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1. Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children.

Author

Guarino A, Lo Vecchio A, Dias JA, Berkley JA, Boey C, Bruzzese D, Cohen MB, Cruchet S, Liguoro I, Salazar-Lindo E, Sandhu B, Sherman PM, and Shimizu T

Subjects
Acute Disease, Adolescent, Child, Child, Preschool, Clinical Protocols standards, Female, Humans, Infant, Infant, Newborn, Male, Societies, Medical, Diarrhea therapy, Gastroenteritis therapy, Gastroenterology standards, Pediatrics standards, Practice Guidelines as Topic
Abstract

Objective: Despite a substantial consistency in recommendations for the management of children with acute gastroenteritis (AGE), a high variability in clinical practice and a high rate of inappropriate medical interventions persist in both developing and developed countries.The aim of this study was to develop a set of clinical recommendations for the management of nonseverely malnourished children with AGE to be applied worldwide., Methods: The Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN) Working Group (WG) selected care protocols on the management of acute diarrhea in infants and children aged between 1 month and 18 years. The WG used a 3-step approach consisting of: systematic review and comparison of published guidelines, agreement on draft recommendations using Delphi methodology, and external peer-review and validation of recommendations., Results: A core of recommendations including definition, diagnosis, nutritional management, and active treatment of AGE was developed with an overall agreement of 91% (range 80%-96%). A total of 28 world experts in pediatric gastroenterology and emergency medicine successively validated the set of 23 recommendations with an agreement of 87% (range 83%-95%). Recommendations on the use of antidiarrheal drugs and antiemetics received the lowest level of agreement and need to be tailored at local level. Oral rehydration and probiotics were the only treatments recommended., Conclusions: Universal recommendations to assist health care practitioners in managing children with AGE may improve practitioners' compliance with guidelines, reduce inappropriate interventions, and significantly impact clinical outcome and health care-associated costs.

Published
2018
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2. Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children.

Author

Lo Vecchio A, Dias JA, Berkley JA, Boey C, Cohen MB, Cruchet S, Liguoro I, Salazar Lindo E, Sandhu B, Sherman P, Shimizu T, and Guarino A

Subjects
Acute Disease, Child, Humans, Gastroenteritis diagnosis, Gastroenteritis therapy, Practice Guidelines as Topic
Abstract

Objective: Acute gastroenteritis (AGE) is a major cause of child mortality and morbidity. This study aimed at systematically reviewing clinical practice guidelines (CPGs) on AGE to compare recommendations and provide the basis for developing single universal guidelines., Methods: CPGs were identified by searching MEDLINE, Cochrane-Library, National Guideline Clearinghouse and Web sites of relevant societies/organizations producing and/or endorsing CPGs., Results: The definition of AGE varies among the 15 CPGs identified. The parameters most frequently recommended to assess dehydration are skin turgor and sunken eyes (11/15, 73.3%), general appearance (11/15, 66.6%), capillary refill time, and mucous membranes appearance (9/15, 60%). Oral rehydration solution is universally recognized as first-line treatment. The majority of CPGs recommend hypo-osmolar (Na 45-60 mmol/L, 11/15, 66.6 %) or low-osmolality (Na 75 mmol/L, 9/15, 60%) solutions. In children who fail oral rehydration, most CPGs suggest intravenous rehydration (66.6%). However, nasogastric tube insertion for fluid administration is preferred according by 5/15 CPGs (33.3%). Changes in diet and withdrawal of food are discouraged by all CPGs, and early refeeding is strongly recommended in 13 of 15 (86.7%). Zinc is recommended as an adjunct to ORS by 10 of 15 (66.6%) CPGs, most of them from low-income countries. Probiotics are considered by 9 of 15 (60%) CPGs, 5 from high-income countries. Antiemetics are not recommended in 9 of 15 (60%) CPGs. Routine use of antibiotics is discouraged., Conclusions: Key recommendations for the management of AGE in children are similar in CPGs. Together with accurate review of evidence-base this may represent a starting point for developing universal recommendations for the management of children with AGE worldwide.

Published
2016
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3. Adherence to guidelines for management of children hospitalized for acute diarrhea

