Evidence-based practice in radiography: A strategy for shifting our culture.

Evidence-based practice (EBP) has a vital role to play in improving outcomes for patients, organisations and individual practitioners. Unfortunately, within diagnostic radiography, literature consistently demonstrates that positive EBP is not the norm. This editorial discusses a strategy for fostering cultural change within the profession to improve EBP.

Fostering the development of research literacy and exposure to current issues in radiography: Experience of a co-designed journal club.

INTRODUCTION/BACKGROUND: Journal clubs are an effective learning activity that can fulfill the continuing professional development requirements for diagnostic radiographers. For students, journal clubs can support the development of critical appraisal skills and identify opportunities to implement evidence-based practice. This educational perspective aims to describe a co-designed journal club program, which was integrated into a 9-week part-time work integrated learning on-campus placement program for diagnostic radiography students. METHODS: The framework for the journal club program was co-designed by students and academics. The benefits and limitations of the program were analysed and discussed in relation to the collaborative aspect of the task, the nature of the program and the focus on continuing professional development. DISCUSSION: Journal club activities provided ample opportunities for students to engage with current issues in radiography. The flexibility and practicality of the program contributed to student engagement, but were also considered a challenge to wide participation in the weekly journal club discussion. A co-designed journal club activity can facilitate reflective practice, independent learning and critical thinking. Whilst the significance of the journal club was not extensively assessed in its first implementation, it has the potential to improve student research literacy skills and critical appraisal. CONCLUSION: A perceived benefit of the journal club activity was the collaboration within groups who were tasked to present each week. Evaluation of the level of engagement with the program as well as its ability to improve critical analytical skills and data interpretation in the future is essential.

Management of Hypertensive Crises in Children: A Review of the Recent Literature.

Hypertensive emergency is a life-threatening condition associated with severe hypertension and organ damage, such as neurological, renal or cardiac dysfunction. The most recent guidelines on pediatric hypertension, the 2016 European guidelines and the 2017 American guidelines, provide recommendations on the management of hypertensive emergencies, however in pediatric age robust literature is lacking and the available evidence often derives from studies conducted in adults. We reviewed PubMed and Cochrane Library from January 2017 to July 2021, using the following search terms: "hypertension" AND "treatment" AND ("emergency" OR "urgency") to identify the studies. Five studies were analyzed, according to our including criteria. According to the articles reviewed in this work, beta-blockers seem to be safe and effective in hypertensive crises, more than sodium nitroprusside, although limited data are available. Indeed, calcium-channel blockers seem to be effective and safe, in particular the use of clevidipine during the neonatal age, although limited studies are available. However, further studies should be warranted to define a univocal approach to pediatric hypertensive emergencies.

Healthy Lifestyle Management of Pediatric Obesity with a Hybrid System of Customized Mobile Technology: The PediaFit Pilot Project.

Pediatric obesity management strategies suffer from a high rate of dropout and persistence of weight excess, despite the use of new tools, such as automated mobile technology (MT). We aimed to compare the efficacy of two 6-month personalized MT protocols in terms of better engagement, adherence to follow-up visits and improved anthropometric and lifestyle parameters. MT contacts consisted of three personalized/not automated What's App® self-monitoring or challenge messages per week. Messages, sent by a dedicated coach were inserted between three-monthly in-presence regular visits with (PediaFit 1.2) or without (PediaFit 1.1) monthly free-of charge short recall visits carried out by a specialized pediatric team. The sample included 103 children (mean age 10 years, range 6-14) recruited in the Pediatric Obesity Clinic between January 2017 and February 2019, randomized into Intervention group (IG) (n = 24 PediaFit 1.1; n = 30 PediaFit 1.2) and Control group (CG) (total n = 49). Controls received standard treatment only (indications for healthy nutrition and physical activity, and three months in presence regular visits). Overall, both IGs achieved significantly better results than the CGs for all considered parameters. Comparison of the two IGs at the sixth month in particular showed an IG 1.2 statistically significantly lower drop-out rate (10% vs. 62%, p = 0.00009), along with significantly improved BMI (p = 0.003), Screen Time (p = 0.04) and fruit and vegetables consumption (p = 0.02). The study suggests that the hybrid association of messaging through personalized/not automated MT plus monthly free-of charge recall visits may improve the prefixed outcomes of MT weight loss intervention programs.

