Understanding the Private Worlds of Physicians, Nurses, and Parents: A Study of Life-Sustaining Treatment Decisions in Italian Paediatric Critical Care

This study's aim was to describe: (a) How life-sustaining treatment (LST) decisions are made for critically ill children in Italy; and (b) How these decisional processes are experienced by physicians, nurses and parents. Focus groups with 16 physicians and 26 nurses, and individual interviews with 9 parents were conducted. Findings uncovered the 'private worlds' of paediatric intensive care unit (PICU) physicians, nurses and parents; they all suffer tremendously and privately. Physicians struggle with the weight of responsibility and solitude in making LST decisions. Nurses struggle with feelings of exclusion from decisions regarding patients and families that they care for. Physicians and nurses are distressed by legal barriers to LST withdrawal. Parents struggle with their dependence on physicians and nurses to provide care for their child and strive to understand what is happening to their child. Features of helpful and unhelpful communication with parents are highlighted, which should be considered in educational and practice changes

Достижение внешнеэкономического равновесия для малой страны с открытой экономикой

Секция II. Современные тенденции и проблемы в мировой экономике. Внешнеэкономическое сотрудничество Республики Беларус

Zinc Oxide 30% and Tocopherol Compared to 10% Zinc Oxide Ointment in the Treatment of Infant\u2019s Diaper Dermatitis: A Triple Blinded Controlled Randomized Trial

1.1. Aim: Assessing the efficacy of an experimental treatment that lasted 5 days and used the paste of Zinc Oxide 30% and tocopherol / Vitamin E compared to the use of a 10% Zinc Oxide ointment in the treatment of diaper dermatitis (DD) affecting the newborn's skin and the premature infant with gestational age 65 34 weeks. Background. DD is a common inflammatory irritating condition among children and infants. In multiple clinical studies, mycosis has been isolated in up to 80% of children with DD which can be present for even three or more days. Design: Triple blinded controlled randomized trial. 1.2. Methods: 169 infants with DD (aged <24 months) were randomized to receive either 10% zinc oxide ointment (n=64) or Zinc Oxide 30% and tocopherol ointment (n=65). Infants were treated with multiple applications for 5 days. The severity of dermatitis was evaluated at both baseline and the end of trial by using the Severity Classification of Diaper Dermatitis scale (SCDD). Results. Improvement in the severity of DD was observed in both treatment groups (P<0.01). There was not a statistically significant difference between the groups as determined by F (2.164) =0.151, p=0.860. There was not any adverse effect from either of the study products. 1.3. Conclusion: There is not any difference on efficacy of both the treatments. No one mycosis emerged in both groups. Management protocols for DD has relevant role on the improvement of diaper dermatitis in infants and on onset mycosis reduction

VARIANT PHILADELPHIA TRANSLOCATION IN EARLY CHRONIC PHASE OF CHRONIC MYELOID LEUKEMIA: RESULTS OF IMATINIB MESYLATE THERAPY (A GIMEMA WP ON CML ANALYSIS)

At diagnosis, variant Philadelphia (Ph) translocation occurringoccurring in patients (pts) with Chronic Myeloid Leukemia (CML) have been reported in 5-10% of pts. Some studies have suggested that variant Ph translocations may have an adverse prognosis with conventional chemotherapy or -interferon, while others have reported that have no impact on prognosis after Imatinib Mesylate (IM) treatment. Variant translocation could be three-way or four-way translocation (involving chromosomes 9, 22 and 1 or 2 additional chromosome respectively), associated or not with deletions of der(9) chromosome. AIM: To investigate the role of occurrence of variant Ph translocations on the response to IM in early chronic phase (CP) CML pts. Methods. A sub-analysis of 531 evaluable CML pts in early CP, have been performed within 3 simultaneously running trials of the GIMEMA WP on CML (CML/021; CML/022; CML/023). Median observation time was 30 months. Monitoring: hematologic, continuously; CC, FISH and molecular analysis were performed at baseline, 3, 6 and 12 months, and then every 6 months by local or reference labs. Results. At enrollment, 28 pts (5.3%) had variant Ph translocation: 1 showed variant Ph translocation by fluorescence in situ hybridization (FISH) but not by conventional cytogenetic (CC); 2 pts (7.1%) had a four-way translocation; 27 pts (96.2%) had a three-way translocation. In 5 pts (17.8%) translocation was associated with deletion of der(9). Only one carried an additional chromosome abnormality: t(7;19)(q21;p13). The two groups of pts, with or without variant translocation, were similar for age, Sokal risk and IM dose. At 12 months, 23 pts achieved complete cytogenetic response (CCgR; 82.2% vs. 83.9% in pts without variant), 2 pts reached partial cytogenetic response (PCgR; 7.1% vs. 6.6%), in 3 treatment was unsuccessful (10.7% vs. 9.5%). The 2 pts with four-way translocation reached CCgR, and 4 of 5 pts (80%) with deletion of der(9) reached CCgR. Conclusions. In the present large series of pts in early CP treated with IM therapy, we found no difference in cytogenetic response rates between pts with variant translocations and with classic ones. It will be discuss the eventual correlation between the complexity of mechanism of translocation genesis (one or two-step) and response to IM therapy. ACKNOWLEDGMENTS: University of Bologna (RFO), Fondazione del Monte di Bologna e Ravenna, European LeukemiaNet founds, MIUR PRIN 2005, Bologna AIL

