulinaemia. One mechanism potentially resulting in excessive immunoglobulin synthesis is a diminished response to inhibitory signals. To test this hypothesis, anti-IgG antisera was used to inhibit pokeweed mitogen activation of cultured lymphocytes from lupus patients and controls. Inhibition of IgG secretion by B cells from lupus patients required more than 75 times as much anti-IgG as normal controls (P less than 0.005), indicating that lupus lymphocytes are hyporesponsive to this inhibitory signal. Similar studies with DR3+ controls demonstrated that diminished responsiveness to anti-IgG inhibition may in part be associated with the HLA-DR3 allele. Defects in this inhibitory mechanism may play a role in the B-cell hyperactivity observed in lupus.
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Affiliation(s)
- M Salata
- Department of Internal Medicine, University of Michigan, Ann Arbor
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Golbus J, Salata M, Greenwood J, Hudson J, Richardson BC. Increased immunoglobulin response to gamma-interferon by lymphocytes from patients with systemic lupus erythematosus. Clin Immunol Immunopathol 1988; 46:129-40. [PMID: 3121224 DOI: 10.1016/0090-1229(88)90013-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The factors responsible for abnormal B-cell activation in systemic lupus erythematosus (SLE) are incompletely understood. This study tested the hypothesis that the abnormal B-cell activation observed in human SLE may be due to an augmented response to a helper signal. We demonstrated that non-T cells from 10 of 19 SLE patients increased IgG production in response to interferon-gamma (IFN-gamma) by a mean factor of 20.9 +/- 3.9 over resting levels, while controls stimulated a mean factor of 3.0 +/- 0.5 (P less than 0.005). We found no relationship of IFN-gamma responsiveness to disease activity. Serotyping for HLA A, B, C, and D loci suggested that the hyperresponsiveness may be genetically linked to HLA-Cw7. We conclude that IFN-gamma may contribute to the development and perpetuation of SLE in a subset of patients with SLE.
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Affiliation(s)
- J Golbus
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109
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