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Trovato CM, Capriati T, Bolasco G, Brusco C, Santariga E, Laureti F, Campana C, Papa V, Mazzoli B, Corrado S, Tambucci R, Maggiore G, Diamanti A. Enteral formula compared to Nissen-Fundoplication: Data from a retrospective analysis on tolerance, utility, applicability, and safeness in children with neurological diseases. Front Nutr 2023; 10:1093218. [PMID: 36969827 PMCID: PMC10034170 DOI: 10.3389/fnut.2023.1093218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives and studyApproximately 46–90% of children with neurological disorders (NDs) suffer from gastrointestinal diseases, such as gastro-esophageal reflux disease (GERD), constipation, or malnutrition. Therefore, enteral feeding is often necessary to achieve nutritional requirements. The treatment of GERD could be based on pharmacological therapy, nutritional treatment (changing the type of formula), or surgical treatment (Nissen Fundoplication, NF). The aim of this study was to describe and compare resource consumption between NE based on different formulas and NF in patients with ND.MethodsWe performed a retrospective analysis on all children with neurological damage (age: 29 days−17 years) treated from January 2009 to January 2019 due to nutritional problems and food and/or gastrointestinal intolerances. For all patients, demographic and anthropometric characteristics, symptoms, type of nutrition (formula and enteral access), and number and type of outpatient or emergency room visits were collected. Patients with <24 months of age at the closing of the database and with <24 months of follow-up were excluded.ResultsOut of 376 children, 309 children (M: 158; median age: 4 IQR 1–10) were enrolled, among which, 65 patients (NF group M: 33; median age: 5.3 IQR 1.8–10.7) underwent NF. Vomit, GERD, and dysphagia were more represented in the NF group (p < 0.05). Our analysis shows that the NF group seems to present a lower number of hospitalization and a lower number of visits for non-GI disorders, but a higher number of visits for GI disorders compared to non-NF. In the NF group, a higher prevalence of the use of amino-acid-based formula and free diet is observed, with a trend for the lower prevalence of casein-based or whey+casein-based formula (Fisher test p = 0.072). The median cost of a patient enrolled in the database is € 19,515 ± 540 ($ 20,742.32 ± 573.96) per year, with no significant difference between the two groups. Regarding formula, at baseline, 76 children consumed a free diet, 24 a casein-based formula, 139 a whey+casein-based formula, 46 a whey-based formula, and 24 an amino-acid-based formula.ConclusionsIn conclusion, compared to EN, NF may not improve the clinical aspect and related costs in children with NDs. Considering the psychological and QoL burden for patients, in a “step-up” strategy, EN could be proposed as an efficient alternative to NF.
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Affiliation(s)
- Chiara Maria Trovato
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Teresa Capriati
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Giulia Bolasco
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Carla Brusco
- Administrative Management, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Emma Santariga
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Laureti
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Carmen Campana
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Valentina Papa
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Bianca Mazzoli
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Corrado
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Tambucci
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Giuseppe Maggiore
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Diamanti
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
- *Correspondence: Antonella Diamanti
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Bozzola E, Marchesani S, Ficari A, Brusco C, Spina G, Marchili MR, Guolo S. Assessing the use of antibiotics in pediatric patients hospitalized for varicella. Ital J Pediatr 2022; 48:196. [PMID: 36503563 PMCID: PMC9743721 DOI: 10.1186/s13052-022-01393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella. METHODS Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1st of November 2005 to the 1st of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered. RESULTS According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures. CONCLUSION Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization.
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Affiliation(s)
- Elena Bozzola
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Silvio Marchesani
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Ficari
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carla Brusco
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giulia Spina
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Maria Rosaria Marchili
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Stefano Guolo
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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Adriani L, Dall'Oglio I, Brusco C, Gawronski O, Piga S, Reale A, Buonomo E, Cerone G, Palombi L, Raponi M. Reduction of Waiting Times and Patients Leaving Without Being Seen in the Tertiary Pediatric Emergency Department: A Comparative Observational Study. Pediatr Emerg Care 2022; 38:219-223. [PMID: 35157406 DOI: 10.1097/pec.0000000000002605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Analyze the effectiveness of an intervention to reduce waiting time and patients leaving without being seen in the pediatric emergency department. METHODS A comparative observational study was carried out from November 2018 to April 2019.Patients aged 3 months to 17 years were included. The new organizational model consisted of a dedicated outpatients' clinic for nonurgent codes and a fast track for traumatic and surgical emergency cases. RESULTS The comparative group included 14,822, and the intervention group included 15,585 patients. The new organizational model significantly reduced the numbers of patients who left the ED without being seen from 12.9% to 5.9%. CONCLUSIONS This new organizational model in the pediatric emergency department could be successfully used to reduce overcrowding, waiting time, and the numbers of patients leaving without being seen. However, more needs to be done by the pediatric services in the community to reduce nonurgent accesses to the emergency department.
