Fathers’ experiences of supporting their partners during their preterm infant’s stay in the neonatal intensive care unit: a multi-method study

Objective To explore how the fathers experience their role as a support for their partner and the relationship with them during their preterm infant's stay in the NICU. Study design Multi-method longitudinal study involving ethnographic observation, semi-structured interviews, self-report questionnaires, and clinical information. Twenty fathers of preterm infants hospitalized in a level-III-NICU were included. Data were analyzed using thematic continent analysis. Results Three main themes were identified: support for mother (subthemes: putting mother's and infant's needs first; hiding worries and negative emotions; counteracting the sense of guilt; fear that the mother would reject the child), mother's care for the infant (subthemes: observing mother engaged in caregiving; mother has "something extra"), and couple relationship (subthemes: collaboration; bond). Conclusion Fathers supporting their partners during the stay in the NICU experience emotional distress and the need for being supported that often are hidden. This demands a great deal of emotional and physical energy

[Non-ketotic hyperglycinaemic encephalopathy (author's transl)]

report of cases of non-ketotic hyperglicinaemi

Antepartum management and neonatal outcome of triplet pregnancies

The maternal and neonatal outcome of 27 triplet and 1 quadruplet gestations was studied at the University Hospital of Verona. Mean maternal age was 31.7+/-3.7 years; 24 women (85.7%) were nulliparous. Six (21.4%) patients had conceived spontaneously. Common maternal complications were: preterm labor (78.6%), anemia (57.1%), preeclampsia (25.0%). Thirteen patients (46.4%) had cervical cerclage, 21(75%) received tocolysis, 20 (71.4%) corticosteroid prophylaxis, 4 (14.3%) unfractionated heparin. All patients underwent Caesarean section with mean gestational age of 32+/-2.5 weeks and mean postoperative stay was 9 days. Three patients were treated in ICU after delivery, 1 was hysterectomized and 6 received blood transfusions. The live newborns were 80, the stillborns 5. Mean birth weight was 1,520+/-516 g (range 650-2,665), 95.0% being LBW. The following neonatal complications were observed: RDS (28.7%), cerebral hemorrhage (26.2% of II degrees and 1.2% of III degrees ), anemia (20%), PDA (12.5%), ROP (6.5%), polyglobulia (3.75%), NEC (2.5%). Mean hospitalization time was 30.6 days (range 2-132). Iatrogenic multiple births are increasing as the use of assisted conception techniques expands. Gynecologists should be aware of maternal complications and neonatal outcome of triplet pregnancies and infertility management strategies should try to avoid iatrogenic multiple gestations

Routine coagulation tests in newborn and young infants

BACKGROUND: The diagnostic approach to haemostatic defects in the newborn is challenging and requires appropriate interpretation of coagulation tests according to reference values dependent on the postnatal age. METHODS: This investigation was designed to study the postnatal development of the human coagulation system in newborn infants and to develop appropriate reference ranges for prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FBG) according at the day of birth and for the following postnatal period (days 1, 2, 3, 4, 5, 6, from 7 to 10 and from 11 to 44). RESULTS: The mean FBG value was already within the adult reference range in newborns at birth, the mean PT value fell within the adult reference range in infants aged 4 days or more, whereas the mean APTT value was still higher than the upper limit of the adult reference range in infants aged between 11 and 20 days. The prevalence of infants with pathological values according to the actual adult reference ranges was limited for FBG (from 24 to 7%), decreased from 92 to 8% in infants aged 0 and 11-20 days for PT, but remained elevated throughout the observational period for APTT (from 94 to 71%). CONCLUSIONS: The results of the present investigation demonstrate that the actual adult reference ranges for coagulation screening tests, especially PT and APTT, cannot be applied to newborns and young infants

Massive ascites complicating preeclampsia: an indication for preterm birth?

