A survey around the Italian pediatric units on current clinical practice for Sleep Disordered Breathing (SDB).

BACKGROUND: During recent years, interest on Sleep Disordered Breathing (SDB) in pediatric age has increased, due to the impact on quality of life, psycho-physical attitude and other serious morbidities if undiagnosed and untreated. METHODS: Italian Pediatric Respiratory Diseases Society (SIMRI) SDB-Working Group carried out an exploratory survey in Italy, from January to December 2016, to assess the diagnostic and therapeutic pathways, perception and relevance of SDB in Italian Hospitals. RESULTS: A questionnaire was sent to 180 Pediatric Units (PUs) distributed throughout the Italy; 102 Pediatric Units (PUs; 56.6%) answered and among them 57% dealt with SDB, and 94% recognized SDB as a major problem. Instrumental tests performed by the PUs were saturimetry (66%), nocturnal polygraphy with complete cardio-respiratory monitoring (46%) and full polysomnography (23%). In addition, hospital pediatricians reported that 54% of parents were unaware of the SDB and 84% did not know their complications. In the Northern Italy, the diagnosis was frequently performed with instrumental tools and the treatment was often surgical. In the Southern Italy the diagnosis was clinical, and the treatment was usually with drugs. CONCLUSIONS: The results of our study showed a heterogeneity in the diagnosis and treatment of SDB throughout Italy. Parents know little about SDB and their complications. The operator satisfaction was associated with the availability of tools for diagnosing SDB.

["A minute for life": resuscitation techniques in infants with risk for sudden infant death syndrome. Development of an instructional video for parents]. / "Un minuto per la vita": tecniche rianimatorie in lattanti a rischio di morte improvvisa. Realizzazione di un video didattico per i genitori.

AIM: The present study describes a project carried out in the Center for SIDS/ALTE of the Pediatric Clinic of Varese, targeted to deliver and provide parents with a movies on PBLS titled "A Minute for Life". The impact on the parent was evaluated by applying a questionnaire. METHODS: The movie "A Minute for Life" was given to 308 parents (122 fathers, mean age 35.2 and 186 mothers, mean age 28.4). All parents completed a questionnaire based on 4 parameters: 1. clarity of the content presented; 2. anxiety felt while watching the movie clip 3. reassurance related to their ability to review other times the movie; 4. the perception of its usefulness. RESULTS: Regarding the clarity of content, the results provide evidence that 231 parents (75% of the sample) rated him "very clear", while 77 subjects (25%) considered it "quite clear". On the possibility of being able to have at home, 277 parents (90% of subjects) believed it would be very reassuring to see it back Home. According to 231 parents (75% of the sample) the vision of the movie does not convey anxiety, while 77 of them (25% of subjects) felt slightly concerned in relation to vision. With regard to the overall assessment of the movie, all parents (308, 100% of the sample) agreed about its extreme usefulness. CONCLUSION: Our study opens the way for further prospective studies regarding the appropriateness and usefulness of the movie. It's also important to consider the release of the movie to all new parents and the possibility of giving first aid courses open to all those who want to be able to act with promptness and expertise if and when necessary.

[A method for optimizing the estimation of the dose to the patient in traditional radiology]. / Un metodo per l'ottimizzazione della stima della dose al paziente nella radiologia tradizionale.

INTRODUCTION: The method recommended by Report no. 34 (1982) of the International Commission on Radiological Protection (ICRP) for patient dose computation in diagnostic radiology is based on tabulated dosimetric data obtained from Monte Carlo simulations on anthropomorphic phantoms described by simple mathematical functions. When computing the dose absorbed by an adult patient, this method suffers from two main limitations: first, the geometrical parameters--and in particular focus-to-film distance and film size--are fixed, which makes the dosimetric data of limited use when the examination geometry differs from the ICRP standard. In addition, when patient size and mass differ considerably from the corresponding quantities of the mathematically described phantom (the so-called reference man, with a height of 174 cm and a mass of 70.9 kg) the ICRP method may lead to great errors in dose estimate. The aim of the present paper is to indicate a method to overcome the above limitations. MATERIAL AND METHODS: The algorithm proposed in this work is based on the method suggested by Huda and Gkanatsios in order to compute the effective dose through a linear first of the energy imparted per unit dose-area product as a function of the half value thickness and by using fit coefficients depending on both phantom thickness and peak voltage. We devised a procedure to normalize the dose computed with this methods with respect to the equivalent effective dose obtained with the ICRP method. We therefore determined the dependence of the absorbed dose on focus-to-film distance, film size and patient anatomy. RESULT AND DISCUSSION: We found that--for each value of patient mass--the dose dependence on film size can be approximated by a polynomial function, while the dose dependence on focus-to-film distance can be approximated by a power law. If the above parameters vary in a limited range close to the ICRP standard, a linear fit can be performed without introducing a considerable error. The linear fit coefficients, on the other hand, were found to depend on the average body surface, a parameter which takes into account both patient height and mass. Thus, determining the normalization factor for each projection and each view allows to estimate the absorbed dose under different geometrical conditions. The method has been verified by considering four of the most common X-ray procedures (chest AP, cervical spine LAT, lumbar spine AP and head LAT). CONCLUSIONS: The average error on dose estimation is about 13%. In the very next future the method will be extended to all the projections and views of ICRP Report no. 34, and we plan to integrate the described algorithm in a computer program devoted to the automatic computation of patient dose.