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Terlizzi V, Claut L, Tosco A, Colombo C, Raia V, Fabrizzi B, Lucarelli M, Angeloni A, Cimino G, Castaldo A, Marsiglio L, Timpano S, Cirilli N, Moroni L, Festini F, Piccinini P, Zavataro L, Bonomi P, Taccetti G, Southern KW, Padoan R. A survey of the prevalence, management and outcome of infants with an inconclusive diagnosis following newborn bloodspot screening for cystic fibrosis (CRMS/CFSPID) in six Italian centres. J Cyst Fibros 2021; 20:828-834. [PMID: 33883100 DOI: 10.1016/j.jcf.2021.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We evaluated the prevalence, Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene profile, clinical data, management and outcome for infants with a CFTR-related metabolic syndrome/CF Screen Positive, Inconclusive Diagnosis (CRMS/CFSPID) designation from six Italian centres. METHODS All newborn bloodspot screening (NBS) positive infants born from January 2011 to August 2018 with a CF diagnosis or a CRMS/CFSPID designation were enrolled. Data on sweat testing, genetics, clinical course and management were collected. RESULTS We enrolled 257 CF patientsand 336 infants with a CRMS/CFSPID designation (CF: CRMS/CFSPID ratio of 1:1.30).Blood immuno-reactive trypsinogen (IRT) was significantly lower in CRMS/CFSPID infants and the F508del variant accounted for only 20% of alleles. Children with CRMS/CFSPID showed a milder clinical course, pancreatic sufficiency compared to CF infants. Varied practice across centres was identified regarding sweat testing, chest radiograph (8-100%) and salt supplementation (11-90%). Eighteen (5.3%) CRMS/CFSPID infants converted or were reclassified to diagnosis of CF. Four infants (1.3%) developed a clinical feature consistent with a CFTR-related disorder (1.2%). Twenty-seven were re-classified as healthy carriers (8.0%) and 16 as healthy infants (4.8%). CONCLUSIONS We have identified considerable variability in the evaluation and management of infants with an inconclusive diagnosis following NBS across six Italian centres. CRMS/CFSPID is more regularly seen in this population compared to countries with higher prevalence of F508del.Conversion to a CF diagnosis was recorded in 18 (5.3%) of CRMS/CFSPID infants and in 16 was as a result of increasing sweat chloride concentration.
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Affiliation(s)
- Vito Terlizzi
- Cystic Fibrosis Regional Reference Center, Department of Paediatric Medicine, Anna Meyer Children's University, Florence, Italy.
| | - Laura Claut
- Cystic Fibrosis Regional Reference Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Antonella Tosco
- Paediatric Unit, Department of Translational Medical Sciences, Cystic Fibrosis Regional Reference Center, University of Naples Federico II, Naples, Italy
| | - Carla Colombo
- Cystic Fibrosis Regional Reference Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Valeria Raia
- Paediatric Unit, Department of Translational Medical Sciences, Cystic Fibrosis Regional Reference Center, University of Naples Federico II, Naples, Italy
| | - Benedetta Fabrizzi
- Cystic Fibrosis Regional Reference Center, Mother - Child Department, United Hospitals, Ancona, Italy
| | - Marco Lucarelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; Pasteur Institute Cenci Bolognetti Foundation, Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cimino
- Cystic Fibrosis Regional Reference Center, A.O.U. Policlinico Umberto I, Rome, Italy
| | - Alice Castaldo
- Paediatric Unit, Department of Translational Medical Sciences, Cystic Fibrosis Regional Reference Center, University of Naples Federico II, Naples, Italy
| | - Laura Marsiglio
- Cystic Fibrosis Regional Support Center, Department of Pediatrics, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy
| | - Silviana Timpano
- Cystic Fibrosis Regional Support Center, Department of Pediatrics, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy
| | - Natalia Cirilli
- Cystic Fibrosis Regional Reference Center, Mother - Child Department, United Hospitals, Ancona, Italy
| | - Laura Moroni
- Cystic Fibrosis Regional Reference Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Filippo Festini
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Lucia Zavataro
- Cystic Fibrosis Regional Reference Center, Department of Paediatric Medicine, Anna Meyer Children's University, Florence, Italy
| | | | - Giovanni Taccetti
- Cystic Fibrosis Regional Reference Center, Department of Paediatric Medicine, Anna Meyer Children's University, Florence, Italy
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Institute in the Park, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Rita Padoan
- Cystic Fibrosis Regional Support Center, Department of Pediatrics, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy
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Botti M, Terlizzi V, Francalanci M, Dolce D, Cavicchi MC, Neri AS, Galici V, Mergni G, Zavataro L, Centrone C, Festini F, Taccetti G. Cystic fibrosis in Tuscany: evolution of newborn screening strategies over time to the present. Ital J Pediatr 2021; 47:2. [PMID: 33407736 PMCID: PMC7788805 DOI: 10.1186/s13052-020-00948-8] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-threatening disease affecting about 1:3000 newborns in Caucasian populations. The introduction of newborn screening for cystic fibrosis (CF NBS) has improved the clinical outcomes of individuals with CF through early diagnosis and early treatment. NBS strategies have been implemented over time. CF NBS was introduced extensively in 1984 in Tuscany, a region with 3.7 million people, characterized by a high allelic heterogeneity of CFTR gene. AIM AND METHODS The aim of the study is to present the results from 34 years (1984-2018) of CF NBS, retrospectively evaluating the sensitivity, specificity and predictive values of the tests. In particular, we studied the impact of the introduction of DNA molecular analysis in NBS in a region with high allelic heterogeneity, such as Tuscany. RESULTS Over these 34 years, 919,520 neonates were screened, using four different NBS strategies. From 1984 to 1991, CF NBS was performed by the determination of albumin on dried meconium (sensitivity 68.75%; specificity 99.82%). Subsequently, the analysis of immunoreactive trypsinogen on a blood spot was adopted as CF NBS protocol (sensitivity 83.33%; specificity 99.77%). From 1992 to 2010, this strategy was associated with lactase meconium dosage: IRT1/IRT2 + LACT protocol (sensitivity 87.50%; specificity 99.82%). From 2011, when the existing algorithm was integrated by analysis of CF causing variants of the CFTR gene (IRT1/IRT2 + LACT + IRT1/DNA protocol), a substantial improvement in sensitivity was seen (senisitivity 96.15%; specificity 99.75%). Other improved parameters with DNA analysis in the NBS programme, compared with the previous method, were the diagnosis time (52 days vs. 38 days) and the recall rate (0.58 to 0.38%). CONCLUSION The inclusion of DNA analysis in the NBS was a fundamental step in improving sensitivity, even in a region with high allelic variability.
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Affiliation(s)
- Matteo Botti
- Tuscany Support Cystic Fibrosis Service, Department of Pediatrics, Leghorn Hospital, Leghorn, Italy
| | - Vito Terlizzi
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Michela Francalanci
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Daniela Dolce
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Maria Chiara Cavicchi
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Anna Silvia Neri
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Valeria Galici
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Gianfranco Mergni
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Lucia Zavataro
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Claudia Centrone
- Diagnostic Genetics Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Festini
- Department of Pediatrics, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Giovanni Taccetti
- Tuscany Referral Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy.
