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1. Lesson in understanding parents’ perspective: perception of quality of care and COVID-19-related fears among users of paediatric health services over the COVID-19 pandemic in 11 facilities in Italy

Author

Egidio Barbi, Silvia Bressan, Stefano Masi, Marzia Lazzerini, Paola Cogo, Vanna Graziani, Federico Marchetti, Giorgio Cozzi, Ilaria Mariani, Ilaria Liguoro, Francesca Tirelli, Chiara Stefani, Sarah Contorno, Stefano Martelossi, Alessandro Amaddeo, Alessia Marcellino, Riccardo Lubrano, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Elia Balestra, Benmario Castaldo, Alice Del Colle, Chiara Pilotto, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Chiara Grisaffi, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Sara Dal Bo, Vanessa Martucci, Mariateresa Sanseviero, Roberta Parrino, Giuseppina de Rosa, Vita Antonella Di Stefano, Francesca Patané, Marta Minute, Fabio Cardinale, Alessandra Iacono, Alessandro Zago, Angela Troisi, Marta Arrabito, Paolo Dalena, Massimo Dagnelut, Maristella Toniutti, Silvia Galiazzo, Maria Luisa Casciana, Marta Gagliardi, Kevin Valentino, Lucia Grazia Tricarico, Mariateresa De Sario, Alessandra Pisani, Maria Carla Finocchiaro, Laura Portale, Marco Greco, Emiliano Talanti, Anna Madera, Paola Stillo, Nicolò Chiti, Silvia Bloise, Silvia Sordelli, Mariangela Labruzzo, Massimo Lo Verde, Domenico Cipolla, Carlotta Farneti, Francesco Oppido, Giulia Sansovini, Giada Sartor, Marta Magnolato, Michele Maiola, Michela Pandullo, and Sara Rivellini

Subjects
Pediatrics, RJ1-570
Abstract

Background The COVID-19 pandemic had an important psychological impact on children and their families. This study aims to explore paediatric health services users’ perceptions of quality of care (QOC) and COVID-19-related fears, and their evolution over time in relation to COVID-19 pandemic.Methods In a multicentre cross-sectional study involving 11 public hospitals providing paediatric care across the Italian territory, we collected data from services users through a validated questionnaire. We analysed four indicators—(1) QOC perceived in relation to COVID-19; (2) overall QOC perceived; (3) fear of accessing health services due to COVID-19; (4) fear of contracting COVID-19 in hospital—and calculated Spearman’s correlation indexes (ρ) with the number of COVID-19 new cases over time. Subgroup analyses were conducted by macroregions and single facility.Results Data from 956 services users were analysed. QOC indicators were stable over time at values close to the maximum (range 77–100 and median 100 for COVID-19 QOC, range 74–98 and median 80 for overall QOC), and no correlations were found with the COVID-19 new cases (ρ=−0.073 and −0.016, respectively). Fear of accessing care and fear of contracting the infection varied over time in between 0%–52% and 0%–53%, respectively, but did not correlate directly with number of COVID-19 new cases (ρ=0.101, 0.107 and 0.233, 0.046, respectively). At subgroup analyses, significantly higher frequencies of fear (p values

Published
2024
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2. Point-of-care ultrasound (POCUS) pediatric resident training course: a cross-sectional survey

Author

Manuela Lo Bianco, Santiago Presti, Maria Carla Finocchiaro, Gian Luca Trobia, Tiziana Virginia Sciacca, Maria Elena Cucuzza, Elia Caudullo, Giacomo Calcara, Martino Ruggieri, and Vita Antonella Di Stefano

Subjects
POCUS, Survey, Pediatric residents, Training course, Ultrasound, Pediatrics, RJ1-570
Abstract

