Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review.

Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa

Consumer Interest, Attitude and Behavior toward a Sustainable Tomato

The steady increase in the consumption of fresh and processed tomatoes is threatening environmental sustainability, as water and fertilizers, two crucial production inputs, are becoming less accessible. To this purpose, the research project TomRes funded by the European Commission H2020 research and innovation programme, is currently undergoing to develop an environmentally sustainable fresh tomato. It is thus of paramount importance to understand if final consumers are willing to accept such a potential sustainable tomato and, may be more importantly, if consumers’ interests and positive attitude towards this product will lead to the decision to purchase.Hence, in this study, we exploit a sample of Italian consumers who responded to a web-survey to analyze the existence of the interest-attitude-behavior gap as well as its main determinants.Our results confirm the existence of this gap in line with other sustainable consumption products

How does consumers’ care for origin shape their behavioural gap for environmentally friendly products?

Climate change is threatening worldwide crop yields and varieties, and the desertification of Southern Europe and Mediterranean areas is endangering the cultivation of tomato, not only one of the most important cultivated crops, but also one of the main pillars of the global food industry. To minimize its environmental impact, current research efforts in Europe are selecting resilient tomato genotypes with reduced use of water and fertilizers. Still, its commercial acceptance depends on consumers’ reaction in terms of interests, attitudes, and willingness to buy and pay for this hypothetical resilient tomato. In our setting, a behavioural gap exists whenever despite an interest for the product, and regardless of a positive attitude towards it, consumers are not willing to pay a premium price for this tomato. This paper focuses on Italians, among the largest tomato consumers across the world, and for whom origin emerges as a relevant consumption driver. We carried out a web-survey, totalling 932 responses. We ran three different ordinal regressions, one for each level of involvement in the purchasing process, identifying the factors affecting consumers’ interest, attitude, and behaviour towards this hypothetical tomato. We prove the existence of a behavioural gap for Italian tomato consumers and observe that this gap widens as consumers’ preferences for origin increase. Hence, policies developing environmentally sustainable products should not forget how consumer preferences for non-strictly environmental attributes might ultimately affect their propensity to buy and pay

Assessment and management of iatrogenic withdrawal syndrome and delirium in pediatric intensive care units across Europe: an ESPNIC survey.

Analgesia and sedation are essential for the care of children in the pediatric intensive care unit (PICU); however, when prolonged, they may be associated with iatrogenic withdrawal syndrome (IWS) and delirium. We sought to evaluate current practices on IWS and delirium assessment and management (including non-pharmacologic strategies as early mobilization), and to investigate associations between presence of an analgosedation protocol and IWS and delirium monitoring, analgosedation weaning, and early mobilization. A multicenter cross-sectional survey-based study collecting data from one experienced physician or nurse per PICU in Europe was conducted from January to April 2021. We then investigated differences among PICUs that did or did not follow an analgosedation protocol. Among 357 PICUs, 215 (60%) responded across 27 countries. IWS was systematically monitored with a validated scale in 62% of PICUs, mostly using the Withdrawal Assessment Tool-1 (53%). Main first-line treatment for IWS was a rescue bolus with interruption of weaning (41%). Delirium was systematically monitored in 58% of PICUs, mostly with the Cornell Assessment of Pediatric Delirium scale (48%) and the Sophia Observation Scale for Pediatric Delirium (34%). Main reported first-line treatment for delirium was dexmedetomidine (45%) or antipsychotic drugs (40%). Seventy-one percent of PICUs reported to follow an analgosedation protocol. Multivariate analyses adjusted for PICU characteristics showed that PICUs using a protocol were significantly more likely to systematically monitor IWS (Odds Ratio [OR ]1.92, 95% Confidence Interval [CI] 1.01-3.67) and delirium (OR 2.00, 95% CI 1.07-3.72), use a protocol for analgosedation weaning (OR 6.38, 95% CI 3.20-12.71), and promote mobilization (OR 3.38, 95% CI 1.63-7.03). Monitoring and management of IWS and delirium are highly variable among European PICUs. The use of an analgosedation protocol was associated with increased likelihood of monitoring IWS and delirium, performing a structured analgosedation weaning, and promoting mobilization. Education on this topic and interprofessional collaborations are highly needed to help reduce the burden of analgosedation-associated adverse outcomes

The milky way

Mediastinal masses may present with signs and symptoms due to either compression of mediastinal structures or systemic effects of the underling disease. The present case highlights the advantages of interventional pulmonology in the diagnosis of lymphoma as a cause of chylothorax and superior vena cava syndrome

La guerra del Peloponneso / Tucidide

Il volume presenta il testo greco e la traduzione italiana dell'opera di Tucidide, introdotta da una presentazione di M.I. Finley. F. Ferrari la traduzione, G. Daverio Rocchi le note di commento storico, l'apparato bibliografico e le tavole cronologich

Effects of the coculture with human endometrial cells on the function of spermatozoa from subfertile men

To evaluate the effects of a coculture with human endometrial cells on the function of spermatozoa from samples obtained from infertile couples