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Affiliation(s)
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS
| | - Carla Brusco
- Medical Direction, Bambino Gesù Children's Hospital
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- From the Emergency Department & General Pediatric, Bambino Gesù Children's Hospital, IRCCS
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, "Tor Vergata" University
| | - Gennaro Cerone
- Department of Biomedicine and Prevention, "Tor Vergata" University
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, "Tor Vergata" University
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Bozzola E, Spina G, Marchili MR, Brusco C, Guolo S, Rossetti C, Logrieco G, Pignatelli F, Raponi M, Villani A. Pediatric Hospitalization for Varicella in an Italian Pediatric Hospital: How Much Does It Cost? Int J Environ Res Public Health 2021; 18:ijerph182212053. [PMID: 34831809 PMCID: PMC8617963 DOI: 10.3390/ijerph182212053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Varicella is a common pediatric infection. Even if it generally has a benign course, it may complicate and require hospitalization. The aim of our study was to estimate the acute hospitalization cost (AHC) for varicella in the acute phase in a pediatric population. METHODS We calculated the AHC of pediatric patients admitted for varicella at Bambino Gesù Children Hospital, Rome, Italy, from 1 November 2005 to 1 November 2020. RESULTS In the study period, 825 pediatric patients affected by varicella were hospitalized. The mean hospitalization cost was EUR 4015.35 (range from EUR 558.44 to EUR 42,608.00). Among patients, 55% were unvaccinable due to either their age or their immunosuppression status. They would benefit from herd immunity, reducing the overall AHC by EUR 182,196,506. Since the introduction of the compulsory vaccination against varicella in Italy, we observed a significant reduction in AHC cost of 60.6% in 2019 and of 93.5% in 2020. Finally, from the beginning of the COVID-19 pandemic, we documented a decline of 81.2% and 76.9% in varicella hospitalization, compared to 2018 and 2019, respectively. CONCLUSIONS Varicella AHC is an important economic and health assessment point and can be useful for improving preventive strategies.
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Affiliation(s)
- Elena Bozzola
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
- Correspondence: ; Tel.: +39-06-6859-2744
| | - Giulia Spina
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Maria Rosaria Marchili
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Carla Brusco
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Chiara Rossetti
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Giuseppe Logrieco
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Francesca Pignatelli
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Massimiliano Raponi
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Alberto Villani
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
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Meregaglia M, Croci I, Brusco C, Herich LC, Di Lallo D, Gargano G, Carnielli V, Zeitlin J, Fattore G, Cuttini M. Low socio-economic conditions and prematurity-related morbidities explain healthcare use and costs for 2-year-old very preterm children. Acta Paediatr 2020; 109:1791-1800. [PMID: 31977107 DOI: 10.1111/apa.15183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 12/29/2022]
Abstract
AIM To estimate healthcare use and related costs for 2-year-old very preterm (VP) children after discharge from the neonatal unit. METHODS As part of a European project, we recruited an area-based cohort including all VP infants born in three Italian regions (Lazio, Emilia-Romagna and Marche) in 2011-2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs. RESULTS The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity-related morbidities significantly increased the risk of rehospitalisation and total healthcare costs. CONCLUSION Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children.