Abstract Background Point-of-care ultrasound (POCUS) is becoming increasingly crucial in the Pediatric Emergency Department for objective patient examination. However, despite its growing interest and wide-ranging applications, POCUS remains relatively unexplored in general pediatric training and education. Many physicians still find it challenging to comprehend and implement. Methods A theoretical-practical POCUS course for pediatric residents was conducted at the University of Catania, Italy. The course’s effectiveness and practical impact on residents was assessed through a pre-post training survey. The first part of the questionnaire focused on the self-perceived time needed to learn how to recognize the following conditions using POCUS: (i) Pleural effusion (ii) Lung consolidation (iii) Pneumothorax (PNX) (iv) Cardiac contractility (v) Pericardial effusion (vi) Perisplenic effusion (vii) Morison’s pouch effusion (viii) Douglas’ pouch effusion (ix) Filling and collapsibility of the inferior vena cava. In the second part, we compared the potential role of POCUS in (i) Reducing the use of ionizing radiation in children (ii) Increasing the sense of security in diagnosis and treatment decisions making and (iii) Increasing the residents’ confidence level with POCUS after the course on a 1-to-10 rating scale. Results Seventy-two residents participated in the study. The statistical analysis showed significant pre-post differences in almost all the items considered, except for “cardiac contractility” and “PNX”. Furthermore, the perceived potential role of POCUS in reducing ionizing radiation usage and the sense of security in diagnosis and treatment decisions showed statistically significant differences (p

Published
2024
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3. Evaluation of the WHO standards to assess quality of care for children with acute respiratory infections: findings of a baseline multicentre assessment (CHOICE) in Italy

Author

Egidio Barbi, Silvia Bressan, Stefano Masi, Marzia Lazzerini, Paola Cogo, Vanna Graziani, Federico Marchetti, Giorgio Cozzi, Ilaria Mariani, Ilaria Liguoro, Francesca Tirelli, Chiara Stefani, Sarah Contorno, Stefano Martelossi, Alessandro Amaddeo, Alessia Marcellino, Riccardo Lubrano, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Elia Balestra, Benmario Castaldo, Alice Del Colle, Chiara Pilotto, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Chiara Grisaffi, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Sara Dal Bo, Vanessa Martucci, Mariateresa Sanseviero, Roberta Parrino, Giuseppina de Rosa, Vita Antonella Di Stefano, Francesca Patané, Marta Minute, Fabio Cardinale, Alessandra Iacono, Angela Troisi, Marta Arrabito, Paolo Dalena, Massimo Dagnelut, Maristella Toniutti, Silvia Galiazzo, Maria Luisa Casciana, Marta Gagliardi, Kevin Valentino, Lucia Grazia Tricarico, Mariateresa De Sario, Alessandra Pisani, Maria Carla Finocchiaro, Laura Portale, Marco Greco, Emiliano Talanti, Anna Madera, Paola Stillo, Nicolò Chiti, Silvia Bloise, Silvia Sordelli, Mariangela Labruzzo, Massimo Lo Verde, Domenico Cipolla, Carlotta Farneti, Francesco Oppido, Giulia Sansovini, Giada Sartor, Marta Magnolato, Michele Maiola, Michela Pandullo, and Sara Rivellini

Subjects
Pediatrics, RJ1-570
Published
2024
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4. Implementation of the WHO standards to assess the quality of care for children with acute diarrhoea: findings of a multicentre study (CHOICE) in Italy

Author

Egidio Barbi, Silvia Bressan, Stefano Masi, Marzia Lazzerini, Paola Cogo, Vanna Graziani, Federico Marchetti, Giorgio Cozzi, Ilaria Mariani, Valentina Baltag, Ilaria Liguoro, Francesca Tirelli, Chiara Stefani, Sarah Contorno, Stefano Martelossi, Alessandro Amaddeo, Alessia Marcellino, Riccardo Lubrano, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Elia Balestra, Benmario Castaldo, Alice Del Colle, Chiara Pilotto, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Chiara Grisaffi, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Vanessa Martucci, Mariateresa Sanseviero, Roberta Parrino, Giuseppina de Rosa, Francesca Patané, Marta Minute, Fabio Cardinale, Alessandra Iacono, Angela Troisi, Marta Arrabito, Paolo Dalena, Massimo Dagnelut, Maristella Toniutti, Silvia Galiazzo, Maria Luisa Casciana, Marta Gagliardi, Kevin Valentino, Lucia Grazia Tricarico, Mariateresa De Sario, Alessandra Pisani, Maria Carla Finocchiaro, Laura Portale, Marco Greco, Emiliano Talanti, Anna Madera, Paola Stillo, Nicolò Chiti, Silvia Bloise, Silvia Sordelli, Mariangela Labruzzo, Massimo Lo Verde, Domenico Cipolla, Carlotta Farneti, Francesco Oppido, Giulia Sansovini, Giada Sartor, Marta Magnolato, Michele Maiola, Michela Pandullo, Sara Rivellini, Sara Dal Bo, and Vita Antonella Di Stefano

