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Copyright of Children's Nurses: Italian Journal of Pediatric Nursing Science / Infermieri dei Bambini: Giornale Italiano di Scienze Infermieristiche Pediatriche is the property of Societa Italiana di Scienze Infermieristiche Pediatriche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Children's Nurses: Italian Journal of Pediatric Nursing Science / Infermieri dei Bambini: Giornale Italiano di Scienze Infermieristiche Pediatriche is the property of Societa Italiana di Scienze Infermieristiche Pediatriche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Children's Nurses: Italian Journal of Pediatric Nursing Science / Infermieri dei Bambini: Giornale Italiano di Scienze Infermieristiche Pediatriche is the property of Societa Italiana di Scienze Infermieristiche Pediatriche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Presents letters to the editor on medical topics as of September 7, 2002. Topic of consultant physician contracts; Telephone use in primary care; Communication of risk between physicians and their patients; Stress and breast cancer; Genetic testing for familial Alzheimer's disease.

A letter to the editor is presented in response to the article by A. Stephenson regarding the prevalence of vertebral fractures in adults with cystic fibrosis and their relationship to bone mineral density that was published in the 2006 issue.

We report the case of a 30-year-old woman with cystic fibrosis (CF) chronically infected with Pseudomonas aeruginosa who delivered and breast-fed a healthy boy. While breast-feeding the woman had to undergo an i.v. antibiotic course with tobramycin, due to pulmonary exacerbation. Tobramycin was not detected in her milk and lactation could be continued. This is the first time that the presence of tobramycin in the milk of a CF woman during i.v. administration has been investigated. [ABSTRACT FROM AUTHOR]

Letters to the editor are presented in response to the article "Community-Associated Methicillin-resistant Staphylococcus aureus," by F. R. DeLeo and colleagues, published in the May 1, 2010 issue, along with the authors' reply.

Introduction: Falls in hospitals are a major problem also in pediatric settings. No Pediatric Fall Risk Assessment Scales (PFRAS) are validated in Italian., Goals: to perform the Italian validation of the Humpty-Dumpty Falls Scale (HDFS); to assess its predictive performance; to estimate the frequency of falls in hospitalized children and to analyze possible associations between children's clinical variables and falls., Methods: The study's first step was the cultural-linguistic validation of HDFS in Italian. Second, evaluation of the Italian HDFS's performance on 1500 hospitalized children. Third, modifications of the Italian HDFS to improve its performance. Fourth, analysis of falls frequency and associations between falls and patients' clinical variables., Results: The Italian HDFS (HDFS-ita) showed good Validity (SCVI=0.92) and inter-rater Reliability (Cohen's kappa=0.965), but poor Sensitivity (77.8%) and Specificity (36.6%). A new 3-item version of the HDFS-ita (HDFS-ita-M) was set, with a cut-off of 7, only for subjects 1 to 15 year-old. Although better, the HDFS-ita-M's performance remains poor (Sensitivity=77.8%, Specificity=53.3%, ROC curve's AOC=0.670). The frequency of pediatric falls was 6.38 per thousand children (CI95% 3.36-12.08) with a maximum frequency in children aged 3 to 6 years (11.28 per thousand children, CI95% 3.84-32.63). Motor/walking disorders (p=0.005), enuresis (p=0.0002), being in single room (p=0.04), admittance to pediatric neuropsychiatry/neurology wards (p=0.001), and neurological disorders (p=0.02) were associated to falls., Discussion: HDFS-ita-M has a better but still poor performance than HDFS-ita. This study provides useful data about pediatric falls and their possible risk factors which will help pediatric hospitals in determining patient safety policies. Further studies are needed to determine an adequate panel of variables to estimate pediatric falls risk.