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Affiliation(s)
- Michela Meregaglia
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Carla Brusco
- Medical Direction Department, Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Lena C. Herich
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | | | - Giancarlo Gargano
- Neonatal Intensive Care Unit Department of Obstetrics and Pediatrics Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy
| | - Virgilio Carnielli
- Maternal and Child Health Institute Marche University and Salesi Hospital Ancona Italy
| | - Jennifer Zeitlin
- Obstetrics, Perinatal and Pediatric Epidemiology Research Team Centre for Epidemiology and Biostatistics (U1153), INSERM and DHU Risks in Pregnancy, Paris‐Descartes UniversityParis France
| | - Giovanni Fattore
- Department of Social and Political Sciences Bocconi University & Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
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Bozzola E, Ciarlitto C, Guolo S, Brusco C, Cerone G, Antilici L, Schettini L, Piscitelli AL, Chiara Vittucci A, Cutrera R, Raponi M, Villani A. Respiratory Syncytial Virus Bronchiolitis in Infancy: The Acute Hospitalization Cost. Front Pediatr 2020; 8:594898. [PMID: 33537260 PMCID: PMC7848214 DOI: 10.3389/fped.2020.594898] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/14/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction: Respiratory syncytial virus (RSV) bronchiolitis is among the leading causes of hospitalization in infants. Prophylaxis with palivizumab may reduce RSV infection, but its prescription is restricted to high-risk groups. The aim of the study is to retrospectively determine acute hospitalization costs of bronchiolitis. Materials and methods: Infants aged 1 month-1 year, admitted to Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of bronchiolitis from January 1 till December 31, 2017, were included in the study. Results: A total of 531 patients were enrolled in the study, and the mean age was 78.75 days. The main etiologic agent causing bronchiolitis was RSV, accounting for 58.38% of infections. The total cost of bronchiolitis hospitalization was 2,958,786 euros. The mean cost per patient was significantly higher in the case of RSV (5,753.43 ± 2,041.62 euros) compared to other etiology (5,395.15 ± 2,040.87 euros) (p = 0.04). Discussion: The study confirms the high hospitalization cost associated with bronchiolitis. In detail, in the case of RSV etiology, the cost was higher compared to other etiology, which is likely due to the longer hospitalization and the more frequent admission to the intensive cure department. Conclusion: This study highlights that bronchiolitis is an important cost item even in a tertiary hospital and that cost-effective interventions targeting RSV are increasingly urgent.
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Affiliation(s)
- Elena Bozzola
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Claudia Ciarlitto
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children Hospital, Rome, Italy
| | - Carla Brusco
- Sanitary Direction, Bambino Gesù Children Hospital, Rome, Italy
| | - Gennaro Cerone
- Sanitary Direction, Bambino Gesù Children Hospital, Rome, Italy
| | - Livia Antilici
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Livia Schettini
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | | | - Anna Chiara Vittucci
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Renato Cutrera
- Pneumology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | | | - Alberto Villani
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
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Caredda E, Guolo S, Rinaldi S, Brusco C, Raponi M. Outpatient surgery is the solution at hand for reducing costs and hospital stays for pediatric surgery too: a hospital trial. Minerva Pediatr 2019; 72:101-108. [PMID: 31129951 DOI: 10.23736/s0026-4946.19.05426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Outpatient management has proven to be the most useful method of treatment for various minimally complex surgical specialties compared to day-hospital management or ordinary inpatient processes, a fact confirmed by numerous technical documents and works in the literature. METHODS We analyzed 27,713 surgical interventions carried out in our hospital between 2005 and 2017. This analysis included all interventions for which the indication of the level of care has moved, over the years, to an outpatient setting. We evaluated the direct costs of these services, comparing them by year and by treatment setting. RESULTS From the analysis of costs in general, for the same number of services, a reduction of 56.6% can be seen in the comparison between 2005 and 2017. In addition, the analysis of the length of stay shows an average reduction in the number of days of hospitalization from 2.9 to 1.2 between 2005 and 2017. On the basis of a large quantity of data, our study confirms that outpatient surgery can have a significant impact in reducing costs and days of hospitalization, even in a pediatric setting, demonstrating that it is the best choice in terms of saving resources and, above all, clinical and organizational appropriateness. CONCLUSIONS Outpatient surgery is in fact a valuable solution that provides an advantage for both the patient and his/her family, especially in the pediatric field, for the hospital and more generally for the health system as a whole.
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Affiliation(s)
- Emanuele Caredda
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy -
| | - Stefano Guolo
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Silvia Rinaldi
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Carla Brusco
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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Ceradini J, Tozzi AE, Agati S, De Zorzi A, Capolupo I, Iannace E, Manuri L, Pirti C, Di Iorio F, Brusco C, Raponi M. Teleconsultation and second opinions to promote high specialization in pediatrics. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky213.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Ceradini
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - AE Tozzi
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - S Agati
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - A De Zorzi
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - I Capolupo
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - E Iannace
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - L Manuri
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - C Pirti
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - F Di Iorio
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - C Brusco
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - M Raponi
- IRCCS Ospedale Bambino Gesù, Roma, Italy
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Diamanti A, Cereda E, Capriati T, Giorgio D, Brusco C, Liguori A, Raponi M. Prevalence and outcome of malnutrition in pediatric patients with chronic diseases: Focus on the settings of care. Clin Nutr 2018; 38:1877-1882. [PMID: 30097363 DOI: 10.1016/j.clnu.2018.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/22/2018] [Accepted: 07/07/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available. METHODS Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening. RESULTS Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7% [95% CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.8]) and day-hospital (28.3% [95% CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95% CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization. DISCUSSION The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.
