Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?

<p>Abstract</p> <p>Background</p> <p>Bronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis.</p> <p>Aim of the study</p> <p>To unravel main reasons of pediatricians in prescribing drugs to infants with bronchiolitis, and to possibly correlate therapeutic choices to the severity of clinical presentation. Also possible influence of socially deprived condition on therapeutic choices is analyzed.</p> <p>Methods</p> <p>Patients admitted to Pediatric Division of 2 main Hospitals of Naples because of bronchiolitis in winter season 2008-2009 were prospectively analyzed. An RDAI (Respiratory Distress Assessment Instrument) score was assessed at different times from admission. Enrolment criteria were: age 1-12 months; 1^stlower respiratory infection with cough and rhinitis with/without fever, wheezing, crackles, tachypnea, use of accessory muscles, and/or nasal flaring, low oxygen saturation, cyanosis. Social deprivation status was assessed by evaluating school graduation level of the origin area of the patients. A specific questionnaire was submitted to clinicians to unravel reasons of their therapeutic behavior.</p> <p>Results</p> <p>Eighty-four children were enrolled in the study. Mean age was 3.5 months. Forty-four per cent of patients presented with increased respiratory rate, 70.2% with chest retractions, and 7.1% with low SaO2. Mean starting RDAI score was 8. Lung consolidation was found in 3.5% on chest roentgenogram. Data analysis also unraveled that 64.2% matched clinical admission criteria. Social deprivation status analysis revealed that 72.6% of patients were from areas "at social risk". Evaluation of length of stay vs. social deprivation status evidenced no difference between "at social risk" and "not at social risk" patients. Following therapeutic interventions were prescribed: nasal suction (64.2%), oxygen administration (7.1%), antibiotics (50%), corticosteroids (85.7%), bronchodilators (91.6%). Statistically significant association was not found for any used drug with neither RDAI score nor social deprivation status. The reasons of hospital pediatricians to prescribe drugs were mainly the perception of clinical severity of the disease, the clinical findings at chest examination, and the detection of some improvement after drug administration.</p> <p>Conclusions</p> <p>We strongly confirm the large use of drugs in bronchiolitis management by hospital pediatricians. Main reason of this wrong practice appears to be the fact that pediatricians recognize bronchiolitis as a severe condition, with consequent anxiety in curing so acutely ill children without drugs, and that sometimes they feel forced to prescribe drugs because of personal reassurance or parental pressure. We also found that social "at risk" condition represents a main reason for hospitalization, not correlated to clinical severity of the disease neither to drug prescription. Eventually, we suggest a "step-by-step" strategy to rich a more evidence based approach to bronchiolitis therapy, by adopting specific and shared resident guidelines.</p

A New Proposal to Model the Relationships between Total Factor Productivity, Institutions and Accumulation

In this paper, we discuss the relationship between Total Factor Productivity (TFP), accumulation and institutions. In order to show these connections, a new model is presented that is able to shed some light on the links involving this multi-dimensional relationship, which goes from countries' quality of institutions to their stocks of physical and human capital and from these to TFP. The model is constructed in analogy with the physical law of thermal expansion and it introduces a new parameter that measures the response of TPF to variations in stocks of capital, in relation to institutional quality. Thanks to the proposed model, an operational methodology of such a parameter is defined (based on certain macroeconomic variables) and an estimate of it is provided (on the basis of a time series relative to a wide range of countries). Keywords: Growth, Total Factor Productivity, Accumulation Processes, Institutions JEL Classifications: O43, O47, E0

The design of an e-learning module centered in the use of an innovative web health application for attention deficit hyperactivity disorder monitoring

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Tecnologie mobili e apprendimento. Alcune considerazioni sull’uso del sistema

In questo articolo si propone una riflessione critica sull'uso delle tecnologie mobili per l'apprendimento, il cosiddetto mobile learning. A partire da una lunga esperienza sul campo, si analizza un progetto di mobile learning, il progetto MoULe (Mobile and Ubiquitous Learning), dalla fase di progettazione alla sua concreta sperimentazione in contesti educativi reali. In questa analisi si cerca di rendere esplicite sia le suggestioni teoriche, esplicite e implicite, che hanno guidato la progettazione del sistema tecnologico, sia il reale impatto che il suo uso ha avuto sugli studenti e all'interno delle classi

THE BASE SYSTEM: A SCHOOL-WIDE POSITIVE BEHAVIOUR SUPPORT TOOL TO FACILITATE EVIDENCE-BASED DIGITAL INTERVENTION PRACTICES