Subjects
Pediatrics, RJ1-570
Published
2024
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5. Implementation of the WHO Standards to assess quality of paediatric care at the facility level using service users’ perspective as source of data: a multicentre quality improvement study in Italy

Author

Egidio Barbi, Silvia Bressan, Stefano Masi, Marzia Lazzerini, Paola Cogo, Vanna Graziani, Federico Marchetti, Giorgio Cozzi, Ilaria Mariani, Valentina Baltag, Ilaria Liguoro, Francesca Tirelli, Chiara Stefani, Sarah Contorno, Stefano Martelossi, Alessandro Amaddeo, Alessia Marcellino, Riccardo Lubrano, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Elia Balestra, Benmario Castaldo, Alice Del Colle, Chiara Pilotto, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Chiara Grisaffi, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Sara Dal Bo, Vanessa Martucci, Mariateresa Sanseviero, Roberta Parrino, Giuseppina de Rosa, Vita Antonella Di Stefano, Francesca Patané, Marta Minute, Fabio Cardinale, Alessandra Iacono, Angela Troisi, Marta Arrabito, Paolo Dalena, Massimo Dagnelut, Maristella Toniutti, Silvia Galiazzo, Maria Luisa Casciana, Marta Gagliardi, Kevin Valentino, Lucia Grazia Tricarico, Mariateresa De Sario, Alessandra Pisani, Maria Carla Finocchiaro, Laura Portale, Marco Greco, Emiliano Talanti, Anna Madera, Paola Stillo, Nicolò Chiti, Silvia Bloise, Silvia Sordelli, Mariangela Labruzzo, Massimo Lo Verde, Domenico Cipolla, Carlotta Farneti, Francesco Oppido, Giulia Sansovini, Giada Sartor, Marta Magnolato, Michele Maiola, Michela Pandullo, Sara Rivellini, and Giuseppina De Rosa

Subjects
Pediatrics, RJ1-570
Published
2024
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6. Implementation of the WHO standards to assess quality of care for children with acute pain in EDs: findings of a multicentre study (CHOICE) in Italy

Author

Egidio Barbi, Silvia Bressan, Stefano Masi, Marzia Lazzerini, Paola Cogo, Vanna Graziani, Federico Marchetti, Giorgio Cozzi, Ilaria Mariani, Valentina Baltag, Ilaria Liguoro, Francesca Tirelli, Chiara Stefani, Sarah Contorno, Stefano Martelossi, Alessandro Amaddeo, Alessia Marcellino, Riccardo Lubrano, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Elia Balestra, Benmario Castaldo, Alice Del Colle, Chiara Pilotto, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Chiara Grisaffi, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Sara Dal Bo, Vanessa Martucci, Mariateresa Sanseviero, Roberta Parrino, Giuseppina de Rosa, Vita Antonella Di Stefano, Francesca Patané, Marta Minute, Fabio Cardinale, Alessandra Iacono, Angela Troisi, Marta Arrabito, Paolo Dalena, Massimo Dagnelut, Maristella Toniutti, Silvia Galiazzo, Maria Luisa Casciana, Marta Gagliardi, Kevin Valentino, Lucia Grazia Tricarico, Mariateresa De Sario, Alessandra Pisani, Maria Carla Finocchiaro, Laura Portale, Marco Greco, Emiliano Talanti, Anna Madera, Paola Stillo, Nicolò Chiti, Silvia Bloise, Silvia Sordelli, Mariangela Labruzzo, Massimo Lo Verde, Domenico Cipolla, Carlotta Farneti, Francesco Oppido, Giulia Sansovini, Giada Sartor, Marta Magnolato, Michele Maiola, Michela Pandullo, and Sara Rivellini