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Affiliation(s)
- Antonella Diamanti
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy.
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Capriati
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Daniela Giorgio
- Medical Direction, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Carla Brusco
- Medical Direction, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Alessandra Liguori
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
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10
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Ceradini J, Tozzi AE, D'Argenio P, Bernaschi P, Manuri L, Brusco C, Raponi M. Telemedicine as an effective intervention to improve antibiotic appropriateness prescription and to reduce costs in pediatrics. Ital J Pediatr 2017; 43:105. [PMID: 29149862 PMCID: PMC5693570 DOI: 10.1186/s13052-017-0423-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
Implementation of antimicrobial stewardship program is a pivotal practice element for healthcare institution. We developed a remote infectious disease consultancy program via telemedicine in a high-specialized pediatric cardiac hospital. A consultation for antibiotic strategy for each patient was available via telemedicine in addition to biweekly discussion of all clinical cases. Aim of this study was to evaluate the impact of the remote stewardship program in terms of a) appropriateness of antibiotic prescription; b) incidence of multi-resistant infection; and c) cost. A ‘before - after’ study was performed comparing the period immediately before starting the program and one year after. There was a trend in the reduction of nosocomial infectious disease rate (9.5 vs 6.5 per 1000 person days), with a reduction in the overall antibiotic cost (25,000 vs 15,000 EUR) and in the average antibiotics packages used per admission (9 vs 6.7 packages). A significant reduction in the multi-drug resistant isolation rate was observed (104 vs 79 per 1000 person days, p = 0.01). In conclusion, the infectious disease meeting via telemedicine has been an effective tool for economic and professional development and multidisciplinary management of complex patients. The appropriate use of antibiotics reduced the multi-drug resistant bacteria selection, thus improving patient safety.
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Affiliation(s)
- Jacopo Ceradini
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | | | - Patrizia D'Argenio
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Paola Bernaschi
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Lucia Manuri
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Carla Brusco
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Massimiliano Raponi
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
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11
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Ciofi degli Atti ML, Cuttini M, Ravà L, Rinaldi S, Brusco C, Cogo P, Pirozzi N, Picardo S, Schiavi F, Raponi M. Performance of the pediatric index of mortality 2 (PIM-2) in cardiac and mixed intensive care units in a tertiary children's referral hospital in Italy. BMC Pediatr 2013; 13:100. [PMID: 23799966 PMCID: PMC3695834 DOI: 10.1186/1471-2431-13-100] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 06/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mortality rate of patients admitted to Intensive Care Units is a widely adopted outcome indicator. Because of large case-mix variability, comparisons of mortality rates must be adjusted for the severity of patient illness at admission. The Pediatric Index of Mortality 2 (PIM-2) has been widely adopted as a tool for adjusting mortality rate by patients' case mix. The objective of this study was to assess the performance of PIM-2 in children admitted to intensive care units after cardiac surgery, other surgery, or for other reasons. METHODS This was a prospective cohort study, conducted in a 607 inpatient-bed tertiary-care pediatric hospital in Italy, with three pediatric intensive care Units (PICUs) and one cardiac Unit (CICU). In 2009-11, all consecutive admissions to PICUs/CICU of children aged 0-16 years were included in the study. Discrimination and calibration measures were computed to assess PIM-2 performance. Multivariable logistic regression analysis was used to assess the association of patients' main reason for intensive care admission (cardiac-surgical, other-surgical, medical), age, Unit and year with observed mortality, adjusting for PIM-2 score. RESULTS PIM-2 data collection was completed for 91.2% of total PICUs/CICU patient admissions (2912), and for 94.8% of patients who died in PICUs/CICU (129). Overall observed mortality was 4.4% (95% CI, 3.7-5.2), compared to 6.4% (95% CI, 5.5-7.3) expected mortality. Standardised mortality ratio was 0.7 (95% CI: 0.6-0.8). PIM-2 discrimination was fair (area under the curve, 0.79; 95% CI: 0.75-0.83). Calibration was less satisfactory, mainly because of the over two-fold overprediction of deaths in the highest risk group (114.7 vs 53; p < 0.001), and particularly in cardiac-surgical patients. Multivariable logistic analysis showed that risk of death was significantly reduced in cardiac-surgical patients and in those aged 1 month to 12 years, independently from PIM-2. CONCLUSIONS The children age distribution and the proportion of cardiac-surgical patients should be taken into account when interpreting SMRs estimated using the PIM-2 prediction model in different Units. A new calibration study of PIM-2 score might be needed, and more appropriate cardiac-focused risk-adjustment models should be developed. The role of age on risk of death needs to be further explored.
