Dietary modifications for infantile colic

Infantile colic can be defined as periods of inconsolable, unexplained, and incessant crying in a seemingly healthy infant that, quite understandably, leads to exhausted, frustrated, and concerned parents seeking to comfort their child (Landgren 2010). The prevalence of excessive crying varies according to the definition used although, most often, it peaks during the second month of life,with a prevalence of 1.5%to 11.9%(Reijneveld 2001).Traditionally, the definition of the condition was based on the rule of three (Wessel 1954): that is, unexplained episodes of paroxysmal crying for more than three hours per day, for three days per week, for at least three weeks. More recently a new definition has been proposed. It refers to a clinical condition of fussing and crying for at least one week in an otherwise healthy infant (Hyman 2006). Colic can be graded as mild, moderate, or severe, though there is no consensus for this classification. Colic can affect up to 10% to 30% of infants worldwide (Clifford 2002; Rosen 2007)

Symptom-Level Description of Nursing Perceptions About Unwarranted Clinical Variation, Inequality in Access to Cancer Services, Specific-Symptom Knowledge: An Italian Web-Based Survey

Objectives: This study aimed to describe the cancer nurses’ views regarding the relevance of cancer symptom-specific knowledge, unwarranted clinical variation, and inequities in access to cancer services. Describing how nurses perceive these aspects could help identify research priorities and a practical framework to prioritize clinical practice guidelines. Data Sources: A web-based survey was performed using a convenience sample of 810 nurses employed in cancer settings and cross-sectional data collection. The survey adopted a previously validated questionnaire investigating 14 symptoms. Conclusion: This study revealed which cancer symptoms require priority attention to define evidence-grounded guidance for decreasing unwarranted clinical variation and inequities in access to cancer services. Future multiprofessional and multinational studies are recommended to provide an in-depth description of the investigated phenomena. Implications for Nursing Practice: Participants reported higher mean scores in pain-specific knowledge than other symptoms. Social functioning alterations and psychological disorders seem to be highly susceptible to unwarranted clinical variation and inequities in access to cancer services. This information could drive tailored interventions to improve nursing practice

The Role of Professional Competency in Influencing Job Satisfaction and Organizational Citizenship Behaviour among Palliative Care Nurses

It is crucial that palliative care nurses feel competent to practice their profession in accordance with ethical principles, to personalise care, to remain sensitive, to ensure respect, and to communicate effectively. The aim of this study was to verify that higher levels of perceived professional competency predict better individual and organizational outcomes, such as job satisfaction (JS) and organizational citizenship behaviour (OCB). METHOD: An online cross-sectional survey was conducted with 107 Italian palliative care nurses. Structural equation modelling technique was employed for data analysis. RESULTS: The model fitted the data well: χ2 = 33.50 p = 0.12, CFI = 0.98, TLI = 0.97, RMSEA = 0.06, SRMR = 0.04. Professional competency was positively associated with both JS (β = 0.39) and OCB (β = 0.53). SIGNIFICANCE OF RESULTS: The more confidence palliative care nurses have in their professional competency, the more they are satisfied with their job and engage in OCB. Fostering professional competency in palliative nursing can help not only patients and their families, but also the nurses themselves, the organisation, and their co-workers

Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review

: Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education

Pain-relieving agents for infantile colic

Background: Infantile colic is a common disorder in the first months of life, affecting somewhere between 4% and 28% of infants worldwide, depending on geography and definitions used. Although it is self limiting and resolves by four months of age, colic is perceived by parents as a problem that requires action. Pain-relieving agents, such as drugs, sugars and herbal remedies, have been suggested as interventions to reduce crying episodes and severity of symptoms. Objectives: To assess the effectiveness and safety of pain-relieving agents for reducing colic in infants younger than four months of age. Search methods: We searched the following databases in March 2015 and again in May 2016: CENTRAL, Ovid MEDLINE, Embase and PsycINFO, along with 11 other databases. We also searched two trial registers, four thesis repositories and the reference lists of relevant studies to identify unpublished and ongoing studies. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of pain-relieving agents given to infants with colic. Data collection and analysis: We used the standard methodological procedures of The Cochrane Collaboration. Main results: We included 18 RCTs involving 1014 infants. All studies were small and at high risk of bias, often presenting major shortcomings across multiple design factors (e.g. selection, performance, attrition, lack of washout period). Three studies compared simethicone with placebo, and one with Mentha piperita; four studies compared herbal agents with placebo; two compared sucrose or glucose with placebo; five compared dicyclomine with placebo; and two compared cimetropium - one against placebo and the other at two different dosages. One multiple-arm study compared sucrose and herbal tea versus no treatment. Simethicone. Comparison with placebo revealed no difference in daily hours of crying reported for simethicone at the end of treatment in one small, low-quality study involving 27 infants. A meta-analysis of data from two cross-over studies comparing simethicone with placebo showed no difference in the number of of infants who responded positively to treatment (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.73 to 1.23; 110 infants, low-quality evidence). One small study (30 participants) compared simethicone with Mentha piperita and found no difference in crying duration, number of crying episodes or number of responders. Herbal agents. We found low-quality evidence suggesting that herbal agents reduce the duration of crying compared with placebo (mean difference (MD) 1.33, 95% CI 0.71 to 1.96; three studies, 279 infants), with different magnitude of benefit noted across studies (I2 = 96%). We found moderate-quality evidence indicating that herbal agents increase response over placebo (RR 2.05, 95% CI 1.56 to 2.70; three studies, 277 infants). Sucrose. One very low-quality study involving 35 infants reported that sucrose reduced hours spent crying compared with placebo (MD 1.72, 95% CI 1.38 to 2.06). Dicyclomine. We could consider only one of the five studies of dicyclomine (48 infants) for the primary comparison. In this study, more of the infants given dicyclomine responded than than those given placebo (RR 2.50, 95% CI 1.17 to 5.34). Cimetropium bromide. Data from one very low-quality study comparing cimetropium bromide with placebo showed reduced crying duration among infants treated with cimetropium bromide (MD -30.20 minutes per crisis, 95% CI -39.51 to -20.89; 86 infants). The same study reported that cimetropium increased the number of responders (RR 2.29, 95% CI 1.44 to 3.64). No serious adverse events were reported for all of the agents considered, with the exception of dicyclomine, for which two of five studies reported relevant adverse effects (longer sleep 4%, wide-eyed state 4%, drowsiness 13%). Authors' conclusions: At the present time, evidence of the effectiveness of pain-relieving agents for the treatment of infantile colic is sparse and prone to bias. The few available studies included small sample sizes, and most had serious limitations. Benefits, when reported, were inconsistent. We found no evidence to support the use of simethicone as a pain-relieving agent for infantile colic. Available evidence shows that herbal agents, sugar, dicyclomine and cimetropium bromide cannot be recommended for infants with colic. Investigators must conduct RCTs using standardised measures that allow comparisons among pain-relieving agents and pooling of results across studies. Parents, who most often provide the intervention and assess the outcome, should always be blinded

Self-care in pediatric patients with chronic conditions: A systematic review of theoretical models

Background: To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support. Aims: (1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework. Methods: A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0-24 years) with chronic conditions were included. Results: Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed. Conclusions: By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable

A bottom-up approach to prioritize the scientific activities of Italian Association of Cancer Nurses (AIIAO): Questionnaire validation and pilot study