Waist Circumference and Healthy Lifestyle Preferences/Knowledge Monitoring in a Preschool Obesity Prevention Program.

Weight and body mass index (BMI) changes appear to be poor measures for assessing the success of most pediatric obesity prevention programs (POPP). The aim of this study is to evaluate the effectiveness of the preschool-age prevention program (3P) in improving and maintaining overtime preschoolers' knowledge/preferences about healthy nutrition and physical activity (PA), and the relationship between acquired healthy behaviors and anthropometrics including waist circumference (WC). Twenty-five preschoolers underwent a 24-month healthy lifestyle multi-component pilot intervention followed by a one-year wash-out period; 25 age-matched served as controls. Anthropometric/behavioral data were monitored. After the 2-year study and wash-out, the rates of children overweight and with obesity decreased only in the intervention group, where, also, normal-weight children with visceral obesity attained WC normal values (p = 0.048). While mean values of BMI Z-scores remained unchanged in both the intervention and control groups, WC (values and percentiles) showed a significant reduction only in the intervention group. Children's adherence to the Mediterranean diet remained acceptable among the entire sample. Although daily sweet beverage consumption remained unchanged in both groups, knowledge/preferences improved significantly more in the intervention group. In conclusion, WC may be more sensitive than BMI for monitoring preschoolers in POPP and reflects healthy behavioral changes acquired during the intervention.

Metabolomic Salivary Signature of Pediatric Obesity Related Liver Disease and Metabolic Syndrome.

Pediatric obesity-related metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD) are increasingly frequent conditions with a still-elusive diagnosis and low-efficacy treatment and monitoring options. In this study, we investigated the salivary metabolomic signature, which has been uncharacterized to date. In this pilot-nested case-control study over a transversal design, 41 subjects (23 obese patients and 18 normal weight (NW) healthy controls), characterized based on medical history, clinical, anthropometric, and laboratory data, were recruited. Liver involvement, defined according to ultrasonographic liver brightness, allowed for the allocation of the patients into four groups: obese with hepatic steatosis ([St+], n = 15) and without hepatic steatosis ([St⁻], n = 8), and with (n = 10) and without (n = 13) MetS. A partial least squares discriminant analysis (PLS-DA) model was devised to classify the patients' classes based on their salivary metabolomic signature. Pediatric obesity and its related liver disease and metabolic syndrome appear to have distinct salivary metabolomic signatures. The difference is notable in metabolites involved in energy, amino and organic acid metabolism, as well as in intestinal bacteria metabolism, possibly reflecting diet, fatty acid synthase pathways, and the strict interaction between microbiota and intestinal mucins. This information expands the current understanding of NAFLD pathogenesis, potentially translating into better targeted monitoring and/or treatment strategies in the future.

Obesity and Obesity Related Diseases, Sugar Consumption and Bad Oral Health: A Fatal Epidemic Mixtures: The Pediatric and Odontologist Point of View.

Obesity and dental caries are increasingly widespread pathologies. The former is growing so rapidly that the WHO classified its trend as an "epidemic". Both are triggered by a number of well known common etiologic factors sharing also the high added sugar amount since childhood. Because of its fermentation and pH lowering, dietary sugar allows the cariogenic bacteria to damage the tooth enamel provoking the carious lesions. WHO guidelines recommend reducing sugar intake to 10% of the total daily energy need, and highlight that there is evidence which suggests cuttingthis value down to 5% at least. The American guidelines addressing paediatric age put the limit to 25gr a day with a total ban on sugar in those aged 2 or less.