Prenatal exposure to antibiotics and wheezing in infancy: a birth cohort study.

The role of prenatal antibiotic exposure in the development of childhood wheezing is debated. We evaluated whether this association could potentially be explained by confounding factors.Antibiotic use in the first and third trimester of pregnancy, wheezing in children aged ≤18 months and confounding factors were assessed in singletons participating in the NINFEA (Nascita e Infanzia: gli Effetti dell'Ambiente) birth cohort (n=3530 for first-trimester exposure and n=3985 for third-trimester exposure).There was no evidence of an association between antibiotic exposure in the first trimester of pregnancy and ever-wheezing (adjusted risk ratio (RR) 1.02, 95% CI 0.80-1.30) or recurrent wheezing (RR 0.99, 95% CI 0.54-1.82). For the third-trimester exposure, the crude RRs (95% CI) of ever-wheezing and recurrent wheezing were 1.34 (1.10-1.64) and 2.72 (1.80-4.11), respectively, which decreased to 1.12 (0.90-1.39) and 2.09 (1.32-3.29) after adjustment. The RRs of wheezing after genitourinary infections during pregnancy were increased independently of antibiotic treatment.In conclusion, the association between prenatal antibiotic exposure and infant wheezing could be largely explained by confounding factors, in particular respiratory infections during pregnancy. An excess risk of wheezing after antibiotic exposure during the third trimester of pregnancy remains after adjustment.

Nurses as seen by patients: a phenomenological study.

OBJECTIVE: during the various periods of the history of the nursing profession, many differing representations of nurses have emerged in the collective imagination. The main purpose of this study, based on a qualitative approach, has been to discover the images of the nurse that patients retain in their minds when receiving care. METHODS: 6 sound-recorded focus groups were created, made up of patients and caregivers. These persons were members of 6 associations. The recordings and observations made were then analysed by adopting a hermeneutic phenomenological approach. RESULTS: 6 themes characterising nurses emerged: Training; Between flexibility and personalisation; Organisation and nursing; Continuity in caregiving; Professional maturity; and Relations. While these themes do not provide a uniform definition for the figure of the nurse they do present the profiles that had the greatest impact on persons receiving care. CONCLUSIONS: From the experiences collected among the participants in the focus groups, no pre-defined "image" of nurses emerged, and the stereotypes and prejudices described in the literature were also not to be found. Important indications did, in any case, emerge as to the type of nurse these people want, and concerning areas which must be worked on. These indications provide valuable information that, if acted upon, might contribute to the profession's growth and improvement. In brief, there are various planes of activity upon which nurses should concentrate their efforts: training (greater specialisation), organisation (greater flexibility), and the profession (consideration of professional identity in the light of the task of meeting patients' needs).

High Fidelity Simulation Experience in Emergency settings: doctors and nurses satisfaction levels.

BACKGROUND AND AIM OF THE WORK: Lots of studies describe High Fidelity Simulation (HFS) as an experience well-accepted by the learners. This study has explored doctors and nurses satisfaction levels during HFS sessions, searching the associations with the setting of simulation events (simulation center or on the field simulation). Moreover, we studied the correlation between HFS experience satisfaction levels and the socio-demographic features of the participants. METHODS: Mixed method study, using the Satisfaction of High-Fidelity Simulation Experience (SESAF) questionnaire through an online survey. SESAF was administered to doctors and nurses who previously took part to HFS sessions in a simulation center or in the field. Quantitative data were analyzed through descriptive and inferential statistics methods; qualitative data was performed through the Giorgi method. RESULTS: 143 doctors and 94 nurses filled the questionnaire. The satisfaction level was high: on a 10 points scale, the mean score was 8.17 (SD±1.924). There was no significant difference between doctors and nurses satisfaction levels in almost all the SESAF factors. We didn't find any correlation between gender and HFS experience satisfaction levels. The knowledge of theoretical aspects of the simulated case before the HFS experience is related to a higher general satisfaction (r=0.166 p=0.05), a higher effectiveness of debriefing (r=0,143 p=0,05), and a higher professional impact (r=0.143 p=0.05). The respondents that performed a HFS on the field, were more satisfied than the others, and experienced a higher "professional impact", "clinical reasoning and self efficacy", and "team dynamics" (p< 0,01). Narrative data suggest that HFS facilitators should improve their behaviors during the debriefing. CONCLUSIONS: Healthcare managers should extend the HFS to all kind of healthcare workers in real clinical settings. There is the need to improve and implement the communication competences of HFS facilitators.

High-Fidelity in Urgency-Emergency Simulation: validation of a tool to determine the satisfaction of participants.

BACKGROUND AND AIM OF THE WORK: In literature there are some tools to measure the satisfaction level related to high-fidelity simulation experience. This paper reports the construction and validation of a specific unique questionnaire in Italian (SESAF - Satisfaction of High-Fidelity Simulation Experience). METHODS: After having reviewed various tools available in literature, and conducted some focus groups with high-fidelity simulation experts, the authors produced the SESAF tool. It was administered to 237 Physicians and nurses participated in high-fidelity simulation of emergency codes. RESULTS: The factorial solution included 7 factors explaining the 71.65% of the total variance. Cronbach Alpha, reported an excellent reliability (0.97). CONCLUSIONS: SESAF can make comparable the satisfaction levels of HFS trainees among various centers.