Background and Aim of the Work: The Activities Scale for Kids performance (ASKp) is one of the few self-assessment questionnaires in pediatric rehabilitation that measures child perception in performance of daily routine activities. ASKp is composed of 30 questions designed to explore activities and participation in children and teenagers with musculoskeletal disorders. Scores assess level of physical ability, identify appropriate treatment and monitor changes over time. We undertook this cross-cultural validation study to achieve a culturally adapted Italian version of ASKp, to be tested on Italian children., Methods: ASKp was converted into Italian by two independent certified translators, supported by two Italian research physiotherapists. Twelve children with musculoskeletal disorders, their parents and eleven expert pediatric physiotherapists independently assessed clarity of language and semantics of each item. Physiotherapists also evaluated content validity of each item., Results: One item out of 30 did not reach inter-rater agreement ≥80% for clarity and was modified according to suggestions given. A panel of three research physiotherapists improved clarity of some other items based on suggestions from study participants. Regarding content validity of ASKp, I-CVI was ≥0.59 for all items and overall ASKp was deemed valid (S-CVI/Ave 0.93)., Conclusions: The Italian version of ASKp is linguistically clear and culturally coherent with a high content validity. It can be extremely useful in assessing activity limitation perspectives in Italian children and adolescent ranging from five to 15 affected by musculoskeletal disorders.

Introduction: Occupational stress is one of the main causes of sick leaves among healthcare professionals and it determines high costs to health systems. Monitoring occupational related stress can be an important tool for policy makers. The Italian nursing research gave little attention to nurses' occupational stress. The aims of this study is to estimate the prevalence of occupational stress and evaluate risks factors among Italian nurses in order to evaluate health promotion intervention., Methods: Cross-sectional study on a convenience sample of nurses from three Italian public hospitals was carried out. The Nursing Stress Scale was administrated together with socio-demographic data information(age, occupational age, family structure etc). The Nursing Stress Scale includes 34 items with a score from 0 to 3. Seven areas of job related stress are investigate in the scale: conflict with physicians, inadequate training, lack of support, conflict with other nurses, workload, uncertainty about treatments, death and suffering. Scores were calculated for each item and for each area. Associations between stress scores and socio-demographic data were analyzed., Results: 231 nurses participated to the study. The two stress areas with the highest scores were "workload" (1.58) and "death and suffering" (1.39). Among the 13 items that exceed the overall mean stress score (i.e. 1.07), five belong to the "workload" area. "Watching a suffering patient" is the single item with the highest mean score. Demographic data associated to higher stress scores are, female gender (p=0.03) and working with night shifts (p=0.02). Intention to leave the nursing profession is associated to higher stress scores (p=0.002). Age, occupational age, time to commute to work, number of children, having disabled relatives at home, were not correlated to higher stress scores., Conclusions: Our study provides data regarding nurses' occupational stress that was not available before. This data may be useful for policy makers to plan preventive interventions for nurses' job related stress and to reduce nurses' intention to leave.

In the year of the 150th anniversary of the Unity of Italy, Italian nurses cannot forget that Florence Nightingale herself, founder of modern Nursing , was a fervid support of the Risorgimento and of Italian unity. An unpublished letter, signed by her and conserved in the State archives of Pistoia, illustrates her feelings about the process of unity under way in the country where she was born.

