Sofia Bisogni

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.

Incidence of cystic fibrosis in the Albanian population

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.

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.

Undertreated and Untreated Pain Should Be Considered an Adverse Event of Neonatal Circumcision

geographic variation in receipt of therapy, despite adjustment for clinical characteristics, may be explained not only by psychologist supply but also by parent, child, or pediatrician preferences for or comfort with nonpharmacologic care. We acknowledge limitations common to analyses of claims data, including no information on services that were not billed to commercial insurance and a limited ability to determine severity of illness or clinical appropriateness for therapy. We cannot comment on therapy receipt in those smaller and more rural counties that we excluded. Nonetheless, our study is the first, to our knowledge, to document the substantial variation in receipt of therapy services among US children treated with ADHD medications and is directly relevant to the ongoing public discourse about how this common condition should be treated.

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.

90 Observational Study on Pain and Distress in Chinese and Italian Children Undergoing Venipuncture

Few studies have examined the influence of ethnic-cultural variables on pain perception and behavioural distress in children. Not considering possible cultural variations of pain manifestation may lead to inadequate assessment and treatment of pain. Goal To evaluate wether differences exist between Italian and non-Italian children with regards to pain perception and behavioural distress during the same invasive procedure. Methods Cross-sectional analytical trial. A group of Italian children (group A) and a group of Chinese children (group B) aged 3 to 11 were observed during a standardized venipuncture for blood sample drawing. Pain was self-rated with a 1–10 Wong faces scale or a 1–10 numeric scale. Behavioural distress was measured with the Observational Behaviour Distress Scale (OBDS, 1–33). Results 246 children were examined, 191 in group A and 55 in group B. In preschool age (3 to 5, n=76), neither mean pain rates nor mean OBDS rates were statistically different in the two groups. On the opposite, in the 6–11 age (n=170), mean pain rate was 2.9 in group A and 4.8 in group B (Anova p=0.00001) while mean OBDS rate was 6.6 in group A and 2.3 in group Bi (Anova p=0.0005). Discussion Our data show that duiring venipuncture Chinese children have less marked behavioural distress manifestations than their Italian peers, even though the perceived pain is higher in Chinese children.

70 Pain Experienced During Venipuncture is Higher in Children with a Chronic Disease

Background Venipuncture pain in children results from several factors, which amplify the nociceptive stimulus; among them anticipatory anxiety plays an important role. Children with a chronic disease undergo invasive procedures and venipunture more frequently than other children. Goal To evaluate whether a difference exists in pain threshold between children with a chronic disease and children with no previous experience of procedural pain. Methods Cross-sectional analytical trial. A group of children with a chronic disease (group A) and a group of children with no previous experience of venipuncture (group B) aged 4 to 12 were observed during a standardized venipuncture for blood sample drawing. Pain was self-rated with a 1–10 Wong faces scale or a 1–10 numeric scale. Behavioural distress was measured with the Observational Behaviour Distress Scale (OBDS, 1–33). Results 230 children were examined, 82 in group A and 148 in group B. With regards to pain, children in group A reported a mean pain score of 8.6 (sd 1.2) while children in group B had a mean score of 3.1 (sd 2.4), Anova p=0.00001. With regards to behavioural distress, children in group A had a mean score of 26.7 (sd 4.3) vs. 8.3 in group B (sd 8.4), Anova p=0.00001. The groups did not show statistically significant differences in age and sex distribution. Discussion Children with a chronic disease, who previously underwent numerous venipunctures, experience a more intense pain and distress than their peers at their first experience of venipuncture.

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.