Author

Lo Vecchio, A, Liguoro, I, Bruzzese, D, Scotto, R, Parola, L, Gargantini, G, Guarino, A, Accreditation, Quality Improvement Working Group of Italian Society of Pediatrics Kosova, P, Di Benedetto, L, Gattinara, Gc, Cursi, L, Parmigiani, S, Maddaluno, S, Campa, A, Caroccia, C, Adamoli, P, Forchì, G, Di Bari, C, Daniele, Rm, Saitta, F, Di Fraia, T, Bellettato, M, Meneghini, A, Principi, N, Esposito, S, Borgna, C, Fiumana, E, Zanconato, S, Masiero, S, Paravati, F, Pacenza, C, Cherubini, S, Frasca, D, Siani, P, De Brasi, D, Montrasio, G, Parolo, E, Podestà, Af, Tonella, M, Longhi, R, Ortisi, Mt, Rondanini, G, Calzi, P, Zucchinetti, P, Insolvibile, A, Navone, C, Ventura, F, Parisi, G, Isolato, V, Martemucci, L, D'Avino, P, Vetrano, G, Limongelli, Mg, Icilio, D, Muccioli, R., COLELLA, Maria Grazia, PACE, Maria Caterina, PERRONE, Laura, CAPRISTO, Carlo, Lo Vecchio, A, Liguoro, I, Bruzzese, D, Scotto, R, Parola, L, Gargantini, G, Guarino, A, Accreditation, Quality Improvement Working Group of Italian Society of Pediatrics Kosova, P, Di Benedetto, L, Gattinara, Gc, Cursi, L, Parmigiani, S, Maddaluno, S, Campa, A, Caroccia, C, Adamoli, P, Forchì, G, Di Bari, C, Daniele, Rm, Saitta, F, Di Fraia, T, Bellettato, M, Meneghini, A, Principi, N, Esposito, S, Borgna, C, Fiumana, E, Zanconato, S, Masiero, S, Paravati, F, Pacenza, C, Colella, Maria Grazia, Cherubini, S, Frasca, D, Siani, P, De Brasi, D, Montrasio, G, Parolo, E, Podestà, Af, Tonella, M, Longhi, R, Ortisi, Mt, Rondanini, G, Calzi, P, Zucchinetti, P, Insolvibile, A, Navone, C, Ventura, F, Parisi, G, Isolato, V, Pace, Maria Caterina, Martemucci, L, D'Avino, P, Vetrano, G, Limongelli, Mg, Perrone, Laura, Capristo, Carlo, Icilio, D, Muccioli, R., LO VECCHIO, Andrea, Bruzzese, Dario, and Guarino, Alfredo

Subjects
Diarrhea, Male, Microbiological Techniques, Microbiology (medical), Acute diarrhea, medicine.medical_specialty, Psychological intervention, Guidelines, Health Services Misuse, Hospital, Internal medicine, medicine, Humans, Prospective Studies, Medical prescription, Child, Preschool, Antidiarrheals, Prospective cohort study, book, Pediatric gastroenterology, Adherence, Gastroenteritis, Acute Disease, Anti-Bacterial Agents, Child, Preschool, Feeding Behavior, Female, Guideline Adherence, Hospitalization, Infant, Italy, Practice Guidelines as Topic, Probiotics, business.industry, Hepatology, Antidiarrheal Drugs, Infectious Diseases, Pediatrics, Perinatology and Child Health, Emergency medicine, Pediatric Infectious Disease, book.journal, business
Abstract

BACKGROUND: The major burden of acute gastroenteritis (AGE) in childhood is related to its high frequency and the large number of hospitalizations, medical consultations, tests and drug prescriptions. The adherence to evidence-based recommendations for AGE management in European countries is unknown. The purpose of the study was to compare hospital medical interventions for children admitted for AGE with recommendations reported in the European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines. METHODS: A multicenter prospective study was conducted in 31 Italian hospitals. Data on children were collected through an online clinical reporting form and compared with European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines for AGE. The main outcomes were the inappropriate hospital admissions and the percentage of compliance to the guidelines (full >90%, partial >80% compliance) based on the number and type of violations to evidence-based recommendations. RESULTS: Six-hundred and twelve children (53.6% male, mean age 22.8 ± 15.4 months) hospitalized for AGE were enrolled. Many hospital admissions (346/602, 57.5%) were inappropriate. Once admitted, 20.6% (126/612) of children were managed in full compliance with the guidelines and 44.7% (274/612) were managed in partial compliance. The most common violations were requests for microbiologic tests (404; 35.8%), diet changes (310; 27.6%) and the prescription of non-recommended probiotics (161; 14.2%), antibiotics (103; 9.2%) and antidiarrheal drugs (7; 0.6%). CONCLUSIONS: Inappropriate hospital admissions and medical interventions are still common in the management of children with AGE in Italy. Implementation of guidelines recommendations is needed to improve quality of care

Published
2014

4. Comparison of recommendations in clinical practice guidelines for acute gastroenteritis in children

Author

Jorge Amil Dias, James A. Berkley, Eduardo Salazar Lindo, Philip M. Sherman, Bhupinder Sandhu, Sylvia Cruchet, Mitchell B. Cohen, Toshiaki Shimizu, Chris Boey, Alfredo Guarino, Ilaria Liguoro, Andrea Lo Vecchio, Lo Vecchio, A, Dias, Ja, Berkley, Ja, Boey, C, Cohen, Mb, Cruchet, S, Liguoro, I, Salazar Lindo, E, Sandhu, B, Sherman, P, Shimizu, T, and Guarino, A.

