Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 6 Articles
Background: Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents.\nItaly is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to\ndescribe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years,\nincluding the prevalence of â??wait and seeâ?? for AOM, where prescription of antibiotics is delayed 48 h from\npresentation, and differences in prescribing for pharyngitis when diagnostic tests are used.\nMethods: The study is a secondary data analysis using Pedianet, a database including data at outpatient level from\nchildren aged 0-14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described\nas percentages. â??Wait and seeâ? approach rate was described for AOM and pharyngitis prescriptions were further\ngrouped according to the diagnostic test performed and test results.\nResults: We identified 120,338 children followed by 125 family pediatricians between January 2010 and December\n2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one\nAOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098).\n82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate)\nand the â??wait and seeâ? approach was adopted only in 17.5% of cases. The trend over time shows an increase in\nbroad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and\namong GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed\nwere treated mainly with broad spectrum antibiotics.\nConclusions: Despite guidance to use the â??wait and seeâ?? approach in the age group analyzed, this strategy is not\noften used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription\nwas more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies\nthat diagnostic uncertainty leads to overuse of antibiotics....
Deleterious consequences of the management of respiratory distress syndrome (RDS) with invasive ventilation have\nled to more in-depth investigation of non-invasive ventilation (NIV) modalities. NIV has significantly and positively\naltered the treatment outcomes and improved mortality rates of preterm infants with RDS. Among the different NIV\nmodes, nasal intermittent positive pressure ventilation (NIPPV) has shown considerable benefits compared to nasal\ncontinuous positive airway pressure (NCPAP). Despite reports of heated humidified high-flow nasal cannulaâ??s\n(HHHFNC) non-inferiority compared to NCPAP, some trials have been terminated due to high treatment failure rates\nwith HHHFNC use. Moreover, RDS management with the combination of INSURE (INtubation SURfactant\nExtubation) technique and NIV ensures higher success rates. This review elaborates on the currently used various\nmodes of NIV and novel techniques are also briefly discussed....
Background: The therapeutic strategy for children with cowâ??s milk allergy (CMA) consists in the elimination of\ncowâ??s milk (CM) from their diet. Donkeyâ??s milk (DM) has been reported to be an adequate alternative, mainly to his\nnutritional similarities with human milk (HM) and excellent palatability. The aim of present prospective study was to\nevaluate the nutritional impact of DM on the diet of children with CMA in term of children growth.\nMethods: Before the nutritional trial on children and during the study the health and hygiene risks and nutritional\nand nutraceuticals parameters of DM were monitored. Children with CMA were identified by the execution of in\nvivo and in vitro tests for CM and subsequent assessment of tolerability of DM with oral food challenge (OFC).\nFinally, we prescribed DM to a selected group of patients for a period of 6 months during which we monitored the\ngrowth of children. A total of 81 children, 70 with IgE mediated cowâ??s milk protein allergy (IgE-CMPA) and 11 with\nFood Protein Induced Enterocolitis Syndrome to CM (CM-FPIES), were enrolled.\nResults: Seventy-eight out of 81 patients underwent the OFC with DM and only one patient with IgE-CMPA (1.5 %)\nreacted. Twenty-two out of 81 patients took part of the nutritional trial. All the 22 patients took and tolerated the\nDM, moreover DM did not change the normal growth rate of infants.\nConclusions: In conclusion, DM resulted safe in term of health and hygiene risks and nutritionally adequate: no\nnegative impact on the normal growth rate of children was assessed. Therefore, it may be a suitable alternative for\nthe management of IgE mediated CMA and FPIES, also in the first 6 months of life, if adequately supplemented....