Subjects
Pediatrics, RJ1-570
Published
2024
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7. Implementation of the WHO Standards to assess the quality of paediatric care using health workers as source of data: findings of a multicentre study (CHOICE) in Italy

Author

Egidio Barbi, Silvia Bressan, Stefano Masi, Marzia Lazzerini, Paola Cogo, Vanna Graziani, Federico Marchetti, Ilaria Mariani, Valentina Baltag, Ilaria Liguoro, Francesca Tirelli, Chiara Stefani, Sarah Contorno, Stefano Martelossi, Alessia Marcellino, Riccardo Lubrano, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Elia Balestra, Benmario Castaldo, Alice Del Colle, Chiara Pilotto, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Chiara Grisaffi, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Vanessa Martucci, Mariateresa Sanseviero, Roberta Parrino, Giuseppina de Rosa, Vita Antonella Di Stefano, Francesca Patané, Marta Minute, Fabio Cardinale, Alessandra Iacono, Marta Arrabito, Paolo Dalena, Massimo Dagnelut, Maristella Toniutti, Silvia Galiazzo, Maria Luisa Casciana, Marta Gagliardi, Kevin Valentino, Lucia Grazia Tricarico, Mariateresa De Sario, Alessandra Pisani, Maria Carla Finocchiaro, Laura Portale, Marco Greco, Emiliano Talanti, Anna Madera, Paola Stillo, Nicolò Chiti, Silvia Bloise, Silvia Sordelli, Mariangela Labruzzo, Massimo Lo Verde, Domenico Cipolla, Carlotta Farneti, Francesco Oppido, Giulia Sansovini, Giada Sartor, Marta Magnolato, Michele Maiola, Michela Pandullo, Sara Rivellini, Sara Dal Bo, Giuseppina De Rosa, Dal Bo Sara, Troisi Angela, Cozzi Giorgio, and Amaddeo Alessandro

Subjects
Pediatrics, RJ1-570
Published
2024
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8. The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review

Author

Mariaclaudia Meli, Lucia Spicuzza, Mattia Comella, Milena La Spina, Gian Luca Trobia, Giuseppe Fabio Parisi, Andrea Di Cataldo, and Giovanna Russo

Subjects
lung ultrasound, pneumonia, pulmonary infection, Medicine (General), R5-920
Abstract

Background: Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., in immunocompromised patients) is still uncertain. Methods: This systematic review aimed to explore the most common LUS patterns in infections caused by intracellular, fungal pathogens or mycobacteria. Results: We included 17 studies, reporting a total of 274 patients with M. pneumoniae, 30 with fungal infection and 213 with pulmonary tuberculosis (TB). Most of the studies on M. pneumoniae in children found a specific LUS pattern, mainly consolidated areas associated with diffuse B lines. The typical LUS pattern in TB consisted of consolidation and small subpleural nodes. Only one study on fungal disease reported LUS specific patterns (e.g., indicating “halo sign” or “reverse halo sign”). Conclusions: Considering the preliminary data, LUS appears to be a promising point-of-care tool, showing patterns of atypical pneumonia and TB which seem different from patterns characterizing common bacterial infection. The role of LUS in the diagnosis of fungal disease is still at an early stage of exploration. Large trials to investigate sonography in these lung infections are granted.