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Botti M, Camera E, Campana S, Dolce D, Mergni G, Orioli T, Ravenni N, Cavicchi M, Francalanci M, Galici V, Neri A, Terlizzi V, Zavataro L, Festini F, Taccetti G. P018 Symptoms at diagnosis and genotype of false negatives (FNs) in newborn screening (NBS) in Tuscany: experience over 26 years. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Terlizzi V, Mergni G, Centrone C, Festini F, Taccetti G. Trend of sweat chloride values in a cohort of patients carrying CFTR mutations of varying clinical consequence: Is there a risk of increasing sweat chloride over time? Pediatr Pulmonol 2020; 55:1089-1093. [PMID: 32150665 DOI: 10.1002/ppul.24721] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/27/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Vito Terlizzi
- Department of Paediatric Medicine, Cystic Fibrosis Centre, Anna Meyer Children's University Hospital, Florence, Italy
| | - Gianfranco Mergni
- Department of Paediatric Medicine, Cystic Fibrosis Centre, Anna Meyer Children's University Hospital, Florence, Italy
| | - Claudia Centrone
- Diagnostic Genetics Unit, Careggi University Hospital, Firenze, Italy
| | - Filippo Festini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Taccetti
- Department of Paediatric Medicine, Cystic Fibrosis Centre, Anna Meyer Children's University Hospital, Florence, Italy
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Tomboloni C, Tersigni C, de Martino M, Dini D, González-López JR, Festini F, Neri S, Ciofi D. Knowledge, attitude and disinformation regarding vaccination and immunization practices among healthcare workers of a third-level paediatric hospital. Ital J Pediatr 2019; 45:104. [PMID: 31426830 PMCID: PMC6701138 DOI: 10.1186/s13052-019-0684-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/17/2019] [Indexed: 11/22/2022] Open
Abstract
Background Vaccination represents one of the most effective means of preventing infections for the population and for the public health in general. Recently there has been a decline in vaccinations, also among healthcare workers (HCWs). The aim of the study is to detect the knowledge, skills, attitudes and barriers of HCWs regarding vaccinations in a tertiary children’s hospital in order to support clinical management in immunisation practices. Methods An observational study was conducted on 255 subjects over a period of 8 months. The 31-item questionnaire considered profession, level of instruction and different ages. It included questions taken from a questionnaire used for a Canadian research and one used by the Bellinzona hospital. A 4-point Likert scale and closed-ended questions were used. A confidence interval of 95%, p value ≤ 0.05, Chi-square, ANOVA and the Kruskal-Wallis test were considered. Results In the last 5 years less than one third of the sample were vaccinated against flu. 77.8% (n.130) of nurses and 45.8% (n.19) of doctors were not vaccinated (p < 0.0001). As for risk perception, 51.5% of nurses and 90.6% of doctors believe that their risk of contracting influenza is greater than that of the general population. In relation to the injection site, in all the age ranges there was a high level of knowledge except for those aged over 61 who responded incorrectly. Doctors were more prepared (p < 0.0001). 50% of the sample used internet only as a source of information for vaccines. Generally, scientific sources were used infrequently. The higher the education level, the more frequent the utilisation of trustworthy scientific resources and literature. (p = 0.0002). Conclusions In line with the attitude observed in recent years, nurses are not inclined to get vaccinated themselves although they agree to having their children vaccinated. HCWs have a good level of knowledge about vaccines and immunisation practices. With the nurses we found that the higher the education level, the greater the knowledge about vaccines which leads to the conclusion that low levels of adherence are not due to a lack of knowledge, but rather, to a low perception of risks. Hence the need to strengthen the vaccination strategies inside the companies.
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Affiliation(s)
- Carlotta Tomboloni
- Oxford University Hospital NHS Foundation Trust, Collaborator of the Italian Science Society of Paediatric Nursing, Oxford, UK
| | - Chiara Tersigni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.
| | - Donata Dini
- Anna Meyer Children's Hospital, Florence, Italy
| | - José Rafael González-López
- Faculty of Nursing, Physiotherapy and Podiatry, Nursing Department, Universidad de Sevilla, Seville, Spain
| | - Filippo Festini
- Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
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Chiappini E, Venturini E, Remaschi G, Principi N, Longhi R, Tovo PA, Becherucci P, Bonsignori F, Esposito S, Festini F, Galli L, Lucchesi B, Mugelli A, Marseglia GL, de Martino M. 2016 Update of the Italian Pediatric Society Guidelines for Management of Fever in Children. J Pediatr 2017; 180:177-183.e1. [PMID: 27810155 DOI: 10.1016/j.jpeds.2016.09.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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] [Received: 03/11/2016] [Revised: 07/29/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review new scientific evidence to update the Italian guidelines for managing fever in children as drafted by the panel of the Italian Pediatric Society. STUDY DESIGN Relevant publications in English and Italian were identified through search of MEDLINE and the Cochrane Database of Systematic Reviews from May 2012 to November 2015. RESULTS Previous recommendations are substantially reaffirmed. Antipyretics should be administered with the purpose to control the child's discomfort. Antipyretics should be administered orally; rectal administration is discouraged except in the setting of vomiting. Combined use of paracetamol and ibuprofen is discouraged, considering risk and benefit. Antipyretics are not recommended preemptively to reduce the incidence of fever and local reactions in children undergoing vaccination, or in attempt to prevent febrile convulsions in children. Ibuprofen and paracetamol are not contraindicated in children who are febrile with asthma, with the exception of known cases of paracetamol- or nonsteroidal anti-inflammatory drug-induced asthma. CONCLUSIONS Recent medical literature leads to reaffirmation of previous recommendations for use of antipyretics in children who are febrile.
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Affiliation(s)
- Elena Chiappini
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
| | - Elisabetta Venturini
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Giulia Remaschi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Nicola Principi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Riccardo Longhi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Pier-Angelo Tovo
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paolo Becherucci
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesca Bonsignori
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Susanna Esposito
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Filippo Festini
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Bice Lucchesi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alessandro Mugelli
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Gian Luigi Marseglia
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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Liguori S, Stacchini M, Ciofi D, Olivini N, Bisogni S, Festini F. Effectiveness of an App for Reducing Preoperative Anxiety in Children: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:e160533. [PMID: 27294708 DOI: 10.1001/jamapediatrics.2016.0533] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Effective methods to reduce children's preoperative anxiety (such as giving information beforehand, organizing a tour of the operating room [OR] before the intervention, and incorporating clown physicians) may be difficult to implement for some hospitals, as they are time-consuming and expensive and require hospital staff to be performed. OBJECTIVE To test the effectiveness of Clickamico, an app that shows clown physicians giving a comical and informative tour of the OR, for reducing preoperative anxiety in children. DESIGN, SETTING, AND PARTICIPANTS This unblinded randomized clinical trial included 40 children aged 6 to 11 years undergoing a planned surgical intervention at a third-level Italian pediatric hospital from December 2013 to September 2014 randomized into experimental (n = 20) and control (n = 20) groups. INTERVENTIONS The experimental intervention was a 6-minute video showing 2 clown physicians visiting the OR and explaining to each other what is in the OR in a joking way. The video was shown on a tablet to children in the experimental group the afternoon preceding a planned surgical procedure. The control intervention was the standard informative intervention regarding the surgical procedure the next day. MAIN OUTCOMES AND MEASURES The main outcome was preoperative anxiety. Preoperative anxiety was measured before the experimental and control interventions and immediately before entering the OR using the modified Yale Preoperative Anxiety Scale (m-YPAS). RESULTS The experimental and control groups were homogeneous with regard to age (mean [SD] age, 8.8 [2.5] vs 8.6 [2.2] years), sex (female, 11 [55.0%] vs 9 [45.0%]), parents' age (mean [SD] age, 41.8 [6.2] vs 41.3 [5.0] years), and previous surgical procedures (already underwent surgical procedure, 9 [45.0%] vs 10 [50.0%]). The initial mean (SD) m-YPAS scores were 37.3 (21.7) and 37.1 (13.8) for the experimental and control groups, respectively; the mean (SD) m-YPAS scores when entering the OR were 33.0 (18.4) and 48.6 (15.9), respectively (P = .009). The mean (SD) difference between the m-YPAS score at the first and second measurements of each participant was -2.8 (7.2) in the experimental group and 10.7 (10.8) in the control group. The 13.5-point difference between these averages was statistically significant (P = .003). CONCLUSIONS AND RELEVANCE The app was effective in reducing preoperative anxiety in Italian children admitted to an Italian National Health System pediatric hospital and may act as a substitute for staff-provided interventions, allowing possible reductions of hospital costs. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01688115.
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Affiliation(s)
| | | | | | - Nicole Olivini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sofia Bisogni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Filippo Festini
- Meyer Children's Hospital, Florence, Italy3Department of Health Sciences, University of Florence, Florence, Italy
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Romano M, Festini F, Bronner L. [Cross-sectional study on the determinants of work stress for nurses and intention of leaving the profession]. Prof Inferm 2016; 68:203-10. [PMID: 26752311 DOI: 10.7429/pi.2015.684203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Occupational stress is one of the main causes of sick leaves among healthcare professionals and it determines high costs to health systems. Monitoring occupational related stress can be an important tool for policy makers. The Italian nursing research gave little attention to nurses' occupational stress. The aims of this study is to estimate the prevalence of occupational stress and evaluate risks factors among Italian nurses in order to evaluate health promotion intervention. METHODS Cross-sectional study on a convenience sample of nurses from three Italian public hospitals was carried out. The Nursing Stress Scale was administrated together with socio-demographic data information(age, occupational age, family structure etc). The Nursing Stress Scale includes 34 items with a score from 0 to 3. Seven areas of job related stress are investigate in the scale: conflict with physicians, inadequate training, lack of support, conflict with other nurses, workload, uncertainty about treatments, death and suffering. Scores were calculated for each item and for each area. Associations between stress scores and socio-demographic data were analyzed. RESULTS 231 nurses participated to the study. The two stress areas with the highest scores were "workload" (1.58) and "death and suffering" (1.39). Among the 13 items that exceed the overall mean stress score (i.e. 1.07), five belong to the "workload" area. "Watching a suffering patient" is the single item with the highest mean score. Demographic data associated to higher stress scores are, female gender (p=0.03) and working with night shifts (p=0.02). Intention to leave the nursing profession is associated to higher stress scores (p=0.002). Age, occupational age, time to commute to work, number of children, having disabled relatives at home, were not correlated to higher stress scores. CONCLUSIONS Our study provides data regarding nurses' occupational stress that was not available before. This data may be useful for policy makers to plan preventive interventions for nurses' job related stress and to reduce nurses' intention to leave.