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Abstract
BACKGROUND Poor survival among African American patients with breast cancer has been attributed to low socioeconomic status and lack of access to health care. However, Hispanics of equivalent socioeconomic status and health care access exhibit much higher survival rates, almost comparable to whites. This suggests that biologic differences play a role in differences in breast cancer survival in addition to socioeconomic and health care access factors. METHODS The authors studied clinical and molecular differences between patients with breast cancer of different ethnicity to determine biologic explanations for the observed differences in survival. Consecutive patients scheduled for breast biopsies were identified preoperatively and were interviewed. Blood was withdrawn for serum marker measurements, and tumor specimens collected at frozen section diagnosis were analyzed by flow cytometry, hormone receptor concentration, tumor grade, and Ki-67 nuclear antigen, HER-2/neu, and epidermal growth factor oncoprotein expression. RESULTS Age, age at menarche, number of lymph nodes with metastasis, estrogen and progesterone receptor levels, ploidy status, S-phase, Ki-67, HER-2/neu expression, tumor grade, epidermal growth factor receptor expression, lipid-associated sialic acid (LASA), and carcinoembryonic antigen level were not significantly related to ethnicity. African Americans presented at a significantly more advanced stage and with significantly larger tumors. They were significantly heavier and had a significantly higher mean Quetelet's index and a significantly higher number of pregnancies and number of live births. Whites and Hispanics were significantly older at menopause. CONCLUSIONS The molecular indices associated with breast cancer prognosis do not differ significantly among whites, African Americans, and Hispanics, suggesting that the reported differences in survival among these groups are not due to biologic differences in breast cancer among ethnic groups.
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Affiliation(s)
- S E Weiss
- Mount Sinai Medical Center, Department of Surgery, New York, New York 10029, USA
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Sperber K, Silverstein L, Brusco C, Yoon C, Mullin GE, Mayer L. Cytokine secretion induced by superantigens in peripheral blood mononuclear cells, lamina propria lymphocytes, and intraepithelial lymphocytes. Clin Diagn Lab Immunol 1995; 2:473-7. [PMID: 7583927 PMCID: PMC170182 DOI: 10.1128/cdli.2.4.473-477.1995] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Superantigens are potent inducers of T-cell proliferation and induce a broad range of cytokines, including tumor necrosis factor (TNF), gamma interferon, and interleukin 2 (IL-2). In the present study, we compared the abilities of different staphylococcal superantigens (staphylococcal enterotoxin B [SEB], staphylococcal enterotoxin E [SEE], and toxic shock syndrome toxin 1 [TSST-1]) to stimulate distinct cytokine profiles in peripheral blood mononuclear cells (PBMC), lamina propria lymphocytes (LPL), and intraepithelial lymphocytes (IEL). One million PBMC, LPL, and IEL were stimulated with various concentrations of superantigen (10 to 0.001 ng/ml) for 24, 48, and 72 h. Maximum cytokine production by PBMC, LPL, and IEL was observed for all three superantigens at 48 h at a concentration of 1 ng/ml. In PBMC, SEE and TSST-1 stimulated more IL-2 and gamma interferon than SEB. SEE and TSST-1 also stimulated more TNF and IL-4 production than SEB. In contrast, SEB stimulated more IL-6 than either SEE or TSST-1. In LPL, there was no SEE-induced IL-2 or IL-4 production, but IL-6, TNF, and gamma interferon were induced. SEB similarly induced no IL-2 or gamma interferon from the LPL, but IL-4, IL-6, and TNF were detected. TSST-1 stimulation of LPL resulted in IL-2 and TNF production but no IL-4, IL-6, or gamma interferon. In IEL, SEE induced no IL-2, IL-4, or gamma interferon but produced IL-6 and TNF, while SEB stimulation resulted in no IL-2 or gamma interferon but did result in detectable IL-4, IL-6, and TNF. Taken together, these data indicate that there are significant differences in the cytokine profiles induced by superantigens in LPL and IEL compared with those in PBMC, and these differences may relate to differences in activation requirements.
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Affiliation(s)
- K Sperber
- Division of Clinical Immunology, Mount Sinai Medical Center, New York 10029, USA
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