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. Early warning scores for clinical deterioration in pediatric patients: a literature review., Introduction: An early recognition of clinical worsening (the manifestation of signs and symptoms resulting in physiological instability) in pediatric inpatients may prevent the evolution towards cardiorespiratory arrest. In recent decades, several tools known as PEWS (Pediatric Early Warning Scores), have been developed, aiming to reduce in-hospital morbidity and mortality., Objective: To describe efficacy, sensitivity and specificity of the available tools for early detection of clinical worsening in children, based on literature review., Methods: Systematic review through the consultation of PubMed and Google Scholar, cross-combining Mesh terms and free text words., Results: Out of 266 analysed papers, 34 were included in this review: 23 retrospective observational studies, 8 reviews, 1 reliability study, and 2 pilot studies. Overall, 23 main PEWS with sufficient evidence of efficacy were described (11 track and trigger and 12 aggregate). Ranges of sensibility and specificity were available only for 18 PEWS. It is not possible to recognize a gold standard, however, some PEWS are better in terms of validity and efficacy in different clinical settings. Internationally, the BPEWS (Brighton Pediatric Early Warning Score) is the most commonly adopted tool, able to identify clinical worsening of in-hospital children almost 11 hours before cardiac arrest., Conclusions: Although with limited evidence, validated PEWS have shown good ability to prevent the risk of clinical worsening by reducing adverse events. Further studies and greater standardization according to the clinical context are still needed.

. Premature departure from pediatric emergency department: retrospective analysis and preventive strategies., Introduction: The overcrowding of Emergency Departments (EDs) is a major cause of increased waiting time for the medical evaluation and dissatisfaction of children and their families, who often decide to leave before the visit is completed., Aim: To describe the characteristics of children who leave a second-level Pediatric ED before the medical examination., Methods: Retrospective descriptive analysis of children who leave before the medical evaluation at the ED of the Regina Margherita Children's Hospital of Turin, Italy between June and November 2018. Data were obtained from the Hospital's informatic registry., Results: 1351 children left the ED during the study period (6.7% of total visits); 9 of them (0.7%) had received a high triage priority code. The highest leaving rate was recorded in November, on the evening-slot and in children ageing 1-10 years. The average and median waiting time of those who left the ED before the medical examination were respectively 131 and 124 minutes. Fever and gastrointestinal problems were the most frequent reasons of access. Overall, 19.8% of children received nursing care during the triage. The revolving door rate was 6.0%., Conclusion: Low priority of urgency, long waiting times, access during periods of increased influx and the age between 1 and 10 years were major factors leading to leave Pediatric ED before the medical evaluation. Further studies are needed to investigate how many early leavings are due to ineffective nursing in the triage setting.

Objectives: Return visit (RV) to the emergency department (ED) is considered a benchmarking clinical indicator for health care quality. The purpose of this study was to develop a predictive model for early readmission risk in pediatric EDs comparing the performances of 2 learning machine algorithms., Methods: A retrospective study based on all children younger than 15 years spontaneously returning within 120 hours after discharge was conducted in an Italian university children's hospital between October 2012 and April 2013. Two predictive models, artificial neural network (ANN) and classification tree (CT), were used. Accuracy, specificity, and sensitivity were assessed., Results: A total of 28,341 patient records were evaluated. Among them, 626 patients returned to the ED within 120 hours after their initial visit. Comparing ANN and CT, our analysis has shown that CT is the best model to predict RVs. The CT model showed an overall accuracy of 81%, slightly lower than the one achieved by the ANN (91.3%), but CT outperformed ANN with regard to sensitivity (79.8% vs 6.9%, respectively). The specificity was similar for the 2 models (CT, 97% vs ANN, 98.3%). In addition, the time of arrival and discharge along with the priority code assigned in triage, age, and diagnosis play a pivotal role to identify patients at high risk of RVs., Conclusions: These models provide a promising predictive tool for supporting the ED staff in preventing unnecessary RVs.

Background: Schistosomiasis is a highly prevalent parasitic disease in Senegal. The early symptoms are hematuria and dysuria. Children's comprehension of the disease is fundamental to preventing the infection., Objectives: The aim of this study was to investigate the knowledge attitudes, and practices related to schistosomiasis among schoolchildren in 2 rural villages in Northern Senegal and to evaluate their impact on the disease., Methods: A cross-sectional study was conducted. Data about children's knowledge of schistosomiasis, behavior, and preventive measures were collected through a questionnaire., Findings: Questionnaire responses from 575 schoolchildren were analyzed. Correct answers about risky behavior for schistosomiasis were associated with early symptoms (P = 0.010). Wearing shoes and washing hands with soap were associated with not having hematuria and dysuria (P = 0.007 and 0.049, respectively). Playing in rivers was associated with the aforementioned symptoms (P < 0.001). Children who had good knowledge of schistosomiasis reportedly did not have symptoms (P = 0.002). A logistic regression model showed that female sex (odds ratio = 0.35; P = 0.01) and attending a primary school (odds ratio = 0.13; P < 0.001) were significant predictors of a lower risk of the early symptoms of urinary schistosomiasis., Conclusions: This study revealed that the level of knowledge among children in North Senegal about the causes, transmission, prevention, and treatment of schistosomiasis warrants implementing educational intervention., (Copyright © 2016 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.)

Background: Electronic cigarette smoking is spreading among health care professionals. E-cigarette smoke effects on health are not known, especially long-term effects., Aim: The aim of this study was to investigate the phenomenon of electronic cigarettes as regards smoking habits, knowledge and opinions of health care professionals., Methods: A multicentre cross-sectional descriptive study was conducted by administering an online questionnaire to all the health care professionals employed in two hospitals., Results: The population included 800 employees. More than half (66.8%) of respondents believed the e-cigarette is potentially harmful and capable of attracting young people to smoking and 38.8% of respondents believed that it can serve to stop smoking. The male gender was statistically associated with tobacco and e-cigarette smoking (p=0.034). The electronic cigarette was smoked little at the work place. The population studied did not have any specific knowledge about e-cigarettes and asked for specific training; the population knew the ban on the sale of e-cigarettes to underaged and emphasized the importance of specific management guidelines., Conclusions: The results of the study show the predominantly negative opinion of health professionals concerning the use of electronic cigarette. Moreover, the study results contributed to an improvement of the smoking policies in the hospitals studied.