Although maintaining a distance of 1 m between persons with cystic fibrosis (CF) is a universal recommendation to prevent respiratory cross-infections such as Pseudomonas aeruginosa, evidence supporting this preventive measure is scarce. Examining 336 samples from 42 patients with CF collected experimentally from sterile surfaces after speaking and coughing, we found that transmission of P aeruginosa beyond 1 m is possible during both talking and coughing, although the probability is low (1.7%)., (2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Hypospadias is one of the most common congenital anomalies occurring in approximately (1/300) male births. If it is not surgically corrected the consequences may negatively impact on quality of life in adolescents. The surgery is very invasive and the post-operative phase very painful. To improve the control of post-operative pain, continuous analgesia via epidural catheter was implemented., Aims: To compare the effectiveness in controlling pain of two different regimens: continuous epidural catheter infusion vs oral and rectal non-steroidal pain-killers., Materials and Methods: Comparative study on children undergoing hypospadias surgery. Group A (catheter) was treated with continuous postoperative analgesia via epidural catheter and Group B (scheduled times) with rectal and oral analgesics at scheduled times and on demand, after caudal block. In both groups nurses measured pain with VAS and FLACC scales (score from 0 to 10) for 72 hours after surgery., Results: 41 children were studied (average age 64.1 months, SD 47.3), with 332 post-operative pain recordings (Group A n = 161, Group B n = 171). Mean pain score of Group A was 0.13 (SD 0.3) and 0.45 (SD 0.8) in group B, p = 0.006. The median duration of the epidural catheter was 65 hours, mean 51.8 hours (SD 24.3). During the 1st post-operative medication, the mean pain score in Group A was 1.2 (SD 1.4), and 3.2 (SD 1.8) in group B, p = 0.003. In group A the number of pain scores indicating pain (> 0) where 3.1% while in group B were 10.5%, p = 0.0007., Conclusions: In children undergoing hypospadias surgery, post-operative analgesia with continuous epidural catheter infusion seems to offer a better analgesic coverage than the traditional oral/rectal analgesic treatment at scheduled times and on demand.

Unlabelled: In recent years Voluntary Incident Reporting (VIR) has spread as a tool to monitor and prevent adverse events in healthcare (AE). In Italy, experiences of VIR are limited., Aim: The goals of this pilot study were to test the feasibility of a VIR system in a population of nurses of a Pediatric Hospital and to make a preliminary survey of situations of risk for patients' safety, to plan corrective actions., Methods: Nurses of 3 wards were asked to report AEs with or without harm for patient, near misses and unsafe behaviours or situations at risk for generating AEs. Results were cumulatively reported to participating nurses during ward's meetings and possible corrective interventions were discussed., Results: The study was carried out from April to August 2006. Eighty-seven nurses participated. Forty-eight reports were made (one third signed, two thirds anonymous). Twenty reports (41.6%) regarded unsafe behaviours or situations at risk for AEs, 11 near misses, 15 AEs without patient harm and 2 AEs with harm. Twenty-three reports involved patients. Reports regarded mainly therapy (62.5%), care delivery (14.5%), equipment (8.3%), clinical documentation (6.3%). 40% of all AEs and near misses were reported to happen during the first or the last hour of the shift. AEs most frequently reported were: missing administration of treatments, administration of a wrong drug or of a wrong dose. "Look-alike" drugs and incomplete or illegible prescriptions., Conclusions: Our pilot study confirms that nurses are generally willing to get involved in VIR systems. It also suggests that to succeed VIR systems have to ensure that reporters remain anonymous and non-prosecutable.

Aims: To evaluate the effects on absenteeism and on costs for the health care system (HCS) of influenza vaccination offered to nurses in a paediatric hospital; the factors associated with vaccination acceptance and non-acceptance; the motivations of vaccine-recipient and non-recipient nurses., Methods: Cohort study. During the 2005-2006 influenza season we observed the entire nurse population of a Paediatric Hospital (n = 327) who were offered influenza vaccination at no cost at the working place. An anonymous questionnaire was also administered., Results: Vaccination rate was 30.3%. Mean days of sick leave of vaccinated nurses (3.4 per 100 calendar days) and non vaccinated nurses (4.5 per 100 calendar days) differed but not significantly. The saving for HCS due to vaccination of less than 1/3 of nurses was equal to 0.67 nurse-years. Age > or = 40 years (RR 1.47, p = 0.01), length of service > or = 20 years (RR 1.81, p = 0.0003) and working in oncology ward (RR 2.09, p = 0.002) were predictors of adhesion to the vaccination campaign. Among motivations given for vaccination were: not to transmit influenza to hospitalised children (62.8%), to avoid getting sick (55.6%), to protect own family members (49.4%). Only 34% of vaccinated nurses would have made vaccination even if not offered for free. Among non-recipients' main motivations were: vaccination is unnecessary (62.4%), no trust in its efficacy (8.8%). No differences were found in the incidence of influenza symptoms reported by vaccinated and non vaccinated nurses., Discussion: The utility of influenza vaccination to reduce absenteeism of nurses remains unclear. Strategies for influenza vaccination campaigns should particularly address younger nurses and should take into account the beliefs of each nurse in regards to own health.

