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

Connecting generations: the ESPNIC mentorship bridge

Mentorship is crucial for career development in healthcare. This report describes the ESPNIC Mentorship Program, established in 2021, which pairs junior healthcare professionals with senior mentors to support career goals. Over four years, 83 pairs were formed, including diverse participants from various roles and countries. Demographic information and feedback forms from mentors and mentees were collected systematically via online surveys at 12-month intervals at the start and end of the program. These data were thematically evaluated to find important areas of satisfaction and recommendations for development. Participants from low and middle income countries were enrolled in the program as well representing 26% of the mentees (22/83) and 10% of mentors (7/67). Women represented 50% (34/67) of mentors; and 71% (59/83) of mentees. Key areas of collaboration included career development, research, international networking, and clinical support. The program emphasised a voluntary and non-judgemental approach, fostering a positive experience for both mentors and mentees, and Feedback from both mentors and mentees so far has been very positive. The ESPNIC Mentorship Program serves as a model for other professional societies seeking to enhance member support and foster career advancement in paediatric and neonatal critical care

Assessment of self-perceived knowledge of key clinical pharmacology concepts and educational needs among European Paediatric Intensive Care Units: an ESPNIC survey

Background: Knowledge of clinical pharmacology concepts is essential to improve patients’ outcomes. Scarce data is available on the utilisation of these concepts in the paediatric intensive care unit (PICU). We aimed to investigate the self-perceived knowledge of clinical pharmacology concepts, educational needs and identify priorities for pharmacological research across European PICUs. Methods: From July to November 2022 an online survey was distributed to evaluate i) the self-reported knowledge, and ii) application of key pharmacology concepts in clinical practice (using a likert scale from 1 = never apply to 10 = always apply); iii) need for additional education on them; and iv) key areas for future pharmacological research. The survey was distributed to European Society of Paediatric and Neonatal Intensive Care (ESPNIC) members and other European national PICUs societies members. Results: Two-hundred-thirty-seven responses from 149 PICUs were collected. 54% of PICUs reported to have a clinical pharmacologist available for consultation during drug prescription and 65% of them regularly contact them during the prescribing process. Among clinical pharmacology concepts the parameter with the highest self-reported knowledge was half-life (99%) and the lowest were pharmacodynamics and volume-of-distribution (92%). The reported median application of these concepts in clinical practice ranged between 5/10 and 7/10. Most of the respondents reported the need for additional education on specific pharmacology concepts. Reported priorities for drug research mostly involved analgesics/sedatives (87%), antimicrobials (86%), and cardiovascular medications (55%). Conclusions: Self-reported knowledge on clinical pharmacology concepts seems good, but self-perceived clinical application may improve and most of the respondents report a need for additional education. These findings call for concerted multidisciplinary efforts to streamline education and guidelines to fill this gap

Digital image correlation : preprocessing delle immagini per la riduzione dell'incertezza ed applicazioni allo studio del size effect di travi

LAUREA SPECIALISTICAIl seguente lavoro di tesi è basato sulla validazione teorica e sull’applicazione pratica di tecniche di Digital Image Correlation (DIC). Gli studi teorici trattati riguardano in particolare l’applicazione in fase di pre-processing di un filtro gaussiano alle immagini analizzate allo scopo di migliorare l'accuratezza di misura. Essi sono strutturati in due parti: la prima è composta dall’analisi dei risultati di simulazioni numeriche, la seconda dalle verifiche sperimentali di tali simulazioni. In entrambe le fasi gli studi effettuati riguardano i benefici che l’applicazione del filtro gaussiano porta all’utilizzo delle tecniche DIC, verificati anche al variare di fattori significativi quali rumore, subset size e principale contenuto in frequenza dello speckle pattern. L’applicazione pratica dei metodi DIC è incentrata sullo studio della meccanica della frattura in travi di calcestruzzo rinforzate a flessione. In particolare si vogliono estrapolare i profili di deformazione in senso longitudinale per travi che variano per dimensione, dimensione degli aggregati presenti nel calcestruzzo e materiale costituente la barra di rinforzo (acciaio o fibra di vetro). Da questi si traggono spunti per la validazione di studi teorici riguardanti il comportamento a rottura di travi strutturali di grandi dimensioni, per il quale ad oggi non si dispone di un modello matematico univoco

Paediatric recreational vehicle-related head injuries presenting to the emergency department of a major paediatric trauma centre in Australia: Is there room for improvement?

Objective: This study examines clinical characteristics and helmet use of children presenting to the ED with a recreational vehicle (RV)-related head injury (HI).Methods: Observational retrospective study of childre

A Single Dose of Oral Sucrose Is Enough to Control Pain During Venipuncture: A Randomized Controlled Trial

Sucrose is effective in reducing pain during minor procedures in neonates. We evaluated whether a second dose of sucrose was more effective than a single dose during venipuncture. We performed a randomised, double-blind, controlled trial at the NICU of Padua Hospital (August 2016-October 2017). We randomised 72 preterm infants undergoing venipuncture for routine test to a control group, which received a single standard dose of sucrose 2′ before the procedure and a placebo 30″ after the venipuncture, and an experimental group in which they received two doses of 24% sucrose 2′ before and 30″ after the venipuncture. No difference in pain perception was found between the groups at 30″, 60″ and 120″. In conclusion, we do not recommend a second dose of sucrose during venipuncture in prematures.</jats:p