Subjects
Acute diarrhea, medicine.medical_specialty, animal structures, purl.org/pe-repo/ocde/ford#3.03.04 [https], MEDLINE, Guidelines, Article, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Child, Children, purl.org/pe-repo/ocde/ford#3.02.03 [https], Acute Disease, Gastroenteritis, Practice Guidelines as Topic, business.industry, purl.org/pe-repo/ocde/ford#3.02.19 [https], Gastroenterology, Gastroenteritis/diagnosis/therapy, Acute gastroenteritis, Child mortality, Clinical Practice, gastroenteritis, diarrhea, guidelines, Pediatrics, Perinatology and Child Health, embryonic structures, business, human activities
Abstract

Objective: Acute gastroenteritis (AGE) is a major cause of child mortality and morbidity. This study aimed at systematically reviewing clinical practice guidelines (CPGs) on AGE to compare recommendations and provide the basis for developing single universal guidelines.Methods: CPGs were identified by searching MEDLINE, Cochrane-Library, National Guideline Clearinghouse and Web sites of relevant societies/organizations producing and/or endorsing CPGs.Results: The definition of AGE varies among the 15 CPGs identified. The parameters most frequently recommended to assess dehydration are skin turgor and sunken eyes (11/15, 73.3%), general appearance (11/15, 66.6%), capillary refill time, and mucous membranes appearance (9/15, 60%). Oral rehydration solution is universally recognized as first-line treatment. The majority of CPGs recommend hypo-osmolar (Na+ 45–60 mmol/L, 11/15, 66.6 %) or low-osmolality (Na+ 75 mmol/L, 9/15, 60%) solutions. In children who fail oral rehydration, most CPGs suggest intravenous rehydration (66.6%). However, nasogastric tube insertion for fluid administration is preferred according by 5/15 CPGs (33.3%). Changes in diet and withdrawal of food are discouraged by all CPGs, and early refeeding is strongly recommended in 13 of 15 (86.7%). Zinc is recommended as an adjunct to ORS by 10 of 15 (66.6%) CPGs, most of them from low-income countries. Probiotics are considered by 9 of 15 (60%) CPGs, 5 from high-income countries. Antiemetics are not recommended in 9 of 15 (60%) CPGs. Routine use of antibiotics is discouraged.Conclusions: Key recommendations for the management of AGE in children are similar in CPGs. Together with accurate review of evidence-base this may represent a starting point for developing universal recommendations for the management of children with AGE worldwide.

Published
2016

5. The Impact of E-Learning on Adherence to Guidelines for Acute Gastroenteritis: A Single-Arm Intervention Study

Author

Ilaria Liguoro, Christine Prell, Irina G. Zakharova, Elena Doroshina, Anna Chmielewska, Caroline De Bruyn, Marta Tavares, Emanuele Nicastro, Alfredo Guarino, Smaragdi Fessatou, Jernej Dolinsek, Bhupinder Sandhu, Andrea Lo Vecchio, Tudor Lucian Pop, Merit M. Tabbers, Pinar Urenden-Elicin, Dario Bruzzese, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Paediatric Gastroenterology, Nicastro, E, LO VECCHIO, Andrea, Liguoro, I, Chmielewska, A, De Bruyn, C, Dolinsek, J, Doroshina, E, Fessatou, S, Pop, Tl, Prell, C, Tabbers, Mm, Tavares, M, Urenden Elicin, P, Bruzzese, Dario, Zakharova, I, Sandhu, B, and Guarino, Alfredo

Subjects
Adult, Male, medicine.medical_specialty, lcsh:Medicine, Electronic learning, Acute Disease, Aged, Child, Preschool, Education, Medical, Continuing, Female, Gastroenteritis, Humans, Infant, Learning, Middle Aged, Practice Guidelines as Topic, Guideline Adherence, Education, Primary outcome, Medical, Online course, medicine, Paediatric age, lcsh:Science, Child, Preschool, Multidisciplinary, business.industry, lcsh:R, Continuing, Acute gastroenteritis, Case management, Intervention studies, Clinical Practice, Physical therapy, lcsh:Q, business, Research Article
Abstract

Objective E-learning is a candidate tool for clinical practice guidelines (CPG) implementation due to its versatility, universal access and low costs. We aimed to assess the impact of a five-module e-learning course about CPG for acute gastroenteritis (AGE) on physicians' knowledge and clinical practice. Study design This work was conceived as a pre/post single-arm intervention study. Physicians from 11 European countries registered for the online course. Personal data, pre- and post-course questionnaires and clinical data about 3 to 5 children with AGE managed by each physician before and after the course were collected. Primary outcome measures included the proportion of participants fully adherent to CPG and number of patients managed with full adherence. Results Among the 149 physicians who signed up for the e-learning course, 59 took the course and reported on their case management of 519 children

Published
2015
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