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Affiliation(s)
- Marina Romano
- Coordinatore Infermieristico, Università degli Studi di Firenze, Corso di Laurea in Infermieristica, Sede di Pistoia. Correspondence:
| | - Filippo Festini
- Professore Associato Scienze Infermieristiche, Università di Firenze
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Fabbri L, Neviani R, Festini F, Costi S. Transcultural validation of Activities Scale for Kids (ASK): translation and pilot test. Acta Biomed 2016; 87 Suppl 2:70-79. [PMID: 27240035] [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] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND AIM OF THE WORK The Activities Scale for Kids performance (ASKp) is one of the few self-assessment questionnaires in pediatric rehabilitation that measures child perception in performance of daily routine activities. ASKp is composed of 30 questions designed to explore activities and participation in children and teenagers with musculoskeletal disorders. Scores assess level of physical ability, identify appropriate treatment and monitor changes over time. We undertook this cross-cultural validation study to achieve a culturally adapted Italian version of ASKp, to be tested on Italian children. METHODS ASKp was converted into Italian by two independent certified translators, supported by two Italian research physiotherapists. Twelve children with musculoskeletal disorders, their parents and eleven expert pediatric physiotherapists independently assessed clarity of language and semantics of each item. Physiotherapists also evaluated content validity of each item. RESULTS One item out of 30 did not reach inter-rater agreement ≥80% for clarity and was modified according to suggestions given. A panel of three research physiotherapists improved clarity of some other items based on suggestions from study participants. Regarding content validity of ASKp, I-CVI was ≥0.59 for all items and overall ASKp was deemed valid (S-CVI/Ave 0.93). CONCLUSIONS The Italian version of ASKp is linguistically clear and culturally coherent with a high content validity. It can be extremely useful in assessing activity limitation perspectives in Italian children and adolescent ranging from five to 15 affected by musculoskeletal disorders.
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Affiliation(s)
- Lucia Fabbri
- Child & Adolescent Neuropsychiatric Unit (NPIA), AUSL of Imola IT.
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Affiliation(s)
- Filippo Festini
- Department of Paediatric Nursing, University of Florence, Meyer Children’s Hospital, Florence, Italy, and Italian Society of Paediatric Nursing Science
| | - Edward Alan Glasper
- Emeritus Professor of Children’s and Young People’s Nursing, University of Southampton, Southampton, UK
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Chiappini E, Camaioni A, Benazzo M, Biondi A, Bottero S, De Masi S, Di Mauro G, Doria M, Esposito S, Felisati G, Felisati D, Festini F, Gaini RM, Galli L, Gambini C, Gianelli U, Landi M, Lucioni M, Mansi N, Mazzantini R, Marchisio P, Marseglia GL, Miniello VL, Nicola M, Novelli A, Paulli M, Picca M, Pillon M, Pisani P, Pipolo C, Principi N, Sardi I, Succo G, Tomà P, Tortoli E, Tucci F, Varricchio A, de Martino M, Italian Guideline Panel For Management Of Cervical Lymphadenopathy In Children. Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology. Expert Rev Anti Infect Ther 2015; 13:1557-67. [PMID: 26558951 DOI: 10.1586/14787210.2015.1096777] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children. METHODS The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014. RESULTS Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified. CONCLUSION The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.
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Affiliation(s)
- Elena Chiappini
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Angelo Camaioni
- b ENT Department , San Giovanni-Addolorata Hospital , Rome , Italy
| | - Marco Benazzo
- c Department of Otorhinolaryngology, "San Matteo" Hospital , University of Pavia , Pavia , Italy
| | - Andrea Biondi
- d Paediatric Haematology-Oncology Department and "Tettamanti" Research Centre , Milano-Bicocca University, "Fondazione Mbbm", San Gerardo Hospital , Monza , Italy
| | - Sergio Bottero
- e ENT Unit, Department of Surgery and Transplantation Centre , Bambino Gesù Children's Hospital, IRCCS , Rome , Italy
| | | | | | | | - Susanna Esposito
- i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy
| | - Giovanni Felisati
- j Department of Otolaryngology , San Paolo Hospital, University of Milan , Milan , Italy
| | - Dino Felisati
- j Department of Otolaryngology , San Paolo Hospital, University of Milan , Milan , Italy
| | - Filippo Festini
- k Department of Health Science , University of Florence , Florence , Italy
| | - Renato Maria Gaini
- l Department of Otorhinolaryngology , San Gerardo Hospital , Monza , Italy.,m Department of Surgery and Translational Medicine , University of Milano-Bicocca , Milan , Italy
| | - Luisa Galli
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Claudio Gambini
- n Pathology Unit , Istituto Giannina Gaslini , Genua , Italy
| | - Umberto Gianelli
- o Fondazione Ircss Ca' Granda-Ospedale Maggiore Policlinico , Italy University of Milan , Milan , Italy
| | | | - Marco Lucioni
- q Otolaryngology Unit , Vittorio Veneto Hospital , Vittorio Veneto , Italy
| | - Nicola Mansi
- r ENT Unit , Santo Bono Posillipo Hospital , Naples , Italy
| | - Rachele Mazzantini
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Paola Marchisio
- i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy
| | - Gian Luigi Marseglia
- s Department of Pediatrics , University of Pavia, Fondazione Irccs Policlinico San Matteo , Pavia , Italy
| | | | - Marta Nicola
- u Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | - Andrea Novelli
- v Department of Health Sciences, Section of Pharmacology , University of Florence , Florence , Italy
| | - Marco Paulli
- w Department of Pathology, Fondazione Irccs Policlinico San Matteo, and Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | | | - Marta Pillon
- y Oncoemaology Unit, Department of Paediatrics , University of Padua , Padua , Italy
| | - Paolo Pisani
- z Otorhinolaryngology Unit, Head and Neck Department , San Paolo Hospital, University of Milan , Milan , Italy
| | - Carlotta Pipolo
- aa Department of Cardiovascular Surgery , Ncc Città Di Alessandria Hospital , Alessandria , Italy
| | - Nicola Principi
- i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy
| | - Iacopo Sardi
- ab Neuro-Oncology Unit, Meyer Meyer Univeristy Hospital , Florence , Italy
| | - Giovanni Succo
- ac Otorhinolaryngology Service, Department of Oncology , San Luigi Gonzaga Hospital, University of Turin , Turin , Italy
| | - Paolo Tomà
- ad Department of Diagnostic Imaging , Children's Hospital Bambino Gesù , Rome , Italy
| | | | - Filippo Tucci
- af University Hospital Pediatric Department , Bambino Gesù Children's Hospital, Rome , Rome , Italy
| | | | - Maurizio de Martino
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
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Bisogni S, Chiarini I, Giusti F, Ciofi D, Poggi GM, Festini F. Impact of hospitalization on the sleep patterns of newborns, infants and toddlers admitted to a pediatric ward: a cross-sectional study. Minerva Pediatr 2015; 67:209-217. [PMID: 25297322] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Sleep is essential for children's physical and mental recovery and it is indispensable for their growth, for endocrine and for immune function, and for the development of cognitive behavioral skills. The purpose of this study is to describe the impact of hospitalization on the sleep patterns of newborns, infants and toddlers, as well as mothers' perceptions of any changes in their children's sleep patterns. METHODS This was a single-centre cross-sectional study. The study included children aged up to 2 years who had been hospitalized for more than two days, selected by accidental sampling. Data were collected using an anonymous questionnaire with open and closed questions administered to mothers. RESULTS Two hundred and one children aged on average 11.2 months (SD 10.3) were enrolled in the study. The percentage of children who at home used to sleep less than 5 hours a night increased by 4.7% in hospital, while the percentage of children sleeping 9 to 11 hours at home decreased by 5.9% in hospital. In hospital mothers put their children to bed later than at home. Indeed, the number of individuals going to bed between 9 and 10 p.m. decreased by 9.8% in hospital, while the number of children going to bed between 10 and 11 p.m. increased by 10.1%. The number of children who had 2 to 4 awakenings per night increased by 13.9% and the number of those who had 4 to 6 nocturnal awakenings increased by 4.8%; 50.5% of mothers reported that their children's sleep was interrupted by nurses to provide care. Mothers generally perceived their children's sleep as adequate, even if they noticed that their children were more restless and irritable. Mothers with only one child reported that they had more difficulty helping their children fall asleep (P=0.02). CONCLUSION The study highlights the need to review the routine in paediatric wards on the basis of the sleep needs of children. Further studies are needed to estimate the effectiveness of the specific measures suggested by mothers.