Variant Philadelphia translocations: Molecular-cytogenetic characterization and prognostic influence on frontline imatinib therapy, a GIMEMA working party on CML analysis

Variant Philadelphia (Ph) chromosome translocations have been reported in 5%-10% of patients with newly diagnosed chronic myeloid leukemia (CML). Variant translocations may involve one or more chromosomes in addition to 9 and 22, and can be generated by 2 different mechanisms, 1-step and 2-step rearrangements, as revealed by fluorescence in situ hybridization. The prognostic significance of the occurrence of variant translocations has been discussed in previous studies. The European LeukemiaNet recommendations do not provide a "warning" for patients with variant translocations, but there is limited information about their outcome after therapy with tyrosine kinase inhibitors. To identify the role of variant translocations in early chronic phase (CP) CML patients treated with imatinib mesylate, we performed an analysis in a large series of 559 patients enrolled in 3 prospective imatinib trials of the Gruppo ItalianoMalattie EMatologiche dell'Adulto (GIMEMA) Working Party on CML. Variant translocations occurred in 30 patients (5%). Our data show that the presence of variant translocations has no impact on the cytogenetic and molecular response or on outcome, regardless of the involvement of different mechanisms, the number of involved chromosomes, or the presence of deletions. Therefore, we suggest that patients with variant translocations do not constitute a "warning" category in the imatinib era. This study is registered at www.clinicaltrials.gov as NCT00514488 and NCT00510926. © 2011 by The American Society of Hematology

Variant Philadelphia translocations: molecular-cytogenetic characterization and prognostic influence on frontline imatinib therapy, a GIMEMA Working Party on CML analysis

Variant Philadelphia (Ph) chromosome translocations have been reported in 5%-10% of patients with newly diagnosed chronic myeloid leukemia (CML). Variant translocations may involve one or more chromosomes in addition to 9 and 22, and can be generated by 2 different mechanisms, 1-step and 2-step rearrangements, as revealed by fluorescence in situ hybridization. The prognostic significance of the occurrence of variant translocations has been discussed in previous studies. The European LeukemiaNet recommendations do not provide a "warning" for patients with variant translocations, but there is limited information about their outcome after therapy with tyrosine kinase inhibitors. To identify the role of variant translocations in early chronic phase (CP) CML patients treated with imatinib mesylate, we performed an analysis in a large series of 559 patients enrolled in 3 prospective imatinib trials of the Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) Working Party on CML. Variant translocations occurred in 30 patients (5%). Our data show that the presence of variant translocations has no impact on the cytogenetic and molecular response or on outcome, regardless of the involvement of different mechanisms, the number of involved chromosomes, or the presence of deletions. Therefore, we suggest that patients with variant translocations do not constitute a "warning" category in the imatinib era. This study is registered at www.clinicaltrials.gov as NCT00514488 and NCT00510926

Mobilization practices in critically ill children: A European point prevalence study (EU PARK-PICU)

Background: Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. Methods: A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. Results: Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. Conclusion: Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children. Graphical abstract: [Figure not available: see fulltext.