Daniele Ciofi

A 1-m distance is not safe for children with cystic fibrosis at risk for cross-infection with Pseudomonas aeruginosa.

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%).

Cross-sectional study on differences in pain perception and behavioral distress during venipuncture between Italian and Chinese children

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.

Actual implementation of sick children’s rights in Italian pediatric units: a descriptive study based on nurses’ perceptions

BackgroundSeveral 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.MethodsCross-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).Results536 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.ConclusionAccording to the perception of pediatric nurses, the implementation of the rights of hospitalized children in Italian pediatrics units is still limited.

Heparin solution for maintaining peripheral venous catheter patency in children: a survey of current practice in italian pediatric units

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.

O-152 Heparin Solution Vs Normal Saline For Flushing Peripheral Venous Catheters In Children. Preliminary Results Of A Rct

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 solution should be used to increase the life of PVCs in children. Goal To compare the effectiveness of Normal Saline (NS) vs Heparin solution (HS) in maintaining the patency of PVCs in hospitalised children. Methods Single blind randomised controlled trial. The study compares two solutions used to flush PVCs between an access and another: NS only (group A) vs a solution of Heparin 50 U/ml in NS (HS) (group B). Subjects are children 2 to 14 with a G22 or G24 PVC, undergoing iv therapy twice-in-day, without coagulation problems and taking no immunosoppresant or steroidal drugs. Recruited subjects are randomised in either group using a randomization list. The sample numerosity was set at 26 per group. The outcomes evaluated are: PVC duration on site in hours; onset of complication. Preliminary results. So far 18 children have been recruited (9 group A, 9 group B). The two groups do not differ statistically with regards to age, sex, location and number of access to PVC. Mean duration of CVPs is 31.4 h in group A and 120.2 h in group B (p = 0.004). Complications have arisen in 88.9% of subjects in group A and 44.4% in group A (p = 0.06). Discussion Preliminary data show a relevant difference in PVCs flushed with HS. The study will continue until the numerosity of 52 subjects is reached.

1730 Humanization of Care in Italian Pediatrics Units: Results of a National Survey

Background Hospital admission is a stressful and fearful experience for children. Several kind of non clinical interventions have shown to be effective in improving the quality of life of children during hospital stay. Goal To survey the interventions performed in Italian Pediatrics Unit to improve children’s life during hospital stay. Methods Cross-sectional study. The study was promoted by the Italian Cultural Association of Pediatricians (ACP) and by the Italian Society of Pediatric Nursing Science (SISIP). A 37-item online questionnaire was set up and an invitation to fill it in was sent by email using the two associations’ mailing lists. Results Questionnaires regarding 111 pediatrics units were returned, out of an extimated total of 724 Italian Pediatrics Units (PU) (15.3%). 43% of PU have more than 50% of beds in 2-bed rooms. In 90.1% of PU walls are multicoloured or decorated with paintings. A school is available only in 47.7% PU. A “toy library” or playroom is present in 66.7% PU. Outdoors playgrounds are available in 37.8% PU. Reading aloud to children is performed in 29.7% PU, activities with animals in 13.5%. Play Volunteers operate in 80.2% of PU, Clown Doctors in 67.6%. In PU with more than 1500 admissions per year, single rooms and a playroom is present more frequently than in others (p 0.02 and p 0.03 respectively). Discussion Although several non clinical interventions are available to reduce distress and anxiety in hospitalised children and to improve their quality of life, their diffusion in Italian Hospital still seems limited.

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

We read with great interest the editorial by Thompson and Watson (2010) which stimulated some considerations. The authors stress the growing importance of the h-index in the evaluation of academic performance in the biomedical disciplines. Therefore, this index of reference cannot be ignored by nursing science either. However, the authors observe that, even if the h-indices reached by the most authoritative professors of nursing in the UK were generally notable, they were in almost all the cases below 20, the mark set by Hirsch as the indicator of academic success. A situation similar to the one highlighted by Thompson and Watson (2010) is also found in Italy. Table 1 shows the nine highest h-indices (using Web of Science) of Italian professors of nursing (from a total of 28 professors) for the period from June 2000–June 2010. Nursing has only been taught in Italian universities for 13 years, and the first professors of nursing were only appointed in 2000. Nonetheless, scientific activity in this field is constantly growing. However, most of the scientific production is published in Italian and it thus has fewer possibilities to be cited in international articles (Zanotti 1999, Pecile & Zanotti 2002, Destrebecq & Terzoni 2010). The Italian Ministry of Education, University and Research has recently issued a call for proposals to award research grants in which Chief Investigators are required to have an hindex of 25. Such a high standard makes it difficult, if not impossible, for research projects on nursing to have access to funding, thus possibly slowing down the growth of nursing research. Even if nursing cannot escape the universal criteria for academic evaluation, it is worth reminding ourselves that it is a younger discipline than others in the biomedical field. It is for this reason that we agree with Thompson and Watson (2010) that we should establish a different h-index level of reference for nursing and for different geographical areas – at least on a temporary basis. In our opinion, this may help encourage the development of nursing research in the academic setting.