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Affiliation(s)
- S Bisogni
- University of L'Aquila, L'Aquila, Italy -
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13
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Bisogni S, Aringhieri C, McGreevy K, Olivini N, Lopez JRG, Ciofi D, Merlo AM, Mariotti P, Festini F. Actual implementation of sick children's rights in Italian pediatric units: a descriptive study based on nurses' perceptions. BMC Med Ethics 2015; 16:33. [PMID: 25964120 PMCID: PMC4455682 DOI: 10.1186/s12910-015-0021-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Several charters of rights have been issued in Europe to solemnly proclaim the rights of children during their hospital stay. However, notwithstanding such general declarations, the actual implementation of hospitalized children’s rights is unclear. The purpose of this study was to understand to which extent such rights, as established by the two main existing charters of rights, are actually implemented and respected in Italian pediatric hospitals and the pediatric units of Italian general hospitals, as perceived by the nurses working in them. Methods Cross-sectional study. A 12-item online questionnaire was set up and an invitation was sent by email to Italian pediatric nurses using professional mailing lists and social networks. Responders were asked to score to what extent each right is respected in their hospital using a numeric scale from 1 (never) to 5 (always). Results 536 questionnaires were returned. The best implemented right is the right of children to have their mothers with them (mean score 4.47). The least respected one is the right of children to express their opinion about care (mean 3.01). Other rights considered were the right to play (4.29), the right to be informed (3.95), the right to the respect of privacy (3.75), the right to be hospitalized with peers (3.39), the right not to experience pain ever (3.41), and the right to school (3.07). According to the majority of nurses, the most important is the right to pain relief. Significant differences in the implementation of rights were found between areas of Italy and between pediatric hospitals and pediatric units of general hospitals. Conclusion According to the perception of pediatric nurses, the implementation of the rights of hospitalized children in Italian pediatrics units is still limited.
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Affiliation(s)
- Sofia Bisogni
- Department of Health Sciences, University of Florence, Florence, Italy.
| | | | | | - Nicole Olivini
- Department of Health Sciences, University of Florence, Florence, Italy.
| | | | - Daniele Ciofi
- Meyer Children's University Hospital of Florence, Florence, Italy.
| | | | - Paola Mariotti
- Health Authority of Florence, Torregalli Hospital, Florence, Italy.
| | - Filippo Festini
- Department of Health Sciences, University of Florence, Florence, Italy.
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Bisogni S, Olivini N, Festini F. Undertreated and untreated pain should be considered an adverse event of neonatal circumcision. JAMA Pediatr 2014; 168:1076-7. [PMID: 25365387 DOI: 10.1001/jamapediatrics.2014.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sofia Bisogni
- Department of Health Sciences, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Nicole Olivini
- Department of Health Sciences, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Filippo Festini
- Department of Health Sciences, University of Florence, Meyer Children Hospital, Florence, Italy
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15
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Baraldi E, Lanari M, Manzoni P, Rossi GA, Vandini S, Rimini A, Romagnoli C, Colonna P, Biondi A, Biban P, Chiamenti G, Bernardini R, Picca M, Cappa M, Magazzù G, Catassi C, Urbino AF, Memo L, Donzelli G, Minetti C, Paravati F, Di Mauro G, Festini F, Esposito S, Corsello G. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr 2014; 40:65. [PMID: 25344148 PMCID: PMC4364570 DOI: 10.1186/1824-7288-40-65] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 01/14/2023] Open
Abstract
Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed.To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age.The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.
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Affiliation(s)
- Eugenio Baraldi
- />SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Kragujevac, Italy
- />Women’s and Children’s Health Department, Unit of Pediatric Respiratory Medicine and Allergy, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | | | - Paolo Manzoni
- />SIN-Società Italiana di Neonatologia, Kragujevac, Italy
| | - Giovanni A Rossi
- />SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Kragujevac, Italy
| | - Silvia Vandini
- />SIN-Società Italiana di Neonatologia, Kragujevac, Italy
| | - Alessandro Rimini
- />SICP-Società Italiana di Cardiologia Pediatrica, Kragujevac, Italy
| | | | - Pierluigi Colonna
- />SICP-Società Italiana di Cardiologia Pediatrica, Kragujevac, Italy
| | - Andrea Biondi
- />AIEOP - Società Italiana di Ematologia e Oncologia Pediatrica, Kragujevac, Italy
| | - Paolo Biban
- />AMIETIP - Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica, Kragujevac, Italy
| | | | - Roberto Bernardini
- />SIAIP - Società Italiana di Allergologia e Immunologia Pediatrica, Kragujevac, Italy
| | - Marina Picca
- />SICuPP - Società Italiana delle Cure Primarie Pediatriche, Kragujevac, Italy
| | - Marco Cappa
- />SIEDP - Società Italiana di Endocrinologia e Diabetologia Pediatrica, Kragujevac, Italy
| | - Giuseppe Magazzù
- />SIFC - Società Italiana per lo studio della Fibrosi Cistica, Kragujevac, Italy
| | - Carlo Catassi
- />SIGENP - Società Italiana Gastroenterologia Epatologia e Nutrizione Pediatrica, Kragujevac, Italy
| | | | - Luigi Memo
- />SIMGePeD - Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite, Kragujevac, Italy
| | | | - Carlo Minetti
- />SINP - Società Italiana di Neurologia Pediatrica, Kragujevac, Italy
| | | | - Giuseppe Di Mauro
- />SIPPS - Società Italiana di Pediatria Preventiva e Sociale, Kragujevac, Italy
| | - Filippo Festini
- />SISIP - Società Italiana di Scienze Infermieristiche Pediatriche, Kragujevac, Italy
| | - Susanna Esposito
- />SITIP - Società Italiana di Infettivologia Pediatrica, Kragujevac, Italy
| | | | - on behalf of their respective Scientific Pediatric Societies
- />SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Kragujevac, Italy
- />Women’s and Children’s Health Department, Unit of Pediatric Respiratory Medicine and Allergy, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- />SIN-Società Italiana di Neonatologia, Kragujevac, Italy
- />SICP-Società Italiana di Cardiologia Pediatrica, Kragujevac, Italy
- />AIEOP - Società Italiana di Ematologia e Oncologia Pediatrica, Kragujevac, Italy
- />AMIETIP - Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica, Kragujevac, Italy
- />FIMP - Federazione Italiana Medici Pediatri, Kragujevac, Italy
- />SIAIP - Società Italiana di Allergologia e Immunologia Pediatrica, Kragujevac, Italy
- />SICuPP - Società Italiana delle Cure Primarie Pediatriche, Kragujevac, Italy
- />SIEDP - Società Italiana di Endocrinologia e Diabetologia Pediatrica, Kragujevac, Italy
- />SIFC - Società Italiana per lo studio della Fibrosi Cistica, Kragujevac, Italy
- />SIGENP - Società Italiana Gastroenterologia Epatologia e Nutrizione Pediatrica, Kragujevac, Italy
- />SIMEUP - Società Italiana di Medicina di Emergenza ed Urgenza Pediatrica, Kragujevac, Italy
- />SIMGePeD - Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite, Kragujevac, Italy
- />SIMP - Società Italiana di Medicina Perinatale, Kragujevac, Italy
- />SINP - Società Italiana di Neurologia Pediatrica, Kragujevac, Italy
- />SIPO - Società Italiana Pediatria Ospedaliera, Kragujevac, Italy
- />SIPPS - Società Italiana di Pediatria Preventiva e Sociale, Kragujevac, Italy
- />SISIP - Società Italiana di Scienze Infermieristiche Pediatriche, Kragujevac, Italy
- />SITIP - Società Italiana di Infettivologia Pediatrica, Kragujevac, Italy
- />SIP-Società Italiana di Pediatria, Kragujevac, Italy
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Bisogni S, Dini C, Olivini N, Ciofi D, Giusti F, Caprilli S, Gonzalez Lopez JR, Festini F. Perception of venipuncture pain in children suffering from chronic diseases. BMC Res Notes 2014; 7:735. [PMID: 25326685 PMCID: PMC4210598 DOI: 10.1186/1756-0500-7-735] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/13/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Venipuncture pain in children results from a variety of co-factors which increase the intensity of the nociceptive stimulus. Among them, anticipatory anxiety plays an important role. Children with chronic diseases undergo invasive procedures and venipuncture more often than other children. Some healthcare professionals still believe that children who are repeatedly exposed to painful procedures, such as children with chronic diseases, gradually increase their pain tolerance and that, as a result, they have a higher pain threshold than children with no chronic diseases. The purpose of this study was to assess whether a difference exists in the perception of venipuncture pain between children with chronic diseases and children with no previous health problems nor experience of venipuncture. METHODS A cross-sectional study was carried out using the Wong and numeric pain scales and the Observational Scale of Behavioral Distress (OSBD) for the assessment of behavioral distress. A group of children with chronic diseases and a group of children with no previous health problems nor experience of venipuncture, aged 4 to 12 years, both boys and girls, were observed during a standardized venipuncture procedure. RESULTS The study included 230 children in total: 82 of them suffered from chronic diseases and had already experienced venipuncture at least once, while the remaining 148 children had no previous experience of venipuncture. The children with chronic diseases reported more pain (median pain score of 8 on the Wong or numeric scales,) and showed more signs of behavioral distress (median score of 27 on the OSBD) than non-chronic children (median pain score of 2 on the Wong/numeric scales, p = 0.00001; median OSBD score 5, p = 0.00001). CONCLUSIONS Our study suggests that children with chronic diseases have a lower pain threshold than children of the same sex and age who experience venipuncture for the first time.
