Consensus communication strategies to improve doctor-patient relationship in paediatric severe asthma

Background: Asthma is a chronic inflammatory disease that is very common among youth worldwide. The burden of this illness is very high not only considering financial costs but also on emotional and social functioning. Guidelines and many researches recommend to develop a good communication between physicians and children/caregiver and their parents. Nevertheless, a previous Italian project showed some criticalities in paediatric severe asthma management. The consensus gathered together experts in paediatric asthma management, experts in narrative medicine and patient associations with the aim of identify simple recommendation to improve communication strategies. Methods: Participants to the consensus received the results of the project and a selection of narratives two weeks before the meeting. The meeting was structured in plenary session and in three working groups discussing respectively about communication strategies with children, adolescents and parents. The task of each working group was to identify the most effective (DO) and least effective practices (DON' T) for 5 phases of the visit: welcome, comprehension of the context, emotions management, duration and end of the visit and endurance of the relationship. Results: Participants agreed that good relationships translate into positive outcomes and reached consensus on communication strategies to implement in the different phase of relationships. Conclusions: The future challenges identified by the participants are the dissemination of this Consensus document and the implementation of effective communication strategies to improve the management of pediatric asthma

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Background: In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods: Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results: The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions: We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research

Gain- and Loss-of-Function CFTR Alleles Are Associated with COVID-19 Clinical Outcomes

Carriers of single pathogenic variants of the CFTR (cystic fibrosis transmembrane conductance regulator) gene have a higher risk of severe COVID-19 and 14-day death. The machine learning post-Mendelian model pinpointed CFTR as a bidirectional modulator of COVID-19 outcomes. Here, we demonstrate that the rare complex allele [G576V;R668C] is associated with a milder disease via a gain-of-function mechanism. Conversely, CFTR ultra-rare alleles with reduced function are associated with disease severity either alone (dominant disorder) or with another hypomorphic allele in the second chromosome (recessive disorder) with a global residual CFTR activity between 50 to 91%. Furthermore, we characterized novel CFTR complex alleles, including [A238V;F508del], [R74W;D1270N;V201M], [I1027T;F508del], [I506V;D1168G], and simple alleles, including R347C, F1052V, Y625N, I328V, K68E, A309D, A252T, G542*, V562I, R1066H, I506V, I807M, which lead to a reduced CFTR function and thus, to more severe COVID-19. In conclusion, CFTR genetic analysis is an important tool in identifying patients at risk of severe COVID-19

Researching children's perspectives in pediatric palliative care: A systematic review and meta-summary of qualitative research

Qualitative research is pivotal in gaining understanding of individuals' experiences in pediatric palliative care. In the past few decades, the number of qualitative studies on pediatric palliative care has increased slightly, as has interest in qualitative research in this area. Nonetheless, a limited number of such studies have included the first-person perspective of children. The aim of this article is to understand the contribution of previous qualitative research on pediatric palliative care that included the voices of children

Indagine sulla formazione in pneumologia pediatrica nelle scuole di specializzazione in pediatria

Riassunto Background Sebbene le malattie respiratorie rappresentino uno dei principali motivi di visita pediatrica, nel nostro paese la formazione in quest’ ambito è attuata in maniera disomogenea. Scopo dell’indagine è stato descrivere lo stato dell’arte della formazione in pneumologia pediatrica nelle scuole di specializzazione in pediatria. Materiali e Metodi: Abbiamo realizzato una survey composta di 25 item e l’abbiamo resa accessibile online per 2 mesi, comunicandone le modalità di accesso a tutti gli specializzandi in pediatria mediante mailing list e newsletter di SIMRI, ONSP (Osservatorio Nazionale Specializzandi Pediatria) e Forum Junior Members SIMRI. Risultati: Hanno partecipato all’indagine 182 specializzandi da 16 regioni. Nessuno riteneva la propria preparazione in ambito pneumologico ottima. Lezioni e tirocini sono diffusi nelle scuole, a differenza di journal club e discussione di casi clinici. Spesso non è disponibile alcuna attività formativa relativa a radioprotezione (85.2%) e fisioterapia respiratoria (71.4%). Uno pneumologo pediatra è presente nell’83% dei casi. I test più diffusi sono: spirometria (97.8%), test del sudore (94%) e pH-metria (78.6%), ma la relativa formazione è attuata capillarmente solo per la spirometria (87.9%). Solo il 7.7% del campione è molto soddisfatto del piano formativo della propria scuola, mentre il 45.6% lo è abbastanza, il 40.1% poco ed il 6.6% per niente. L’84% ritiene fondamentali gli anni della specializzazione per la formazione sub-specialistica. Conclusioni: La nostra indagine suggerisce che nelle scuole di specializzazione in pediatria la formazione pneumologica deve essere incrementata

Evaluation of two DNA amplification PCR tests for the diagnosis of Clostridium difficile infection

Introduction. Clostridium Difficile (CD) usually is present in the gut of healthy subjects without giving any disease. As a consequence of various stress, including antibiotic therapy, CD can replicate and produce A and B toxins that induce diarrhoea.The finding of A and B toxins is a landmark for diagnosis of CD infection. Methods. 60 stool samples have been tested for CD presence. All the samples have been tested for the glutamate dehydrogenase (GDH) presence.The GDH positive samples have been tested with two rapid tests to evidence A and B toxins. Moreover, 18 positive and 3 negative GDH samples have been examined by means of cultivation tests and using two nested PCR (n-PCR) commercial kits (Neomed, Rho, Italy) to amplify the CD toxin coding gene tcdC and tcdB. Results.Among 60 examined samples, 52 (45%) were GDH positive, and, among these, 46 (76%) and 37 (62%) resulted respectively positive for both AB and for only A CD toxin using screening tests.Among the 18 GDH positive samples tested, 14 were positive for tcdC and tcdB n-PCR, while all the 3 GDH negative samples were confirmed as negative. The isolation in colture was positive in 16 of the GDH positive and in 2 of the 3 GDH negative samples. Conclusions.These data suggest that the GDH test is a useful screening method that must be associated to a confirmatory assay.The search of CD toxin coding gene by n-PCR seems to be a sensitive and specific method to assess the infection with toxins producing CD

Sleep architecture in infants with spinal muscular atrophy type 1

Objective: Few reports on sleep patterns of patients with spinal muscular atrophy type 1 (SMA1) have been published and none on sleep microstructure. The aim of this study was to analyze sleep architecture and microstructure in a group of infants with SMA1, compared with age- and sex-matched controls. Methods: Twelve SMA1 patients (six males, mean age 5.9 months) and 10 controls (five males, mean age 4.8 months) underwent full polysomnography to evaluate their sleep architecture and microstructure by means of the cyclic alternating pattern (CAP). Results: Compared with control children, SMA1 patients showed increased sleep latency and apnea/hypopnea index. CAP analysis revealed a significant increase in the percentage of A1 CAP subtypes, a reduction of that of A3 subtypes and of A2 and A3 indexes (number/h), indicating a dysfunction of the arousal system in these patients. Conclusion: The results indicate the presence of an abnormality of sleep microstructure in SMA1 patients, characterized by a reduction of A2 and A3 CAP subtypes. We hypothesize that SMA1 patients have reduced arousability during non-rapid eye movement sleep, which could be interpreted as additional evidence of central nervous system involvement in this disease. © 2014 Elsevier B.V. All rights reserved