Published
2023
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9. WHO standards-based tools to measure service providers’ and service users’ views on the quality of hospital child care: development and validation in Italy

Author

Egidio Barbi, Marta Arpone, Silvia Bressan, Marzia Lazzerini, Emanuelle Pessa Valente, Paola Cogo, Federico Marchetti, Giorgio Cozzi, Francesco Tagliaferri, Ilaria Mariani, Valentina Baltag, Francesca Peri, Ilaria Liguoro, Chiara Stefani, Claudio Germani, Silvana Schreiber, Stefano Martelossi, Angelika Velkoski, Alessandro Amaddeo, Alessia Marcellino, Riccardo Lubrano, Moise Muzigaba, Tereza Rebecca de Melo e Lima, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Daniela Nisticò, Wilson Milton Were, Elia Balestra, Benmario Castaldo, Alice Del Colle, De Monte Roberta Coordinatrice, Tamara Strajn Coordinatrice, Livia Bicego, Andrea Cassone, Chiara Pilotto, Lisa Stavro, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Pelazza Carolina, Marta Coppola, Chiara Grisaffi, Elisabetta Mingoia, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Sara Dal Bo, Vanessa Martucci, Mariateresa Sanseviero, Bloise Silvia, Eleonora Canzio, Roberta Parrino, Salvatore Gambino, Melania Guardino, Luca Lagalla, Beatrice Vaccaro, Giuseppina de Rosa, Vita Antonella Di Stefano, and Francesca Patané

Subjects
Medicine
Abstract

Objectives Evidence showed that, even in high-income countries, children and adolescents may not receive high quality of care (QOC). We describe the development and initial validation, in Italy, of two WHO standards-based questionnaires to conduct an assessment of QOC for children and young adolescents at inpatient level, based on the provider and user perspectives.Design Multiphase, mixed-methods study.Setting, participants and methods The two questionnaires were developed in four phases equally conducted for each tool. Phase 1 which included the prioritisation of the WHO Quality Measures according to predefined criteria and the development of the draft questionnaires. In phase 2 content face validation of the draft questionnaires was assessed among both experts and end-users. In phase 3 the optimised questionnaires were field tested to assess acceptability, perceived utility and comprehensiveness (N=163 end-users). In phase 4 intrarater reliability and internal consistency were evaluated (N=170 and N=301 end-users, respectively).Results The final questionnaires included 150 WHO Quality Measures. Observed face validity was excellent (kappa value of 1). The field test resulted in response rates of 98% and 76% for service users and health providers, respectively. Among respondents, 96.9% service users and 90.4% providers rated the questionnaires as useful, and 86.9% and 93.9%, respectively rated them as comprehensive. Intrarater reliability was good, with Cohen’s kappa values exceeding 0.70. Cronbach alpha values ranged from 0.83 to 0.95, indicating excellent internal consistency.Conclusions Study findings suggest these tools developed have good content and face validity, high acceptability and perceived utility, and good intrarater reliability and internal consistency, and therefore could be used in health facilities in Italy and similar contexts. Priority areas for future research include how tools measuring paediatric QOC can be more effectively used to help health professionals provide the best possible care.

Published
2022
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10. Epidemiology, Microbiology and Severity of Bronchiolitis in the First Post-Lockdown Cold Season in Three Different Geographical Areas in Italy: A Prospective, Observational Study

Author

Anna Camporesi, Rosa Morello, Valentina Ferro, Luca Pierantoni, Alessandro Rocca, Marcello Lanari, Gian Luca Trobia, Tiziana Sciacca, Agata Giuseppina Bellinvia, Alessandra De Ferrari, Piero Valentini, Damian Roland, and Danilo Buonsenso

Subjects
bronchiolitis, COVID-19, RSV, respiratory syncytial virus, children, Pediatrics, RJ1-570
Abstract

The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021–2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age.

Published
2022
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12. Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study

Author

Laura, Gori, Antonella, Amendolea, Danilo, Buonsenso, Stefano, Salvadori, Maria Chiara, Supino, Anna Maria, Musolino, Paolo, Adamoli, Alfina Domenica, Coco, Gian Luca, Trobia, Carlotta, Biagi, Marco, Lucherini, Alberto, Leonardi, Giuseppe, Limoli, Matteo, Giampietri, Tiziana Virginia, Sciacca, Rosa, Morello, Francesco, Tursi, Gino, Soldati, and Ecobron Group

Subjects
General Medicine, bronchiolitis, lung ultrasound, children, respiratory syncytial virus, ultrasound score
Abstract

There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up.

Published
2022

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