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Affiliation(s)
- Sofia Bisogni
- />PhD School in Nursing Science, University of L’Aquila, L’Aquila, Italy
| | - Chiara Dini
- />Undergraduate BSN Course, University of Florence, Florence, Italy
| | - Nicole Olivini
- />Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Daniele Ciofi
- />Nursing Research Unit, Meyer Children Hospital of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Francesca Giusti
- />Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Simona Caprilli
- />Psychology Unit, Meyer Children Hospital of Florence, Florence, Italy
| | | | - Filippo Festini
- />Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
- />Nursing Research Unit, Meyer Children Hospital of Florence, Viale Pieraccini 24, 50139 Florence, Italy
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Chiappini E, Mazzantini R, Bruzzese E, Capuano A, Colombo M, Cricelli C, Di Mauro G, Esposito S, Festini F, Guarino A, Miniello VL, Principi N, Marchisio P, Rafaniello C, Rossi F, Sportiello L, Tancredi F, Venturini E, Galli L, de Martino M. Rational use of antibiotics for the management of children's respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics. Paediatr Respir Rev 2014; 15:231-6. [PMID: 24666567 DOI: 10.1016/j.prrv.2013.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Received: 10/31/2013] [Accepted: 11/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Several guidelines for the management of respiratory tract infections in children are available in Italy, as well as in other European countries and the United States of America. However, poor adherence to guidelines and the sustained inappropriate use of antibiotics have been reported. In the outpatient setting, almost half of antibiotics are prescribed for the treatment of common respiratory tract infections. In Italy the antibiotic prescription rate is significantly higher than in other European countries, such as Denmark or the Netherlands, and also the levels of antibiotic resistance for a large variety of bacteria are higher. Therefore, the Italian Society of Preventive and Social Paediatrics organised a consensus conference for the treatment of respiratory tract infections in children to produce a brief, easily readable, evidence-based document. METHODS The conference method was used, according to the National Institute of Health and the National Plan Guidelines. A literature search was performed focusing on the current guidelines for the treatment of airway infections in children aged 1 month-18 years in the ambulatory setting. RESULTS Recommendations for the treatment of acute pharyngitis, acute otitis media, sinusitis, and pneumonia have been summarized. Conditions for which antibiotic treatment should not be routinely prescribed have been highlighted. CONCLUSION This evidence-based document is intended to accessible to primary care pediatricians and general practice physicians in order to make clinical practice uniform, in accordance with the recommendations of the current guidelines.
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Affiliation(s)
- Elena Chiappini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Rachele Mazzantini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | | | - Claudio Cricelli
- Health Search Institute, Italian College of General Practitioners, Florence, Italy
| | - Giuseppe Di Mauro
- President Italian Society of Preventive and Social Pediatrics Primary care Pediatrician, Caserta, Italy
| | - Susanna Esposito
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Filippo Festini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples
| | | | - Nicola Principi
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Concetta Rafaniello
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | | | - Elisabetta Venturini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
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Bisogni S, Calzolai M, Olivini N, Ciofi D, Mazzoni N, Caprilli S, Lopez JRG, Festini F. Cross-sectional study on differences in pain perception and behavioral distress during venipuncture between italian and chinese children. Pediatr Rep 2014; 6:5660. [PMID: 25635220 PMCID: PMC4292063 DOI: 10.4081/pr.2014.5660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/05/2014] [Indexed: 11/23/2022] Open
Abstract
Venipuncture is perhaps the scariest aspect of hospitalization for children as it causes pain and high levels of behavioral distress. Pain is a complex experience which is also influenced by social factors such as cultural attitudes, beliefs and traditions. Studies focusing on ethnic/cultural differences in pain perception and behavioral distress show controversial results, in particular with regards to children. The aim of this paper is to evaluate differences in pain perception and behavioral manifestations between Italian and Chinese children undergoing a venipuncture, through a cross-sectional study. Behavioral distress and self-reported pain were measured in Chinese and Italian outpatient children during a standardized blood-drawing procedure, using the Observational Scale of Behavioral Distress (OSBD) and pain scales. We observed 332 children: 93 Chinese and 239 Italian. Chinese children scored higher than Italians on pain scales - mean scores 5.3 (95%CI 4.78-5.81) vs. 3.2 (95%CI 2.86-3.53) - but lower mean OSBD scores - mean 4.1 (95%CI 3.04-5.15) vs. 8.1 (95%CI 7.06-9.14). Our data suggest that Chinese children experience higher levels of pain than their Italian peers, although they show more self-control in their behavioral reaction to pain when experiencing venipuncture.
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Affiliation(s)
- Sofia Bisogni
- School of Nursing, University of L’Aquila, Italy
- Department of Health Sciences, University of Florence, Italy
| | - Marta Calzolai
- Department of Health Sciences, University of Florence, Italy
| | - Nicole Olivini
- Department of Health Sciences, University of Florence, Italy
| | - Daniele Ciofi
- Department of Health Sciences, University of Florence, Italy
- Nursing Research Unit Meyer Children Hospital of Florence; Spain
| | - Nicola Mazzoni
- Department of Health Sciences, University of Florence, Italy
| | - Simona Caprilli
- Nursing Research Unit Meyer Children Hospital of Florence; Spain
| | | | - Filippo Festini
- Department of Health Sciences, University of Florence, Italy
- Nursing Research Unit Meyer Children Hospital of Florence; Spain
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Bisogni S, Giusti F, Ciofi D, Festini F. Heparin solution for maintaining peripheral venous catheter patency in children: a survey of current practice in Italian pediatric units. ACTA ACUST UNITED AC 2014; 37:122-35. [PMID: 24666274 DOI: 10.3109/01460862.2014.895562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Prolonging the duration of peripheral venous catheters (PVC) as long as possible in children is a nursing priority. However, available studies provide conflicting evidence on what kind of flush/lock solution should be used to increase the life of PVCs in children. OBJECTIVES To describe the clinical behavior of nurses working in Italian pediatric units with regards to PVCs flushing and locking practices. METHODS Cross-sectional study. Nurses were invited to participate using the network of the Italian Society of Pediatric Nursing Science. Those participating completed an online questionnaire available on a website established for this specific purpose. Results: 405 questionnaires were completed. RESULTS The majority of nurses reported using Normal saline solution (NS) to flush 22 gauge PVCs: 77.6% in children up to 6 months of age, 74.7% in children 6 months to 2 years, and 74.6% in children over 2 years. Nurses tend to use heparin solutions (HS) more frequently when a smaller gauge PVC is used (24 instead of 22) and when access is less frequent. The use of HS for PVC lock is more common in onco-hematology units (54.5% in children over 6 months with 24 gauge PVC), pediatric surgery units (35%), and in short-stay units (55.6%), whereas NS is used more frequently in Intensive care units (9.4%) and neonatology units (12.2%). CONCLUSION Although the majority of respondents use NS, we found a high variability in practices among Italian nurses. More research on the effectiveness and safety of HS in maintaining the patency of PVCs is needed.