Background: Interprofessional education (IPE) is an important part of the landscape of modern education.\nHowever, there is a significant deficiency of studies that evaluate IPE in dentistry. The aim of this article is to\nevaluate the effects of an oral health educational program on the dental knowledge, awareness, attitude,\nconfidence, and behavior of pediatric nurse practitioner (PNP) students and to emphasize the importance of IPE for\nPNP.\nMethods: First-year pediatric nurse practitioners from Northeastern University participated in an IPE oral health\neducation seminal and practical session as a pilot study. Several tests were used to evaluate the effectiveness of the\neducational program. The post-test assessed the knowledge, awareness, attitude, confidence, and behavior of the\nstudents immediately after attending the lecture; again immediately after hands on experience; and finally at a\nfollow-up approximately a month after attending the training module. The training module consists of prevention\nand anticipatory guidance; caries process and management; trauma and dental emergencies. Differences in score\nitems were evaluated between 4 time points. Friedmanâ??s, Wilcoxon signed-rank and McNemarâ??s tests were used to\nanalyze the results.\nResults: Knowledge score was determined based on the number of correct responses to seven questions, while\nawareness score was based on the median of eight questions. Fifteen confidence, attitude, and behavior questions\nwere used. The total sample size was 16 students with a mean ageâ?¦â?¦â?¦â?¦â?¦â?¦...
Background: Premature infants may present with damage to the autonomic nervous system (ANS), which may be\nrelated to poorer neurological development. Among the techniques used to evaluate the ANS, heart rate variability\n(HRV) emerged as a simple, non-invasive, and easy to apply tool. The aim of the present study was to analyze and\ncompare HRV in preterm infants at different times of hospitalization in order to verify the possible environmental\nrelationships or clinical evolution with HRV.\nMethods: A longitudinal, prospective, and descriptive study with non-probabilistic sampling composed of 25\ncollections of preterm infants of HRV at two moments: moment I (within 15 days of birth) and moment II\n(after 45 days post-birth). The Polar V800 heart rate monitor was used with the Polar H10 cardiac transducer\nto collect HRV, which was collected in the supine position for 15 min. The HRV data were analyzed by the\nlinear method in frequency domain and time domain and by the nonlinear method using Kubios HRV\nanalysis software, version 3.0.2.\nResults: There was an increase in HRV values at moment II, these being statistically significant in the SD1,\nApEn, and SampEn. Data related to increased sympathetic nervous system activity, parasympathetic nervous\nsystem activity, and increased index complexity.\nConclusions: The data demonstrate an increase in HRV values in premature infants at moment II, demonstrating a\npossible development in the maturation of the ANS during hospitalization. Trial registration: RBR-3x7gz8 retrospectively\nregistered....
Background: Vaccination represents one of the most effective means of preventing infections for the population\nand for the public health in general. Recently there has been a decline in vaccinations, also among healthcare\nworkers (HCWs). The aim of the study is to detect the knowledge, skills, attitudes and barriers of HCWs regarding\nvaccinations in a tertiary childrenâ??s hospital in order to support clinical management in immunisation practices.\nMethods: An observational study was conducted on 255 subjects over a period of 8 months. The 31-item\nquestionnaire considered profession, level of instruction and different ages. It included questions taken from a\nquestionnaire used for a Canadian research and one used by the Bellinzona hospital. A 4-point Likert scale and\nclosed-ended questions were used. A confidence interval of 95%, p value less than equal to 0.05, Chi-square, ANOVA and the\nKruskal-Wallis test were considered.\nResults: In the last 5 years less than one third of the sample were vaccinated against flu. 77.8% (n.130) of nurses\nand 45.8% (n.19) of doctors were not vaccinated (p < 0.0001).\nAs for risk perception, 51.5% of nurses and 90.6% of doctors believe that their risk of contracting influenza is greater\nthan that of the general population.\nIn relation to the injection site, in all the age ranges there was a high level of knowledge except for those aged\nover 61 who responded incorrectly. Doctors were more prepared (p < 0.0001).\n50% of the sample used internet only as a source of information for vaccines. Generally, scientific sources were\nused infrequently. The higher the education level, the more frequent the utilisation of trustworthy scientific\nresources and literature. (p = 0.0002).\nConclusions: In line with the attitude observed in recent years, nurses are not inclined to get vaccinated\nthemselves although they agree to having their children vaccinated. HCWs have a good level of knowledge about\nvaccines and immunisation practices.\nWith the nurses we found that the higher the education level, the greater the knowledge about vaccines which\nleads to the conclusion that low levels of adherence are not due to a lack of knowledge, but rather, to a low\nperception of risks. Hence the need to strengthen the vaccination strategies inside the companies....
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