Introduction. There are no national data aimed to describe nurses' perception of variability in delivering nursing activities in relation to best practice and inequality in receiving nursing care. Moreover, there are no validated tools to be used in research. Therefore, the aims of this study are: a) to develop and validate a questionnaire to describe nurses' perceptions of variability and inequality in the oncology setting; b) to test content and face validity; c) to provide preliminary data (pilot study) to plan strategies for future national studies. Material and methods. This is a multi-phase and multi-method study. Phase 1 is focused on questionnaire's development (i.e., literature review and consensus discussion); phase 2 is aimed to determine content and face validity of the questionnaire; and phase 3 was a pilot data collection through an on-line survey. Results. The questionnaire that was developed yielded an adequate content and face validity (S-CVI=0.89 and CVR >0.60 for all items). The pilot study (75 nurses) found that nurse participants perceived as the most relevant categories pain and gastrointestinal and oral cavity dysfunctions. Fatigue, impairments of social function and psychological disorders were the areas in which greater variability and inequalities in receiving nursing care emerged. Overall, more than 50% of nurses reported variability and inequalities in oncology symptom management (in the investigated categories). Conclusions. The study results support the content validity of the questionnaire that can thereby be used for pan-national investigations

Pediatric nurses in pediatricians' offices: a survey for primary care pediatricians

Background: The role played by nurses in caring for children in pediatricians' officies in the community is crucial to ensure integrated care. In Italy, pediatricians are responsible for the health of children aged 0-14 years living in the community. This study aimed to describe Italian primary care pediatricians' opinions about the usefulness of several nursing activities that pediatric nurses could perform in pediatricians' offices. Methods: An online survey with pediatricians working in primary care in Italy was conducted between April-December 2018. A 40-item questionnaire was used to assess four types of nursing activities: clinical care, healthcare education, disease prevention, and organizational activities. The answers ranged from 1 (not useful at all) to 6 (very useful). Moreover, three open-ended questions completed the questionnaire. Results: Overall, 707 pediatricians completed the online survey. Participants were mainly female (63%), with a mean age of 57.74 (SD = 6.42). The presence of a pediatric nurse within the pediatrician's office was considered very useful, especially for healthcare education (Mean 4.90; SD 1.12) and disease prevention (Mean 4.82; SD 1.11). Multivariate analysis confirmed that pediatricians 'with less working experience', 'having their office in a small town', and 'collaborating with a secretary and other workers in the office' rated the nurse's activities significantly more useful. Conclusions: A pediatric nurse in the pediatrician's office can significantly contribute to many activities for children and their families in the community. These activities include clinical care, healthcare education, disease prevention, and the organizational processes of the office. Synergic professional activity between pediatricians and pediatric nurses could ensure higher health care standards in the primary care setting

Hijacking SARS-CoV-2/ACE2 Receptor Interaction by Natural and Semi-synthetic Steroidal Agents Acting on Functional Pockets on the Receptor Binding Domain

The coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by the severe acute respiratory syndrome coronavirus (SARS)-CoV-2. In light of the urgent need to identify novel approaches to be used in the emergency phase, we have embarked on an exploratory campaign aimed at repurposing natural substances and clinically available drugs as potential anti-SARS-CoV2-2 agents by targeting viral proteins. Here we report on a strategy based on the virtual screening of druggable pockets located in the central β-sheet core of the SARS-CoV-2 Spike's protein receptor binding domain (RBD). By combining an in silico approach and molecular in vitro testing we have been able to identify several triterpenoid/steroidal agents that inhibit interaction of the Spike RBD with the carboxypeptidase domain of the Angiotensin Converting Enzyme (ACE2). In detail, we provide evidence that potential binding sites exist in the RBD of the SARS CoV-2 Spike protein and that occupancy of these pockets reduces the ability of the RBD to bind to the ACE2 consensus in vitro. Naturally occurring and clinically available triterpenoids such as glycyrrhetinic and oleanolic acids, as well as primary and secondary bile acids and their amidated derivatives such as glyco-ursodeoxycholic acid and semi-synthetic derivatives such as obeticholic acid reduces the RBD/ACE2 binding. In aggregate, these results might help to define novel approaches to COVID-19 based on SARS-CoV-2 entry inhibitors

barocco a randomized phase ii study of weekly paclitaxel vs cediranib olaparib with continuous schedule vs cediranib olaparib with intermittent schedule in advanced platinum resistant ovarian cancer

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