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Affiliation(s)
- Sofia Bisogni
- University of L'Aquila, School of Doctorate in Science of Nursing , L'Aquila , Italy
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Braccini G, Lori I, Neri A, Festini F, Pela I, Ciuti R, Boni V, Zavataro L, Braggion C, De Martino M, Taccetti G. Parenteral Administration of Tobramycin for Pulmonary Exacerbations in Cystic Fibrosis Patients: Toxicity, Serum Levels and Efficacy. J Chemother 2013; 21:101-4. [DOI: 10.1179/joc.2009.21.1.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Braccini G, Festini F, Boni V, Neri A, Galici V, Campana S, Zavataro L, Trevisan F, Braggion C, Taccetti G. The Costs of Treatment of Early and ChronicPseudomonas aeruginosaInfection in Cystic Fibrosis Patients. J Chemother 2013; 21:188-92. [DOI: 10.1179/joc.2009.21.2.188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Repetto T, Galici V, Mergni G, Zavataro L, Festini F, Taccetti G. 357 Is being Albanian a risk factor for cystic fibrosis? J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
In Italy the regulatory framework of the nursing professions presents critical aspects. While a Children Nurse cannot provide care to an adult, a newly graduated General Nurse can legally be assigned to a Neonatal Intensive Care Unit without having ever touched a newborn before. Italian general hospitals with pediatric departments almost always prefer to hire General Nurses rather than Children Nurses, because the former, albeit insufficiently prepared, make staff management easier for nursing directors. Italian Children Nurses are not only penalized by this situation, but also by the public's lack of interest in the specific wellbeing and health needs of children. In addition, they must defend themselves from a part of the Italian nursing leadership, which periodically tries to eliminate the pediatric nursing profession. In an environment that is essentially hostile to Children Nurses, the young who decide nonetheless to take up this profession have very strong and enduring motivations.
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Affiliation(s)
- Filippo Festini
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, Florence, Italy.
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Chiappini E, Venturini E, Principi N, Longhi R, Tovo PA, Becherucci P, Bonsignori F, Esposito S, Festini F, Galli L, Lucchesi B, Mugelli A, de Martino M. Update of the 2009 Italian Pediatric Society Guidelines About Management of Fever in Children. Clin Ther 2012; 34:1648-1653.e3. [DOI: 10.1016/j.clinthera.2012.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 12/20/2022]
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Festini F, Giusti F, Paoletti E, Biancalani L, Poggi GM. Is early use of pacifier a risk factor for diarrhea? Minerva Pediatr 2012; 64:303-305. [PMID: 22555322] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Non nutritive suckling has been always used by mothers for calming and comforting infants and young children. Previous studies have suggested that pacifiers may get contaminated but only three studies have shown a possible association between the use of pacifiers and diarrhea or enteric infections. The goal of this study was to investigate whether the early start of pacifier within the first month of life is a risk factor for diarrhea in early childhood. METHODS Case-control study. Subjects 12 to 36 month old were recruited. Cases were children with at least 1 episode of diarrhea per year of life. RESULTS Among cases (N.=63), those who had started using pacifier in the first month of life were 61.9%, while among controls (N.=78) they were 29.4%, OR 3.89, CI95% 1.92-7.85. Type and frequency of pacifier hygiene practices were not associated with diarrhea. CONCLUSION Our results suggest that the recommendation to postpone pacifier use after the first month of life not to interfere with the duration of breastfeeding, may have also the effect to reduce the risk of episodes of diarrhea in the first three years of life.
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Affiliation(s)
- F Festini
- Department of Sciences of Women's and Children's Health, University of Florence, Florence, Italy.
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Festini F, Giusti F. ["The grandest hero who has ever lived": an unpublished letter written by Florence Nightingale about Garibaldi]. Prof Inferm 2012; 65:11-13. [PMID: 22463749] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In the year of the 150th anniversary of the Unity of Italy, Italian nurses cannot forget that Florence Nightingale herself, founder of modern Nursing , was a fervid support of the Risorgimento and of Italian unity. An unpublished letter, signed by her and conserved in the State archives of Pistoia, illustrates her feelings about the process of unity under way in the country where she was born.
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Affiliation(s)
- Filippo Festini
- Università degli Studi di Firenze, Dipartimento di Scienze per la Salute della Donna e del Bambino, Viale Pieraccini 24, Italy.
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Ciofi D, Bisogni S, Festini F. Commentary on Thompson DR & Watson R (2010) Guest Editorial: h-indices and the performance of professors of nursing in the UK. Journal of Clinical Nursing19, 2957-2958. J Clin Nurs 2011; 20:1212. [DOI: 10.1111/j.1365-2702.2010.03630.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Festini F, Cocchi P, Mambretti D, Tagliabue B, Carotti M, Ciofi D, Biermann KP, Schiatti R, Ruggeri FM, De Benedictis FM, Plebani A, Guarino A, de Martino M. Nosocomial Rotavirus Gastroenteritis in pediatric patients: a multi-center prospective cohort study. BMC Infect Dis 2010; 10:235. [PMID: 20696065 PMCID: PMC2928776 DOI: 10.1186/1471-2334-10-235] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 08/09/2010] [Indexed: 11/30/2022] Open
Abstract
Background Few data are available on the incidence of nosocomial Rotavirus infections (NRVI) in pediatric hospitals and on their economic impact. The goals of this study were: to evaluate the incidence of NRVI in various Italian pediatric wards during the course of two peak RV seasons; to investigate possible risk factors for NRVI; to estimate the costs caused by NRVI. Methods prospective cohort study. Population: all the children under 30 months of age who were admitted without any symptom or diagnosis of gastroenteritis in the pediatric hospitals of Florence, Naples, Brescia and Ancona, Italy, during the winter-spring periods 2006-2007 and 2007-2008. Serial RV rapid tests and clinical monitoring were carried out on the cohort. Telephone interviews were performed from 3 to 5 days after discharge. Results 520 out of 608 children completed the study (85.6%). The overall incidence of NRVI was 5.3% (CI95% 3.6-7.5), (7.9 per 1,000 days of hospital stay, CI 95% 5.3-11.3). The average duration of hospital stay was significantly longer for children who had NRVI (8.1 days, SD 5.4) than for non-infected children (6.4 days, SD 5.8, difference 1.7 days, p = 0.004). The risk of contracting NRVI increased significantly if the child stayed in hospital more than 5 days, RR = 2.8 (CI95% 1.3-6), p = 0.006. In Italy the costs caused by NRVI can be estimated at 8,019,155.44 Euro per year. 2.7% of the children hospitalized with no gastroenteritis symptoms tested positive for RV. Conclusions Our study showed a relevant incidence of NRVI, which can increase the length of the children's stay in hospital. Limiting the number of nosocomial RV infections is important to improve patients' safety as well as to avoid additional health costs.
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Affiliation(s)
- Filippo Festini
- Department of Pediatrics, University of Florence, Florence, Italy.
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32
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Catastini P, Festini F, Di Marco S, Genovese C, Grande A, Iacinti E, Iusco D, Nobili R, Pescini R, Ragni R, Risso C, Tabarini P, Biondi G. The International Depression and Anxiety Epidemiological Study (TIDES): results from Italy. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Festini F, Procopio E, Taccetti G, Repetto T, Cioni ML, Campana S, Mergni G, Mascherini M, Marianelli L, de Martino M. Birth weight for gestational age centiles for Italian neonates. J Matern Fetal Neonatal Med 2010; 15:411-7. [PMID: 15280114 DOI: 10.1080/147670410001728223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To provide centiles for birth weight (BW) according to gestational age (GA) and sex for infants born in Italy. METHODS We used records of the whole neonatal population of Tuscany, a region in Italy, from July 1991 to June 2002 as resulting from the database of the cystic fibrosis neonatal screening program (n=290129). We excluded as unlikely for GA those BW that were more than two interquartile ranges above the 75th centile or below the 25th centile for each GA and gender group. RESULTS We present the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles of BW for GA from the 24th to 43rd week of gestation for male and female Italian neonates, as both tables and smoothed curves. CONCLUSIONS The large size of the examined population allows us to provide up-to-date, reliable BW for GA centiles for Italian newborns, especially for lower GAs.