Background: Exercise is integral to the life of T1DM subjects. Several factors influence the metabolic response to exercise in these patients. Despite physical and psychological benefits of exercise, its hypo- and hyperglycemic effects may cause discouragement from participation in sports and games., Aim: To use existing evidence from literature to provide practical indications for the management of insulin therapy in subjects with T1DM who practice sports or physical activities., Methods: Bibliographic research was performed on PubMed and the main Systematic Review and Guidelines database were also searched., Results: Existing guidelines are useful but the exact adjustments of insulin dose must be made on an individual basis and these adjustments can be made only by "trial and error" approach., Conclusions: These clinical indications may be a starting point from which health care providers can find practical advices for each patient.

Unlabelled: Antibiotic intravenous (IV) therapy is of paramount importance in the treatment of cystic fibrosis (CF) lung disease. During their life CF patients have to undergo frequent IV antibiotic treatments. Peripheral venous catheters (PVC) -or cannulas- are often used to reduce the number of venepunctures needed to complete a treatment cycle, as well as to provide patients the best possible level of autonomy. The clinical experience in managing IV therapy in CF patients at Meyer Hospital in Florence, suggested that the in situ duration of PVCs varies greatly., Goal: To understand which factors influence the duration of PVCs used to administer IVantibiotic in people with CF., Study Design: Cohort prospective study, integrated with retrospective data retrieval. MATERIALS, PATIENTS AND METHODS: We observed all the PVCs inserted during an 8-month period to CF patients followed at the CF Centre of Tuscany (Florence, Italy)., Results: We studied 87 PVCs inserted to 36 patients in 56 IV antibiotic treatment cycles. The mean duration of PVCs was 8.3 days. The mean duration of PVCs used for 3 daily antibiotic administrations was longer than that of PVCs used for 2 daily antibiotic administrations (10.3 days vs. 6.5 days, p=0.001). Moreover, PVCs with a larger gauge (G22) had longer mean duration than smaller (G24) PVCs (9.6 days vs. 7.2 days, p=0.03). No statistically significant association was found between PVCs' duration and, respectively, the place where the treatment was administered (in hospital or at home), the arm used (dominant or non-dominant), the PVC's brand, patient's clinical condition and the concurrent use of either steroidal antinflammatory drugs or NSAIDs per os.

Infections caused by respiratory pathogens such as Burkholderia cepacia and Pseudomonas aeruginosa are associated with an increased morbidity and mortality in people affected by cystic fibrosis, the most common lethal genetic disease in Caucasian populations. Preventing the acquisition of these pathogens is paramount for these patients. The goal of this survey was to assess the distribution and the prevalence of the measures adopted for the prevention and control of infections caused by respiratory pathogens in the 28 italian centres for cystic fibrosis. 21 questionnaires were returned and some important differences can be observed in the adoption of segregation measures. Although results may be influenced by other factors, specific segregation policies appear to be more directly associated than other measures (e.g., intensive disinfection; behavioural rules to minimise patient' contacts) with lower prevalence of Pseudomonas aeruginosa (OR 0.36 CI95% 0.31-0.42), of multidrug-resistant Pseudomonas aeruginosa (OR 0.30 CI95% 0.22-0.40), and of methicillin-resistant Staphylococcus aureus (OR 0.67 CI95% 0.48-0.94).