We report rare cases of massive maternal ascites complicating severe pre-eclamptic toxemia. This complication developed in association with the rise of blood pressure to 160/110 mmHg or more, worsening of proteinuria and hyperuricemia. The onset of massive ascites often caused respiratory compromise in these patients, thus necessitating immediate termination of pregnancy. The point is to identify if massive ascites is an indication of preterm birth even if the respiratory function is conserved

I medici veronesi e le problematiche deontologiche della professione

Viene presentato l'esito di un'indagine rivolta a tutti i medici della provincia di Verona iscritti all'ordine professionale e muniti di indirizzo di posta elettronica e disponibili a rispondere a delle interviste. Si tratta di oltre un migliaio di medici a cui è stata chiesta la reatiività personale relativamente a problematiche che li coinvolgono attualmente: invecchiamento della popolazione, immigrazione e multiculturalità, rifiuto della sofferenza e della morte, medicalizzazione impropria di problemi esistenziali, rischio professionale, riduzione delle risorse economiche, burocratizzazione dell'assistenza sanitaria, difficoltà di aggiornamento, difficoltà di comunicazione con i pazienti, implicazioni etiche del medico, carenza di supporti

Medici a Verona 2: Indagine sui fattori di benessere/malessere dei professionisti veronesi (parte seconda)

Questo secondo articolo presenta altri dati relativi alla pratica professionale, emersi dall\u2019elaborazione delle risposte a un questionario sulle cause di malessere e benessere dei medici ed odontoiatri veronesi. Tra i molti risultati quelli pi\uf9 significativi indicano un minore interesse per la comunicazione-relazione con i pazienti nei professionisti che maggiormente avvertono il peso della responsabilit\ue0 nei confronti dei loro pazienti e in quelli che maggiormente si preoccupano per le possibili denunce di questi ultimi.Viceversa, due fattori di malessere come la preoccupazione per la sofferenza dei pazienti e la solitudine professionale si accompagnano a una maggiore propensione alla relazione e quindi a una maggiore attenzione a comportamenti eticamente rilevanti, con un ricorso minore alla medicina difensiva. Esiste inoltre una relazione tra fattori di malessere del medico e ricorso alla medicina difensiva, intesa sia come eccesso che come difetto di prestazioni.In sintesi, \ue8 stato rilevato un nesso stretto tra modalit\ue0 di comunicazione con i pazienti, livello di soddisfazione dei professionisti della cura e ricorso alla medicina difensiva.In letteratura esistono gi\ue0 dati che dimostrano il rapporto tra modalit\ue0 di comunicazione e soddisfazione del paziente, e rispettivamente tra comunicazione ed efficacia delle cure (dati recenti stimano una riduzione degli errori di circa il 50% per il miglioramento della comunicazione interna ai reparti e una riduzione dei ricoveri di circa il 30% per il miglioramento della comunicazione tra strutture specialistiche e del territorio). Altri dati della letteratura evidenziano l\u2019esistenza di correlazioni molto strette tra modalit\ue0 di comunicazione e contenzioso da parte di pazienti (\ue8 noto che circa il 70% dei casi di contenzioso in medicina sono dovuti a cattiva comunicazione).Anche i risultati di questo studio confermano la necessit\ue0 e l\u2019urgenza di un forte impegno nella formazione pre- e post-laurea per il miglioramento delle competenze comunicative e relazionali dei professionisti sanitari, questo al fine di migliorare efficacia ed efficienza delle cure e soddisfazione sia dei pazienti che dei medici

Strategic roadmap for an early diagnosis of Alzheimer's disease based on biomarkers

The diagnosis of Alzheimer's disease can be improved by the use of biological measures. Biomarkers of functional impairment, neuronal loss, and protein deposition that can be assessed by neuroimaging (ie, MRI and PET) or CSF analysis are increasingly being used to diagnose Alzheimer's disease in research studies and specialist clinical settings. However, the validation of the clinical usefulness of these biomarkers is incomplete, and that is hampering reimbursement for these tests by health insurance providers, their widespread clinical implementation, and improvements in quality of health care. We have developed a strategic five-phase roadmap to foster the clinical validation of biomarkers in Alzheimer's disease, adapted from the approach for cancer biomarkers. Sufficient evidence of analytical validity (phase 1 of a structured framework adapted from oncology) is available for all biomarkers, but their clinical validity (phases 2 and 3) and clinical utility (phases 4 and 5) are incomplete. To complete these phases, research priorities include the standardisation of the readout of these assays and thresholds for normality, the evaluation of their performance in detecting early disease, the development of diagnostic algorithms comprising combinations of biomarkers, and the development of clinical guidelines for the use of biomarkers in qualified memory clinics

Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian neonatal network

Introduction: Variation of respiratory care is described between centers around the world.The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. Methods:We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. Results: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. Conclusions. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement. \ua9 Mattioli 1885

Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian neonatal network

Introduction: Variation of respiratory care is described between centers around the world.The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. Methods:We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. Results: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. Conclusions. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement. © Mattioli 1885