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Affiliation(s)
- F Festini
- Regional Cystic Fibrosis Center of Tuscany, Division of Paediatric Infectious Diseases, Meyer Pediatric Hospital, Department of Pediatrics, University of Florence, Via Luca Giordano 12, 50132 Florence, Italy
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Festini F, Taccetti G, Galici V, Neri S, Bisogni S, Ciofi D, Braggion C. A 1-m distance is not safe for children with cystic fibrosis at risk for cross-infection with Pseudomonas aeruginosa. Am J Infect Control 2010; 38:244-5. [PMID: 20129701 DOI: 10.1016/j.ajic.2009.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/26/2009] [Accepted: 09/29/2009] [Indexed: 11/19/2022]
Abstract
Although maintaining a distance of 1 m between persons with cystic fibrosis (CF) is a universal recommendation to prevent respiratory cross-infections such as Pseudomonas aeruginosa, evidence supporting this preventive measure is scarce. Examining 336 samples from 42 patients with CF collected experimentally from sterile surfaces after speaking and coughing, we found that transmission of P aeruginosa beyond 1 m is possible during both talking and coughing, although the probability is low (1.7%).
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Affiliation(s)
- Filippo Festini
- Department of Pediatrics, Section of Nursing Sciences, University of Florence, Florence, Italy.
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Chiappini E, Principi N, Longhi R, Tovo PA, Becherucci P, Bonsignori F, Esposito S, Festini F, Galli L, Lucchesi B, Mugelli A, de Martino M. Management of fever in children: summary of the Italian Pediatric Society guidelines. Clin Ther 2009; 31:1826-43. [PMID: 19808142 DOI: 10.1016/j.clinthera.2009.08.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGLP). METHODS Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through December 31, 2007. Based on the consensus of a multidisciplinary expert panel, the strength of the recommendations was categorized into 5 grades (A-E) according to NGLP methodology. SUMMARY In the health care setting, axillary measurement of body temperature using a digital thermometer is recommended in children aged <4 weeks; for children aged > or =4 weeks, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended. When body temperature is measured at home by parents or care-givers, axillary measurement using a digital thermometer is recommended for all children. Children who are afebrile when seen by the clinician but are reported to have had fever by their caregivers should be considered febrile. In special circumstances, high fever may be a predictive factor for severe bacterial infection. Use of physical methods of reducing fever is discouraged, except in the case of hyperthermia. Use of antipyretics-paracetamol (acetaminophen) or ibuprofen-is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age. Whenever possible, oral administration of paracetamol is preferable to rectal administration. Use of ibuprofen is not recommended in febrile children with chickenpox or dehydration. Use of ibuprofen or paracetamol is not contraindicated in febrile children with asthma. There is insufficient evidence to form any recommendations concerning fever in children with other chronic conditions, but caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age. Use of paracetamol or ibuprofen is not effective in preventing febrile convulsion or the adverse effects of vaccines.
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Affiliation(s)
- Elena Chiappini
- Department of Pediatrics, University of Florence, I-50139 Florence, Italy
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Dal Molin A, Gatta C, Festini F. Management of totally implantable vascular access devices in patients with cystic fibrosis. Minerva Pediatr 2009; 61:549-555. [PMID: 19794380] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Cystic fibrosis (CF) is a genetic disease associated with recurrent lung infections, that represent a major cause of mortality and morbidity. Cystic fibrosis requires frequent antibiotic treatments, sometimes by mouth or via aerosol but often via the intravenous route. Totally implanted venous access devices (ports) allow an easy and safe vascular access for unlimited periods of time, and they can be used in CF to administer antibiotics and other i.v. infusions; if compared to external central venous catheters, ports are better tolerated, since they permit almost unlimited physical activity and do not interfere with patient's self-image. Though ports require a minimal level of care, they may be sometimes associated with relevant complications, which can be insertion-related (pneumothorax, arterial puncture, local hematoma), or management-related (infection, occlusion of the lumen, venous thrombosis). This article summarizes some recommendations on the management of ports in CF, considering the existing literature. Still, some issues remain unsolved and will need further research and studies.
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Festini F, Ciuti R, Taccetti G, Repetto T, Campana S, De Martino M. Breast-feeding in a woman with cystic fibrosis undergoing antibiotic intravenous treatment. J Matern Fetal Neonatal Med 2009; 19:375-6. [PMID: 16801316 DOI: 10.1080/14767050600631468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report the case of a 30-year-old woman with cystic fibrosis (CF) chronically infected with Pseudomonas aeruginosa who delivered and breast-fed a healthy boy. While breast-feeding the woman had to undergo an i.v. antibiotic course with tobramycin, due to pulmonary exacerbation. Tobramycin was not detected in her milk and lactation could be continued. This is the first time that the presence of tobramycin in the milk of a CF woman during i.v. administration has been investigated.
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Affiliation(s)
- Filippo Festini
- Division of Nursing Sciences, Department of Pediatrics, University of Florence, Florence, Italy.
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Festini F, Focardi S, Bisogni S, Mannini C, Neri S. Providing Transcultural to Children and Parents: An Exploratory Study From Italy. J Nurs Scholarsh 2009; 41:220-7. [DOI: 10.1111/j.1547-5069.2009.01274.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dal Molin A, Braggion C, Bisogni S, Rizzi E, Tacchella N, Carnovale V, Del Vecchio S, Furnari M, Calamia M, Tuccio G, Spadea V, Festini F. Multicenter prospective study about complications of totally implantable central venous access ports in Italian people with CF: preliminary results. J Cyst Fibros 2009. [DOI: 10.1016/s1569-1993(09)60369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Festini F, Occhipinti V, Cocco M, Biermann K, Neri S, Giannini C, Galici V, de Martino M, Caprilli S. Use of non-conventional nurses’ attire in a paediatric hospital: a quasi-experimental study. J Clin Nurs 2009; 18:1018-26. [DOI: 10.1111/j.1365-2702.2008.02430.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Cystic fibrosis (CF) is the most common life-threatening genetic disease in the Western world. Its incidence varies between 1:4,000 and 1:2,500 among Europeans. No data are available on the incidence of CF among Albanians, mainly due to difficulties of the local health system. GOALS To estimate the incidence of CF and the prevalence of healthy carrier status among Albanian ethnic people; to evaluate the incidence of hypertrypsinaemia at birth among Albanian newborns. METHODS We used the database of the newborn screening of Tuscany, Italy for the period 1991-2005. Children born to both Albanian parents in Tuscany were identified and incidences were calculated. RESULTS The incidence of CF among Albanians (1/555, 99% CI: 1/2,980-1/306) was significantly higher than the rest of the Tuscan population (1/4,101, 99% CI: 1/5,564-1/3,248). The prevalence of CF carrier status among Albanians living in Tuscany is estimated to be 1/12 (99%CI 1/27-1/9) while in the rest of the Tuscan population it is 1/32 (99%CI 1/37-1/28). The incidence of hypertrypsinaemia at birth among Albanian newborns (1/55 99%CI: 1/74-1/44) was significantly higher than in the rest of the population (1/84, 99%CI 1/88-1/82). CONCLUSION The incidence of CF among Albanians is considerably higher than expected. Albanian people have a risk to give birth to children with CF higher than the rest of Europeans. The implementation of a newborn screening program in Albania, together with a CF follow up program is highly advisable.