The Positive Behaviour Intervention and Support system is a framework aimed to introduce a change at school-wide level. It promotes a disciplinary system change process, from a reactive punishment- based strategies of specific student misbehaviours to a proactive system, where different behavioural principles such as the modelling and reinforcement of positive prosocial students’ behaviours are applied to improve school values and to create a positive climate. This paper presents the Behavioural Assessment to improve School Environment (BASE) system and the BASE repository. The BASE system supports evidence-based digital intervention practices for stimulating the academic, social, emotional, and behavioural competencies of all students. The BASE repository is a collection of good practices, tools, and instructional contents. Both of the tools are able to support and facilitate, through the use of mobile devices and a web-based responsive system, different prevention and instructional practices at the three-tiers PBS model. At the first level of prevention (Tier 1) the system allows to the school PBS team to define the Expectation Matrix, a set of positive behaviours grouped according to predefined school values and locations. Moreover, the PBS team members are able to define the list of problem behaviours, classifying them in minor and major. The matrix and the list of minor and major problem behaviours are at the base of the development of a screening tool for identifying behavioural risk problems, the Positive Office Referral and the Office Disciplinary Referral tools. At the target prevention level (Tier 2) the BASE application provides the Check-in/Check-out (CICO) tool, as PBIS recommends. It is addressed to a targeted group of students, resulted unresponsive to the Tier I, and implements the practice of ‘Positive reinforcement contingent on meeting behavioural goals’ throughout a reward system. At the intensive prevention level (Tier 3) the system allows users to perform Functional Behaviour Assessment for students considered unresponsive to Tier I and II and to create customized measurement tools for designing single case studies. The measure can be assigned to the observers able to collect data and organize them in phases. A TAU analysis algorithm is applied to the gathered data for showing the effectiveness of intervention. In the BASE application, each student can access to the system with personal credentials and to visualize his significant progresses into a smart dashboard. The BASE repository represents a hub for digital resources collection concerning both theoretical and methodological aspects of the PBIS approach. The Internet users interested to know the European experience of the involved partner schools, and to enlarge their knowledge about the principles to implement the PBIS in their own school, can find a first set of multimedia contents, webinars, collection of good practices gathered during the lifespan of the European Erasmus+ BASE project. The repository facilitates the finding of high-quality contents and represents a learning corner and an important knowledge repository for teachers and health professionals to understand and apply this approach

The WHAAM Application: a Tool to Support the Evidence-Based Practice in the Functional Behaviour Assessment

Background: The most recent computing technologies can promote the application of evidence-based practice (EBP) in the field of Applied Behavior Analysis (ABA).Objective: The study describes how the use of technology can simplify the application of evidence-based practices in applied behaviour analysis.Methods: The WHAAM application demonstrates this in the following two case studies. We are monitoring dysfunctional behaviours, collecting behavioural data, performing systematic direct observations, creating a visual baseline and intervention charts and evaluating the planned interventions using the TAU-U statistical index. Results: Significant positive changes of children's problem behaviours are observed and recorded. Both the duration of the identified behaviour "to get out of bed in time" (r = -.79, TAU-U = -.58, p < .05) and the frequency of the behaviour "interrupting others" (r= -.96, TAU-U = -.82, p < .01) decreased. Conclusion: the WHAAM application is an effective tool to support functional behaviour assessments and it is an example of how technology can support practitioners by facilitating the application of evidence-based practices and increasing the communication among clinical, educational and family environments

WHAAM: A new online service supporting parents and teachers of children with ADHD

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The BEHAVE application as a tool to monitor inclusive interventions for subjects with neurodevelopmental disorders

In the last few years, many educational and therapeutic interventions for young people with neurodevelopmental disorders are based on systematic monitoring of the outcomes. These interventions are typically conducted using single-case experimental designs, (SCEDs) a set of methods aimed at testing the effect of an intervention on a single subject or a small number of subjects. In SCEDs, an effective process of decision-making needs accurate, precise, and reliable data but also that caregivers and health professionals can gather information with minimal effort. The use of Information Communication Technologies in SCEDs can support the process of data collection and analysis, facilitating the collection of accurate and reliable data, providing reports accessible also by non-experts, and promoting interactions and sharing among clinicians, educators, and caregivers. The present paper introduces the BEHAVE application, a web-based highly customizable application, designed to implement SCEDs, supporting both data collection and automatic analysis of the datasets. Moreover, the paper will describe two case studies of kindergarten children with neurodevelopmental disorders, highlighting how the BEHAVE application supported the entire process, from data collection in multiple contexts to decision-making based on the analysis provided by the system. In particular, the paper describes the case studies of Carlo and Dario, two children with severe language and communication impairments, and the inclusive education interventions carried out to maximize their participation in a typical home and school setting increasing their mand repertoire. Results revealed an increase in the mand repertoire in both children who become able to generalize the outcomes to multiple life contexts. The active participation of the caregivers played a crucial role in the ability of children to use the learned skills in settings different from the ones they were learned in

Web Health Application for ADHD Monitoring (WHAAM): Context-Driven Framework

The Framework (FW) summarizes the experiences and vision of the WHAAM project partners, providing the basis for the development of the WHAAM app and online services. There are many approaches to the treatment of ADHD, with excellent resources available. This FW is a working tool based on partners' experiences, inspiring subsequent project activities. It is divided into three parts: part A explores general issues related to ADHD, focusing on key life contexts such as school, family, and social relationships. Each context is explored in terms of assessment, intervention and support. Part B delves into the relationship between ICT use and ADHD treatment. Finally, Part C briefly explains the main features of the WHAAM app, including functionality and interfaces. The WHAAM project considers the app and online service accessible via PC and mobile devices as a significant advancement in monitoring process management

The ARETE Ecosystem for the Creation and Delivery of Open Augmented Reality Educational Resources: The PBIS Case Study

Augmented reality (AR) is rapidly emerging as an increasingly useful technology in educational settings. In the ARETE (Augmented Reality Interactive Educational System) H2020 project, consortium members designed and implemented an ecosystem aimed at supporting teachers in building a collaborative learning environment through the use of AR in order to improve educational experiences. In particular, one of the pilot projects aims to introduce AR into school behavior lessons for the first time, leveraging the Positive Behaviour Intervention and Support (PBIS) methodology. Specifically, in this paper we will discuss the proposed architecture within the ARETE project that incorporates AR technology into the learning process of behavior lessons to support the teaching, practice and reinforcement phases of expected behaviors. Through the combination of different technologies and systems, it is possible to create an example of a technological and innovative ecosystem designed for creating behavioral lessons in AR