[Complexity of care: meanings and interpretation]. / Complessità assistenziale: significati e interpretazioni.

INTRODUCTION: Although the concept of complexity of care is widely used and discussed, its meaning is blurred and its characteristics are not well defined. AIMS: To identify the words used to define the concept of complexity in the literature and its meaning. METHOD: A literature search was performed on the following databases: Pubmed, Medline, Ebsco, Cinahl and Cochrane. No temporal limits were set; publications written in English and Italian were included. RESULTS: Several terms are used to define the concept of complexity, often interchangeably notwithstanding their different meaning. Three main concepts were identified: nursing intensity that includes the concepts of dependency, severity and complexity of patients care; nursing workload that comprises the concept of nursing intensity and all the activities not patient-related; and the patient acuity that includes the severity of illness and the caring intensity. CONCLUSIONS: A common definition is needed to be able to use the concept of complexity of care to allocate nursing resources.

Mother-to-Infant Microbial Transmission from Different Body Sites Shapes the Developing Infant Gut Microbiome.

The acquisition and development of the infant microbiome are key to establishing a healthy host-microbiome symbiosis. The maternal microbial reservoir is thought to play a crucial role in this process. However, the source and transmission routes of the infant pioneering microbes are poorly understood. To address this, we longitudinally sampled the microbiome of 25 mother-infant pairs across multiple body sites from birth up to 4 months postpartum. Strain-level metagenomic profiling showed a rapid influx of microbes at birth followed by strong selection during the first few days of life. Maternal skin and vaginal strains colonize only transiently, and the infant continues to acquire microbes from distinct maternal sources after birth. Maternal gut strains proved more persistent in the infant gut and ecologically better adapted than those acquired from other sources. Together, these data describe the mother-to-infant microbiome transmission routes that are integral in the development of the infant microbiome.

[Family presence during cardiopulmonary resuscitation in children]. / La presenza dei familiari durante la rianimazione cardiopolmonare del bambino in ambito ospedaliero.

UNLABELLED: Witnessing a cardiopulmonary resuscitation is a dramatic event for health care workers and for the relatives of those involved, especially for parents and relatives of children. METHOD: A literature review was performed on MedLine, PubMed, Ebsco, with the following keywords: Family presence, Relatives, Parents presence, Pediatric Resuscitation, Cardiopulmonary Resuscitation (CPR), Pediatric intensive care unit, to explore if parents should be allowed to witness or not and their need of support. RESULTS: Most paediatric guidelines favour the presence of relatives during CPR and the results of surveys are consistent in reporting that parents prefer to see what is happening to their child. The benefits for health care workers include an improvement of the relationship with family members, thus facilitating the flow of information and health education. Years of education and experience, together with specific protocols may help health care workers to accept the presence of relatives during critical events.

Maternal inheritance of bifidobacterial communities and bifidophages in infants through vertical transmission.

BACKGROUND: The correct establishment of the human gut microbiota represents a crucial development that commences at birth. Different hypotheses propose that the infant gut microbiota is derived from, among other sources, the mother's fecal/vaginal microbiota and human milk. RESULTS: The composition of bifidobacterial communities of 25 mother-infant pairs was investigated based on an internal transcribed spacer (ITS) approach, combined with cultivation-mediated and genomic analyses. We identified bifidobacterial strains/communities that are shared between mothers and their corresponding newborns. Notably, genomic analyses together with growth profiling assays revealed that bifidobacterial strains that had been isolated from human milk are genetically adapted to utilize human milk glycans. In addition, we identified particular bacteriophages specific of bifidobacterial species that are common in the viromes of mother and corresponding child. CONCLUSIONS: This study highlights the transmission of bifidobacterial communities from the mother to her child and implies human milk as a potential vehicle to facilitate this acquisition. Furthermore, these data represent the first example of maternal inheritance of bifidobacterial phages, also known as bifidophages in infants following a vertical transmission route.

[Medication errors. Preventive measures in neonatal intensive care]. / Gli errori di terapia. Interventi di prevenzione in Terapia Intensiva Neonatale.

UNLABELLED: Medications errors are one on the main problems in the National Health Service. The Neonatal Intensive Care Unit (NICU) is a very specific area and newborns are highly exposed to the risk of medication errors. MATERIALS AND METHODS: A revision of the therapeutic process was started, involving NICU doctors, nurses and the pharmacist, to identify problems and implement adequate solutions. The main high risk areas identified were: prescription of the drug and its transcription on the drug sheet, calculation of drugs dilutions and dosages to be administered, fragmentation of tasks (drugs prepared and administered by different professionals). RESULTS: The analysis of the process allowed different professionals to be aware of the risks and of the importance of standardized behaviours; of the implementation of protocols to prevent possible errors. The implementation of computerized calculation of dosages of drugs to be infused allowed to prevent errors and favoured personalized prescriptions. The introduction of the voluntary complaint forms will hopefully allow to have a clearer picture of the magnitude of the problem together with data on its nature, to identify future appropriate corrective measures.