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Affiliation(s)
- Filippo Festini
- Department of Paediatrics, University of Florence, Florence, Italy
| | | | | | - Claudia Mannini
- Department of Paediatrics, University of Florence, Florence, Italy
| | - Stella Neri
- Department of Paediatrics, University of Florence, Florence, Italy
| | - Sofia Bisogni
- Department of Paediatrics, University of Florence, Florence, Italy
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Festini F, Dini D, Neri C, Neri S. [Control of postoperative pain in children undergoing hypospadias surgery: quasi-experimental controlled trial]. Assist Inferm Ric 2008; 27:197-201. [PMID: 19260368] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hypospadias is one of the most common congenital anomalies occurring in approximately (1/300) male births. If it is not surgically corrected the consequences may negatively impact on quality of life in adolescents. The surgery is very invasive and the post-operative phase very painful. To improve the control of post-operative pain, continuous analgesia via epidural catheter was implemented. AIMS To compare the effectiveness in controlling pain of two different regimens: continuous epidural catheter infusion vs oral and rectal non-steroidal pain-killers. MATERIALS AND METHODS Comparative study on children undergoing hypospadias surgery. Group A (catheter) was treated with continuous postoperative analgesia via epidural catheter and Group B (scheduled times) with rectal and oral analgesics at scheduled times and on demand, after caudal block. In both groups nurses measured pain with VAS and FLACC scales (score from 0 to 10) for 72 hours after surgery. RESULTS 41 children were studied (average age 64.1 months, SD 47.3), with 332 post-operative pain recordings (Group A n = 161, Group B n = 171). Mean pain score of Group A was 0.13 (SD 0.3) and 0.45 (SD 0.8) in group B, p = 0.006. The median duration of the epidural catheter was 65 hours, mean 51.8 hours (SD 24.3). During the 1st post-operative medication, the mean pain score in Group A was 1.2 (SD 1.4), and 3.2 (SD 1.8) in group B, p = 0.003. In group A the number of pain scores indicating pain (> 0) where 3.1% while in group B were 10.5%, p = 0.0007. CONCLUSIONS In children undergoing hypospadias surgery, post-operative analgesia with continuous epidural catheter infusion seems to offer a better analgesic coverage than the traditional oral/rectal analgesic treatment at scheduled times and on demand.
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MESH Headings
- Acetaminophen/administration & dosage
- Administration, Oral
- Administration, Rectal
- Analgesia, Epidural/methods
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Opioid/administration & dosage
- Anesthesia, Caudal
- Anesthetics, Local/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Bupivacaine/administration & dosage
- Bupivacaine/analogs & derivatives
- Chi-Square Distribution
- Child
- Codeine/administration & dosage
- Codeine/therapeutic use
- Data Interpretation, Statistical
- Drug Therapy, Combination
- Fentanyl/administration & dosage
- Humans
- Hypospadias/surgery
- Levobupivacaine
- Male
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/drug therapy
- Pain, Postoperative/nursing
- Pain, Postoperative/prevention & control
- Statistics, Nonparametric
- Time Factors
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Affiliation(s)
- Filippo Festini
- Dipartimento di pediatria, Sezione di Scienze infermieristiche e Professioni sanitarie, Università di Firenze
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Abstract
Antibiotic strategies against Pseudomonas aeruginosa infection in cystic fibrosis (CF) patients should consider the natural history of the P. aeruginosa infection, ranging from the first isolation of the germ in the airways to isolation at every microbiological culture, and the patient's clinical condition. Antibiotic treatment against P. aeruginosa given at the time of first isolation may prevent or delay chronic infection. The period of intermittent colonization can be considered the time before the development of mucoid P. aeruginosa phenotype. The optimal treatment strategy in this stage remains unclear in terms of agents used and duration of treatment. To treat acute exacerbation, the authors suggest using intravenous administration of two different classes of antibiotics. Maintenance antibiotics are administered to slow the decline in pulmonary function for P. aeruginosa chronic infection. The meaning of maintenance therapy has changed over time, beginning from intravenous quarterly anti-Pseudomonas antibiotics, irrespective of symptoms, to other strategies such as oral macrolides, ciprofloxacin or inhaled antibiotics (tobramycin and colistin). Aerosol delivery can provide a high concentration at the desired site with minimal absorption and therefore low risk of toxicity. There is scientific evidence that antibiotics are clinically effective in CF patients. Antibiotic selection should be based on periodic isolation and identification of pathogens and antimicrobial susceptibility.
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Affiliation(s)
- G Taccetti
- Cystic Fibrosis Center, Meyer Hospital, Florence, Italy.
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Festini F, Neri S, Taccetti G, Repetto T, Braggion C. PROLONGING THE DURATION OF PERIPHERAL VENOUS CATHETERS IN CYSTIC FIBROSIS PATIENTS. RANDOMIZED CONTROLLED STUDY ON THE EFFECT OF DIFFERENT CONCENTRATIONS OF ANTIBIOTICS IN NORMAL SALINE. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Taccetti G, Neri A, Galici V, Boni V, Fanti F, Braggion C, Campana S, Festini F. Cost analysis of treatment for Pseudomonas aeruginosa infection in cystic fibrosis patients. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Neri AS, Lori I, Festini F, Masi L, Brandi ML, Galici V, Braggion C, Taccetti G. Bone mineral density in cystic fibrosis patients under the age of 18 years. Minerva Pediatr 2008; 60:147-154. [PMID: 18449130] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The increase in life expectancy of cystic fibrosis (CF) patients has brought about a rise in new clinical problems in these patients, such as a decrease in bone mineral density (BMD). The cause of diminished BMD in CF is multi-factorial. METHODS The aim of this cross-sectional study, conducted on 39 CF patients under the age of 18 years, was to evaluate the degree of bone mineralization and the prevalence of low BMD in these patients during a follow-up at the Cystic Fibrosis Regional Center of Tuscany, using a dual energy X-ray absorptiometry (DXA) scan, and to then study the factors correlated with low BMD. RESULTS Areas BMD values (g/cm2) and Z-score values were determined. Eighteen patients (46%) out of the our sample had decreased BMD, while 21 patients (54%) had normal values. A statistically significant association was found between BMD Z-score values and pancreatic insufficiency, BMI<5th percentile and DeltaF508 homozygosis. Subjects treated with oral steroid therapy had a 3.9 times greater risk of developing osteoporosis compared to non-treated subjects (95% C.I.: 1.07-22.6; R.R. 4.9). An association was found between BMD Z-score values and FEV1 values (r=0.29; P=0.06), physical activity total score values (r=0.22; P=0.19) and the Chrispin-Norman chest radiographic score (r=-0.31; P=0.06). CONCLUSION Early identification of reduced bone mass values would permit early intervention to prevent the development of osteoporosis. Maintaining pulmonary function, guaranteeing optimal nutritional status, following an adequate program of physical activity and controlling steroid intake could maintain BMD over time.
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Affiliation(s)
- A S Neri
- Cystic Fibrosis Center of Tuscany, Meyer Hospital, Florence, Italy
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Gori F, Gori S, Mannini C, Festini F. [Medication errors at home: risks related to parental administration of paediatric drugs and strategies for prevention]. Assist Inferm Ric 2008; 27:99-107. [PMID: 18630494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Francesca Gori
- Dipartimento di Pediatria, Sezione di Scienze Infermieristiche e delle Professioni Sanitorie, Università di Firenze
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Taccetti G, Neri AS, Festini F, Galici V, Cocchi P, Campana S. Methicillin resistant Staphylococcus aureus in cystic fibrosis. Pediatr Pulmonol 2008; 43:309; author reply 310. [PMID: 18214947 DOI: 10.1002/ppul.20774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Festini F, Bisogni S, Galici V, Neri S. [Voluntary incident reporting by nurses in a pediatric hospital: a pilot study]. Assist Inferm Ric 2008; 27:27-32. [PMID: 18757004] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED In recent years Voluntary Incident Reporting (VIR) has spread as a tool to monitor and prevent adverse events in healthcare (AE). In Italy, experiences of VIR are limited. AIM The goals of this pilot study were to test the feasibility of a VIR system in a population of nurses of a Pediatric Hospital and to make a preliminary survey of situations of risk for patients' safety, to plan corrective actions. METHODS Nurses of 3 wards were asked to report AEs with or without harm for patient, near misses and unsafe behaviours or situations at risk for generating AEs. Results were cumulatively reported to participating nurses during ward's meetings and possible corrective interventions were discussed. RESULTS The study was carried out from April to August 2006. Eighty-seven nurses participated. Forty-eight reports were made (one third signed, two thirds anonymous). Twenty reports (41.6%) regarded unsafe behaviours or situations at risk for AEs, 11 near misses, 15 AEs without patient harm and 2 AEs with harm. Twenty-three reports involved patients. Reports regarded mainly therapy (62.5%), care delivery (14.5%), equipment (8.3%), clinical documentation (6.3%). 40% of all AEs and near misses were reported to happen during the first or the last hour of the shift. AEs most frequently reported were: missing administration of treatments, administration of a wrong drug or of a wrong dose. "Look-alike" drugs and incomplete or illegible prescriptions. CONCLUSIONS Our pilot study confirms that nurses are generally willing to get involved in VIR systems. It also suggests that to succeed VIR systems have to ensure that reporters remain anonymous and non-prosecutable.
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Affiliation(s)
- Filippo Festini
- Università di Firenze, Dipartimento di pediatria, Sezione di Scienze infermieristiche e delle Professioni sanitarie
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